Review Article
Year: 2014 | Month: February | Volume: 4 | Issue: 2 | Pages: 170-177
Supratentorial Gliomas: A Review of Neurosurgical Management, Technological Advancements and New Therapeutic Interventions
V K S Gautam1, Ravinder Singh2
1Assistant Professor, Department of Neuosurgery,
2Associate Professor & Head, Department of Medical Anthropology,
IHBAS Hospital, Faculty of Medical Sciences, University of Delhi, GNCT Delhi, Dilshad Garden, Delhi-95.
Corresponding Author: Ravinder Singh
ABSTRACT
Introduction: Generally Supratentorial tumors are glial in origin. Their management is challenging despite of various advancements. Therefore, there is need to integrate various diagnostic and therapeutic modalities to achieve best clinical outcome following neurosurgical interventions.
Objective: Paper aims to review recent advances in the field of neuroimaging, operative techniques, intra-operative technologies, chemoradiation and other modalities of therapeutic interventions affecting the prognosis of supratentorial gliomas.
Materials and Methods: Pre and post operative clinical evaluation, psychological assessment, neuroimaging with CT scan, or MRI brain with contrast and or MR spectroscopy were done in 18 patients of supratentorial gliomas operated and followed up in last 3 years. Per operative frozen section biopsy was obtained in each case.
Results: Seizures and headache were common presentation of supratentorial gliomas. Craniotomy and tumor decompression were common neurosurgical intervention. MRI brain with contrast enhancement was the main modality of investigation in the preoperative and post operative evaluation of these patients. Pre operative frozen section biopsy guided the extent of the tumor resection. Majority of patients had shown significant neurological improvement after surgery.
Conclusion: Pre-operative neurological status of the patient, neuroimaging, per-operative frozen section biopsy, histopathological grade of the tumor has guided treatment of supratentorial gliomas. Various technological advancements e.g. PET scan, functional MRI, intra operative ultra sonogram, intra operative MRI and other technologies, advances in chemoradiation, immunotherapy , molecular based therapy and other newer therapeutic interventions have been reviewed for better clinical outcome. In view of recent advances it is imperative to establish an evidence based guideline for the comprehensive management.
Key words: Gliomas, Neuroimaging, Supratentorial