Understanding of Disease
- First described in 1988: DNET is a relatively “new” tumor type, first identified in 1988 (11) and described in the WHO classification only in 1993. Nonetheless, DNETs are not rare; in unselected series they make up approximately 1% of brain tumors, while in epilepsy surgery centers they account for 5–20 % of resective epilepsy surgeries.
- Misidentified as other low-grade gliomas: Before the entity was described, these lesions were probably diagnosed as low-grade astrocytomas, oligodendrogliomas, oligoastrocytomas, or gangliogliomas.
- Some classify DNET as neurodevelopmental tumor: Together with gangliogliomas, DNETs are classified by some authors as neurodevelopmental tumors, believed to have developed during embryogenesis (2).
- MRI scan: The preoperative diagnosis of a DNET depends heavily on MRI. Indeed, the entity was not described until 1988, a few years after the widespread introduction of MRI for the evaluation of patients with epilepsy.
- Advancement in surgical technology: The surgical treatment of DNET borrows both from glioma surgery and from nonlesional epilepsy surgery. Technological advances in glioma surgery such as ultrasound aspirators (CUSA), awake surgery, image-guided surgery, and interventional MRI have played important roles. All investigations performed in epilepsy surgery to detect the surgical focus that has to be resected have also improved the results.
- Intraoperative MRI: The role of interventional MRI in low-grade glioma surgery is increasing, both to enhance safety and to maximize tumor removal. It can be expected that interventional MRI will also become more important for surgery of DNETs.
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