A comprehensive framework for glioma surgery by the PIONEER Consortium and RANO resect group, part 1: intraoperative recommendations for mapping, monitoring, and decision making - 23/12/25

Doi : 10.1016/S1470-2045(25)00531-5

Jasper K W Gerritsen, MD PhD ^a,^b,^{*
Contributed equally}⁎ , Philipp Karschnia, MD MSc ^c,^d,^{*
Contributed equally}, Lorenzo Bello, ProfMD PhD ^e,^f, Shawn Hervey-Jumper, ProfMD ^b, Jacob S Young, MD ^b, Kathleen Seidel, ProfMD ^g, Djaina D Satoer, PhD ^a, Oliver Schnell, ProfMD MHBA ^d, Michael Parsons, PhD ^h, Brian V Nahed, MD FACS ⁱ, Grazia Menna, MD ^j, Nico Teske, MD MSc ^c,^d,
External Rater Panel^†
Members listed at the end of the Policy Review
Keyoumars Ashkan, Marion Barberis, Chetan Bettegowda, Florien Boele, Richard W. Byrne, Daniel P. Cahill, Daniel Delev, Elke De Witte, Katharine Drummond, Johnny Duerinck, Gavin Dunn, Samuel Emerson, Yoshua Esquenazi, Christian F. Freyschlag, Marjolein Geurts, Rachel Grossman, Constantinos G. Hadjipanayis, Margret Jensdottir, Markus Klimek, Chanhung Lee, Amy Maguire, Alireza Mansouri, James M. Markert, Yoshitaka Narita, Alessandro Olivi, Johan Pallud, Karin Piil, Matthias Preusser, Alfredo Quinones-Hinojosa, Jane Skjøth-Rasmussen, Michael Sabel, Christian Senft, Susan Short, Ole S. Solheim, Walter Stummer, Andrea Szelényi, Einar O. Vik-Mo, Colin Watts, Michael Weller, Patrick Wen

Timothy R Smith, MD PhD ^k, Nader Sanai, MD ^l, Sandro M Krieg, ProfMD MBA ^m, Philippe Schucht, ProfMD ^g, Marike L D Broekman, ProfMD PhD ^n,^o, Steven De Vleeschouwer, ProfMD PhD ^p, Asgeir S Jakola, ProfMD PhD ^q,^r, Martin J van den Bent, ProfMD PhD ^s, Susan M Chang, ProfMD ^b, Michael A Vogelbaum, MD PhD ^t, Arnaud J P E Vincent, ProfMD PhD ^a,^{‡
Contributed equally}, Joerg-Christian Tonn, ProfMD ^c,^{‡
Contributed equally}, Mitchel S Berger, ProfMD FACS ^b,^{‡
Contributed equally}
^a Department of Neurosurgery, Erasmus Medical Center, Rotterdam, Netherlands
^b Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
^c Department of Neurosurgery, LMU University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
^d Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
^e Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
^f IRCCS Ospedale Galeazzi Sant’Ambrogio, Milano, Italy
^g Department of Neurosurgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
^h Department of Neuro-Oncology, Massachusetts General Hospital, Mass General Brigham and Harvard Medical School, Boston, MA, USA
ⁱ Department of Neurosurgery, Massachusetts General Hospital, Mass General Brigham and Harvard Medical School, Boston, MA, USA
^j Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
^k Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
^l Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
^m Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
ⁿ Department of Neurosurgery, Haaglanden Medical Center, The Hague, Netherlands
^o Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
^p Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
^q Department of Clinical Neuroscience, Section of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
^r Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
^s Department of Neurology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
^t Department of Neurosurgery, Moffitt Cancer Center, Tampa, FL, USA

^*Correspondence to: Dr Jasper K W Gerritsen, Department of Neurosurgery, Erasmus Medical Center, 3015 GD Rotterdam, NetherlandsDepartment of NeurosurgeryErasmus Medical CenterRotterdamGD3015Netherlands

Summary

In adult patients with newly diagnosed or recurrent diffuse glioma, more extensive resection is associated with longer progression-free and overall survival. Intraoperative mapping techniques are used to safely increase the extent of resection by locating, monitoring, and preserving the function of potentially infiltrated brain during surgery. However, there is no consensus on the indications for intraoperative mapping, the optimal functional tests to be used intraoperatively, or intraoperative decision making. Furthermore, there are no consensus standardised neurological, language, and functional outcome assessments that should be applied pre-operatively and post-operatively. The Personalized Interventions and Outcomes in Neurosurgical Oncology Research (PIONEER) Consortium and the Response Assessment in Neuro-Oncology (RANO) resect group are collaborative, multidisciplinary efforts that aim to standardise and enhance research and clinical practices in surgical neuro-oncology. Here, both working groups review the evidence and provide recommendations in an effort to improve standardisation in intraoperative stimulation mapping, electrophysiological monitoring, and intraoperative decision making during glioma resections in adults. The Policy Review offers an intraoperative framework to reduce heterogeneity and improve the quality of clinical and scientific practice. In addition to standardising practices and improving individual patient outcomes, this Policy Review provides a foundation for better consistency between institutions and facilitates multicentre collaboration in surgical neuro-oncology. Ultimately, reducing heterogeneity might accelerate the development of personalised surgical care by enabling advanced computational modelling techniques.

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Plan

Introduction

Methods

Literature review: search strategy and selection criteria

Modified eDelphi survey: refinement of recommendations

Clinical results

Clinical and oncological benefits of intraoperative mapping and monitoring techniques

A brief introduction to the technical aspects of different mapping techniques

Awake mapping considerations

Asleep mapping considerations

Surgical indications for the use of mapping

Neuroanesthesiological considerations

Decision making considerations

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Vol 27 - N° 1

P. e11-e23 - janvier 2026 Retour au numéro

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A comprehensive framework for glioma surgery by the PIONEER Consortium and RANO resect group, part 2: perioperative recommendations for neurological, language, functional, and quality-of-life assessment
Jasper K W Gerritsen, Philipp Karschnia, Lorenzo Bello, Shawn Hervey-Jumper, Jacob S Young, Kathleen Seidel, Djaina D Satoer, Oliver Schnell, Michael Parsons, Brian V Nahed, Grazia Menna, Nico Teske, External Rater Panel, Timothy R Smith, Nader Sanai, Sandro M Krieg, Philippe Schucht, Marike L D Broekman, Steven De Vleeschouwer, Asgeir S Jakola, Martin J van den Bent, Susan M Chang, Michael A Vogelbaum, Arnaud J P E Vincent, Joerg-Christian Tonn, Mitchel S Berger, Keyoumars Ashkan, Marion Barberis, Chetan Bettegowda, Florien Boele, Richard W. Byrne, Daniel P. Cahill, Daniel Delev, Elke De Witte, Katharine Drummond, Johnny Duerinck, Gavin Dunn, Samuel Emerson, Yoshua Esquenazi, Christian F. Freyschlag, Marjolein Geurts, Rachel Grossman, Constantinos G. Hadjipanayis, Margret Jensdottir, Markus Klimek, Chanhung Lee, Amy Maguire, Alireza Mansouri, James M. Markert, Yoshitaka Narita, Alessandro Olivi, Johan Pallud, Karin Piil, Matthias Preusser, Alfredo Quinones-Hinojosa, Jane Skjøth-Rasmussen, Michael Sabel, Christian Senft, Susan Short, Ole S. Solheim, Walter Stummer, Andrea Szelényi, Einar O. Vik-Mo, Colin Watts, Michael Weller, Patrick Wen

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A comprehensive framework for glioma surgery by the PIONEER Consortium and RANO resect group, part 1: intraoperative recommendations for mapping, monitoring, and decision making - 23/12/25

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