Controversies in the Therapy of Low-Grade Gliomas

Carabenciov, Ivan D.; Buckner, Jan C.

doi:10.1007/s11864-019-0625-6

Cited by 16 publications

(14 citation statements)

References 56 publications

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“…It should be noted that the 2016 World Health Organization (WHO) classification for glioma added the molecular subtype [isocitrate dehydrogenase (IDH) or telomerase reversetranscriptase promoter (TERTp) mutation and 1p19q codeletion], which is highly associated with tumor invasiveness and prognosis (16,17). There were even evidence that the IDH wild-type LGGs should be treated as glioblastomas (GBMs, Grade IV), as they shared similar clinical and genetic characteristics (18). Therefore, except classical histological grading, different molecular subtypes might also reflect different biological behaviors and might lead to different neuroplastic results.…”

Section: Introductionmentioning

confidence: 99%

Contralesional Structural Plasticity in Different Molecular Pathologic Subtypes of Insular Glioma

Huang

et al. 2021

Front. Neurol.

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Neuroplasticity may preserve neurologic function in insular glioma, thereby improving prognosis following resection. However, the anatomic and molecular bases of this phenomenon are not known. To address this gap in knowledge, the present study investigated contralesional compensation in different molecular pathologic subtypes of insular glioma by high-resolution three-dimensional T1-weighted structural magnetic resonance imaging. A total of 52 patients with insular glioma were examined. We compared the gray matter volume (GMV) of the contralesional insula according to histological grade [low-grade glioma (LGG) and high-grade glioma (HGG)] and molecular pathology status [isocitrate dehydrogenase (IDH) mutation, telomerase reverse-transcriptase (TERT) promoter mutation, and 1p19q codeletion] by voxel-based morphometry (VBM). A cluster of 320 voxels in contralesional insula with higher GMV was observed in glioma with IDH mutation as compared to IDH wild-type tumors by region of interest-based VBM analysis (family-wise error-corrected at p < 0.05). The GMV of the entire contralesional insula was also larger in insular glioma patients with IDH mutation than in patients with wild-type IDH. However, there was no association between histological grade, TERT promoter mutation, or 1p19q codeletion and GMV in the contralesional insula. Thus, IDH mutation is associated with greater structural compensation in insular glioma. These findings may be useful for predicting neurocognitive and functional outcomes in patients undergoing resection surgery.

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Section: Introductionmentioning

confidence: 99%

Contralesional Structural Plasticity in Different Molecular Pathologic Subtypes of Insular Glioma

Huang

et al. 2021

Front. Neurol.

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“…Lior Ungar et al, Utility of the Polestar N30 low-field MRI system for resecting non-enhancing intra-axial brain lesions Carabenciov et al [33] stated that in the context of the new WHO classification system, all low-grade gliomas must have an IDH mutation, with or without a 1p/19q co-deletion. Upon discovery of the tumour, maximal safe surgical resection is the most appropriate first step due to the current inability to differentiate between IDH mutant and IDH wild-type tumours by imaging alone.…”

Section: Discussionmentioning

confidence: 99%

Utility of the Polestar N30 low-field MRI system for resecting non-enhancing intra-axial brain lesions

Ungar

Zibly

Wohl

et al. 2021

Neurol Neurochir Pol.

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Background. To determine the utility of an intraoperative magnetic resonance imaging (iMRI) system, the Polestar N30, for enhancing the resection control of non-enhancing intra-axial brain lesions.Materials and methods. Seventy-three patients (60 males [83.3%], mean age 37 years) with intra-axial brain lesions underwent resection at Sheba Medical Centre using the Polestar between February 2012 and the end of August 2018. Demographic and imaging data were retrospectively analysed. Thirty-five patients had a non-enhancing lesion (48%).Results. Complete resection was planned for 60/73 cases after preoperative imaging. Complete resection was achieved in 59/60 (98.3%) cases. After iMRI, additional resection was performed in 24/73 (32.8%) cases, and complete resection was performed in 17/60 (28.8%) cases in which a complete resection was intended. In 6/13 (46%) patients for whom incomplete resection was intended, further resection was performed. The extent of resection was extended mainly for non-enhancing lesions: 16/35 (46%) as opposed to only 8/38 (21%) for enhancing lesions. Further resection was not significantly associated with sex, age, intended resection, recurrence, or affected side. Univariate analysis revealed non-eloquent area, intended complete resection, and enhancing lesions to be predictive factors for complete resection, and non-enhancing lesions and scan time to be predictive factors for an extended resection. Non-enhancement was the only independent factor for extended resection. Conclusions.The Polestar N30 is useful for evaluating residual non-enhancing intra-axial brain lesions and achieving maximal resection.

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“…Initially, the approach "wait and see" was applied, but nowadays we can talk even about supratotal resection. The conservative treatment was indicated for incidental glioma and for young patients with minor symptoms [9,21,54].…”

Section: Surgical Approachmentioning

confidence: 99%

The evolution of eloquent located low-grade gliomas surgical approaches, their natural history and molecular classification

Coșman¹,

Cucu²,

Iordache³

et al. 2021

roneuro

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Low-grade glioma is characterized by slow growth, infiltrative pattern through white matter tracts and progression to a malignant tumour type. The traditional classification is newly replaced by molecular stratification. This reorganisation gathers glioma with similar prognosis and treatment protocols. The preferential location of that tumour in eloquent areas constituted, over time, a real challenge regarding the best surgical approach. Because of the high risk of postoperative neurological deficits initially a more conservative management was adopted. Once with the development of preoperative and intraoperative functional assessment techniques, a higher degree of resection was possible in the limits of cortico-subcortical eloquence, being well known that this is a statistically significant factor for survival. We present in this paper the natural evolution of low-grade glioma, their new molecular classification, prognostic factors and the various approach proposed for eloquent ones.

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Controversies in the Therapy of Low-Grade Gliomas

Cited by 16 publications

References 56 publications

Contralesional Structural Plasticity in Different Molecular Pathologic Subtypes of Insular Glioma

Contralesional Structural Plasticity in Different Molecular Pathologic Subtypes of Insular Glioma

Utility of the Polestar N30 low-field MRI system for resecting non-enhancing intra-axial brain lesions

The evolution of eloquent located low-grade gliomas surgical approaches, their natural history and molecular classification

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