Neurosurgical considerations in supratentorial low-grade gliomas: experience with 175 patients

Abstract

<jats:p>The authors reviewed 175 low-grade hemispheric gliomas surgically treated by one surgeon (P.B.) between 1987 and 1996: 74 astrocytomas (42%), 35 oligodendrogliomas (20%), 52 mixed gliomas (30%), 12 gangliogliomas (7%), and two ependymomas (1%). Patient age ranged from 7.5 to 81.9 years (mean 39.2 years); 84 patients (48%) were males and 91 (52%) females. Postsurgical follow-up review ranged from 0.1 to 225.2 months (mean 36.2 months, median 24.9 months). Either T<jats:sub>2</jats:sub>-weighted or contrast-enhanced T<jats:sub>1</jats:sub>-weighted magnetic resonance (MR) images were used to evaluate the percentage of resection achieved and volume of residual disease postoperatively. The majority of patients (55%) had seizures as the presenting symptom, and 45% experienced preoperative symptoms for more than 12 months. Tumor enhancement was present in 21% of cases. In 66% of surgical procedures at least one of the following technical adjuncts was used: monitored local anesthesia, real-time MR imaging, stereotactic guidance with computerized tomography, three dimensional reconstruction, cortical mapping with cortical stimulation, somatosensory or visual evoked potential recording, corticography, or intraoperative ultrasound. Intraoperative MR imaging was used for 40 (22.9%) of the craniotomies and nine (5.14%) biopsies. There were no surgery-related deaths. Complications appeared in 6% of the patients. Progression to a higher-grade tumor occurred in 9.2% of patients within the 3-year follow-up period.</jats:p>

Awake craniotomy for low-grade gliomas

“…The incidence of serious sequelae consisting in permanent deterioration of the patient's neurological function was only 6% in the latter group, compared to 17% in the former one. Similar results were also obtained by other researchers (13)(14)(15)(16)(17) , noting the occurrence of new neurological deficits in an average of 4.7% in the group of 457 operated patients (0-10% depending on the group). Surgical treatment under local anaesthesia using direct electrical stimulation of the brain in an awake patient enables more effective monitoring of the patient's status than surgeries under general anaesthesia with monitoring of evoked potentials.…”

The present and future of cerebral tumor surgery in children

“…With image-guided resection, we have found an 80% ability to resect the signal abnormality for low-grade gliomas or dysplastic cortex [45,56,61]. Others have reported similar results with brain mapping [38].…”

“…About 50% of cerebral tumors in children are low-grade gliomas, about 30% anaplastic gliomas or glioblastomas, and the rest a variety of less common tumors, such as primitive neuroectodermal tumor (PNET), choroid plexus carcinoma, and meningiomas. The characteristics of specific tumors and their management have been described in a number of publications [4,6,10,20,21,22,28,45,53,55,63,68].…”

Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases

“…The epidemiological characteristics of this series did not differ from those in other series of GIIGs reported in the literature. 33,36,44,45,60,64 Despite our efforts, this study was subject to already-mentioned biases and drawbacks inherent to this pathology, which needs successive and individually adapted treatments of different modalities.…”