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Low-grade glioma management: a contemporary surgical approach
1aUniversità degli Studi di Milano bDepartment of Biotechnology and Translational Medicine, Università degli Studi di Milano, and Humanitas Research Hospital, IRCCS, Milan, Italy.
Purpose Of Review:
The primary treatment of low-grade gliomas is still claimed to lack robust supporting evidence. Yet, several investigations were performed in the last 2 decades. To critically review these studies could help in further clarifying the role of surgery aimed at maximal resection.
Recent Findings:
Despite the lack of randomized clinical trials hampering the performance of appropriate meta-analyses, the increasing amount of evidence pointed toward an aggressive surgical strategy to low-grade glioma. Low-grade glioma surgery has to be performed with the appropriate armamentarium, which is the availability of intraoperative stimulation mapping, especially for those lesions occurring in cortical and subcortical eloquent sites.
Summary:
According to the recently published guidelines, surgical treatment has been increasingly recognized as the initial therapeutic act of choice for patients diagnosed with a presumed low-grade glioma, given that total resection can improve seizure control, progression-free survival and overall survival, while reducing the risk of malignant transformation and preserving patients' functional status.
Insights
Aggressive surgical resection for low-grade gliomas is increasingly recommended. Maximal resection, aided by intraoperative mapping, improves survival and preserves function, despite limited randomized trials.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- The optimal primary treatment for low-grade gliomas remains debated due to limited robust evidence.
- Numerous studies over the past two decades have investigated surgical approaches.
- A critical review is needed to clarify the role of maximal resection in low-grade glioma management.
Purpose of the Study:
- To critically review existing investigations on low-grade glioma treatment.
- To clarify the role of surgery aimed at maximal resection.
- To provide evidence-based recommendations for low-grade glioma management.
Main Methods:
- Systematic review of studies published in the last two decades.
- Analysis of evidence supporting surgical resection strategies.
- Evaluation of the impact of intraoperative stimulation mapping.
Main Results:
- Despite a lack of randomized clinical trials, evidence supports an aggressive surgical strategy for low-grade gliomas.
- Intraoperative stimulation mapping is crucial for maximal resection in eloquent brain areas.
- Total resection is associated with improved outcomes.
Conclusions:
- Surgical treatment is increasingly recognized as the initial choice for presumed low-grade gliomas.
- Total resection improves seizure control, progression-free survival, and overall survival.
- Maximal resection reduces malignant transformation risk and preserves functional status.
