Neurosurgical considerations in supratentorial low-grade gliomas

We reviewed the outcomes of patients with low-grade glioma-LGG (and particularly astrocytoma-LGA) treated with advanced intraoperative methods (intraoperative MRI,, 3D-reconstruction). T2 or contrast-enhanced T1 weighted-images were used. Intraoperative MRI was used in 22.9% of craniotomies and 5.14% of biopsies. No surgical mortality. Complications in 6%. Progression to a higher grade: 9.2% within 3y. LGA showed these characteristics: frontal: 39%, temporal: 33%, parietal: 22%, occipital: 6%, enhancement: 20%, cyst: 16%, calcification: 14%, size >5cm: 55%, resection: gross total 33%, partial 35%, minimal/biopsy 32%, presentation: seizures 76%, headache 21%, personality change 21%, focal motor deficit 9%, visual changes 10%, nausea/ vomiting 6%, progression (follow up 6-360m, median 43m): death 24%, recurrence 47%, dedifferentiation 31%. The major problem in LGA was progression to a higher grade. Time to recurrence was linearly related to the degree of resection. Surgical resection appeared to increase survival time and decrease time to recurrence and can be done effectively and safely with modern navigational methods.