Aghi Manish K, Nahed Brian V, Sloan Andrew E, Ryken Timothy C, Kalkanis Steven N, Olson Jeffrey J
Department of Neurosurgery, University of California, 505 Parnassus Avenue, Room M779, San Francisco, CA, 94143-0112, USA.
Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
J Neurooncol. 2015 Dec;125(3):503-30. doi: 10.1007/s11060-015-1867-1. Epub 2015 Nov 3.
Should patients with imaging suggestive of low grade glioma (LGG) undergo observation versus treatment involving a surgical procedure?
These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).
Surgical resection is recommended over observation to improve overall survival for patients with diffuse low-grade glioma (Level III) although observation has no negative impact on cognitive performance and quality of life (Level II).
What is the impact of extent of resection on progression free survival (PFS) or overall survival (OS) in LGG patients?
These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).
IMPACT OF EXTENT OF RESECTION ON PFS:
It is recommended that GTR or STR be accomplished instead of biopsy alone when safe and feasible so as to decrease the frequency of tumor progression recognizing that the rate of progression after GTR is fairly high.
Greater extent of resection can improve OS in LGG patients.
What tools are available to increase extent of resection in LGG patients?
These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).
INTRAOPERATIVE MRI DURING SURGERY:
The use of intraoperative MRI should be considered as a method of increasing the extent of resection of LGGs.
What is the impact of surgical resection on seizure control and accuracy of pathology in low grade glioma patients?
These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).
SURGICAL RESECTION AND SEIZURE CONTROL:
After taking into account the patient's clinical status and tumor location, gross total resection is recommended for patients with diffuse LGG as a way to achieve more favorable seizure control.
Taking into account the patient's clinical status and tumor location, surgical resection should be carried out to maximize the chance of accurate diagnosis.
What tools can improve the safety of surgery for LGGs in eloquent locations?
These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).
PREOPERATIVE IMAGING:
It is recommended that preoperative functional MRI and diffusion tensor imaging be utilized in the appropriate clinical setting to improve functional outcome after surgery for LGG.
Intraoperative mapping is recommended for patients with diffuse LGGs in eloquent locations compared to patients with non-eloquently located diffuse LGGs as a way of preserving function.
影像显示为低级别胶质瘤（LGG）的患者应接受观察还是采取包括外科手术的治疗？
这些建议适用于影像显示为世界卫生组织2级胶质瘤（少突胶质细胞瘤、星形细胞瘤或少突星形细胞瘤）的成年人。
对于弥漫性低级别胶质瘤患者，推荐手术切除而非观察，以提高总生存期（III级），不过观察对认知能力和生活质量无负面影响（II级）。
切除范围对LGG患者的无进展生存期（PFS）或总生存期（OS）有何影响？
这些建议适用于影像显示为世界卫生组织2级胶质瘤（少突胶质细胞瘤、星形细胞瘤或少突星形细胞瘤）的成年人。
切除范围对PFS的影响：
II级：建议在安全可行的情况下进行大体肿瘤切除（GTR）或次全切除（STR）而非仅行活检，以降低肿瘤进展频率，同时要认识到GTR后的进展率相当高。
III级：更大范围的切除可改善LGG患者的OS。
有哪些工具可用于增加LGG患者的切除范围？
这些建议适用于影像显示为世界卫生组织2级胶质瘤（少突胶质细胞瘤、星形细胞瘤或少突星形细胞瘤）的成年人。
手术中使用术中磁共振成像（MRI）：
III级：应考虑将术中MRI作为增加LGG切除范围的一种方法。
手术切除对低级别胶质瘤患者的癫痫控制和病理诊断准确性有何影响？
这些建议适用于影像显示为世界卫生组织2级胶质瘤（少突胶质细胞瘤、星形细胞瘤或少突星形细胞瘤）的成年人。
手术切除与癫痫控制：
III级：在考虑患者临床状况和肿瘤位置后，对于弥漫性LGG患者，建议进行大体全切除以实现更良好的癫痫控制。
III级：考虑患者临床状况和肿瘤位置后，应进行手术切除以最大化准确诊断的机会。
哪些工具可提高功能区LGG手术的安全性？
这些建议适用于影像显示为世界卫生组织2级胶质瘤（少突胶质细胞瘤、星形细胞瘤或少突星形细胞瘤）的成年人。
术前成像：
III级：建议在适当的临床情况下使用术前功能MRI和弥散张量成像，以改善LGG手术后的功能结局。
III级：与非功能区弥漫性LGG患者相比，建议对功能区弥漫性LGG患者进行术中定位，以保留功能。
