Departments of Neurosurgery, University of California, Los Angeles, Los Angeles, USA.
David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
J Neurooncol. 2022 Aug;159(1):81-94. doi: 10.1007/s11060-022-04045-0. Epub 2022 Jun 15.
Gliomas are the most common primary tumors of the central nervous system and are categorized by the World Health Organization into either low-grade (grades 1 and 2) or high-grade (grades 3 and 4) gliomas. A subset of patients with glioma may experience no tumor-related symptoms and be incidentally diagnosed. These incidental low-grade gliomas (iLGG) maintain controversial treatment course despite scientific advancements. Here we highlight the recent advancements in classification, neuroimaging, and surgical management of these tumors.
A review of the literature was performed. The authors created five subtopics of focus: histological criteria, diagnostic imaging, surgical advancements, correlation of surgical resection and survival outcomes, and clinical implications.
Alternating studies suggest that these tumors may experience higher mutational rates than their counterparts. Significant progress in management of gliomas, regardless of the grade, has been made through modern neurosurgical treatment modalities, diagnostic neuroimaging, and a better understanding of the genetic composition of these tumors. An optimal treatment approach for patients with newly diagnosed iLGG remains ill-defined despite multiple studies arguing in favor of safe maximal resection. Our review emphasizes the not so benign nature of incidental low grade glioma and further supports the need for future studies to evaluate survival outcomes following surgical resection.
神经胶质瘤是中枢神经系统最常见的原发性肿瘤，根据世界卫生组织的分类，可分为低级别（1 级和 2 级）或高级别（3 级和 4 级）神经胶质瘤。一部分神经胶质瘤患者可能没有肿瘤相关症状，而是偶然被诊断出来。尽管科学取得了进步，但这些偶然发现的低级别神经胶质瘤（iLGG）的治疗方案仍存在争议。在这里，我们重点介绍了这些肿瘤在分类、神经影像学和手术治疗方面的最新进展。
我们对文献进行了回顾。作者创建了五个重点关注的子主题：组织学标准、诊断影像学、手术进展、手术切除与生存结果的相关性以及临床意义。
交替研究表明，这些肿瘤的突变率可能高于其对应肿瘤。通过现代神经外科治疗方式、诊断神经影像学以及对这些肿瘤遗传成分的更好理解，无论肿瘤级别如何，神经胶质瘤的治疗都取得了显著进展。尽管多项研究支持安全的最大限度切除，但对于新诊断的 iLGG 患者，仍缺乏最佳治疗方法。我们的综述强调了偶然发现的低级别神经胶质瘤并非良性肿瘤，需要进一步研究来评估手术切除后的生存结果。
