Surgical Management of Low-Grade Gliomas

Diffuse low-grade gliomas are infiltrative brain tumours that predominantly affect young adults. Surgical resection remains the primary intervention, aiming to remove as much tumour volume as possible while preserving neurological function. Advances over the past two decades have centred on maximising the extent of resection through refined intraoperative mapping techniques, integration of advanced imaging modalities and a shift towards supratotal removal beyond MRI-defined borders. Awake craniotomy with continuous functional monitoring, multimodal navigation and real-time neuropsychological assessment has enabled surgeons to push resection limits without increasing permanent deficits. The degree of tumour removal correlates closely with progression-free survival, overall survival and seizure control. Equally important is the timing of surgery: whether incidental lesions are resected asymptomatically or after symptom onset, total removal appears to drive long-term benefit. Together, these developments underscore a paradigm in which individual patient anatomy, molecular tumour profile and functional anatomy guide a tailored surgical strategy that balances aggressive tumour clearance with quality of life.

Research from Nature Portfolio

Recent studies have demonstrated that a multimodal operative protocol combining direct electrical stimulation, functional MRI and diffusion tensor imaging integrated through a neuronavigation platform, together with real-time neuropsychological testing, can elevate median tumour resection from around 83 per cent to 98 per cent. This approach has yielded reduced rates of permanent neurological deficit and has shown that overall survival is influenced significantly by both molecular class and the achieved extent of resection. In parallel, analysis of incidental low-grade gliomas treated in asymptomatic and symptomatic phases revealed that surgical timing—before or after symptom emergence—does not independently affect progression-free, overall or malignant progression-free survival provided that total resection is achieved. These findings reinforce the central role of maximal safe resection and suggest flexibility in timing without compromising outcome.

Surgical Management of Low-Grade Gliomas publication trend

The graph below shows the total number of articles in surgical management of low-grade gliomas across all publications each year (not limited to Nature Index journals).

Technical terms

Low-grade glioma: A World Health Organization grade II tumour of glial origin that grows slowly but infiltrates surrounding brain tissue.

Extent of resection (EOR): The percentage of tumour volume removed during surgery, as assessed by postoperative imaging.

Gross total resection (GTR): Complete removal of all contrast-enhancing tumour visible on MRI.

Supratotal resection: Removal of tumour and adjacent non-enhancing tissue beyond the MRI-demarcated margin.

Direct electrical stimulation (DES): Intraoperative method of mapping functional brain areas by delivering electrical currents to cortical and subcortical sites.

Awake craniotomy: Neurosurgical procedure conducted while the patient is conscious to allow real-time functional monitoring.

Diffusion tensor imaging (DTI): MRI technique that visualises white matter tracts to guide safe surgical corridors.

Real-time neuropsychological testing (RTNT): Continuous assessment of cognitive and language functions during surgery to minimise postoperative deficits.

Progression-free survival (PFS): Time from surgery until tumour growth or recurrence is radiologically confirmed.

References

1. Supratotal Surgical Resection for Low-Grade Glioma: A Systematic Review. Cancers (2023).
2. Relationship between the extent of resection and the survival of patients with low-grade gliomas: a systematic review and meta-analysis. BMC Cancer (2018).
3. Does early resection of presumed low-grade glioma improve survival? A clinical perspective. Journal of Neuro-Oncology (2017).
4. Multimodal integrated approaches in low grade glioma surgery. Scientific Reports (2021).
5. A survival analysis of surgically treated incidental low-grade glioma patients. Scientific Reports (2021).
6. Reasoning and causal inference regarding surgical options for patients with low‐grade gliomas using machine learning: A SEER‐based study. Cancer Medicine (2023).