Neurosurg Focus
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Early and aggressive resection of low-grade gliomas (LGGs) leads to increased overall patient survival, decreased malignant progression, and better seizure control. This case series describes the authors' approach to achieving optimal neurological and surgical outcomes in patients referred by outside neurosurgeons for stereotactic biopsy of tumors believed to be complex or a high surgical risk, due to their diffuse nature on neuroimaging and their obvious infiltration of functional cortex. ⋯ Significant resection of diffuse, infiltrating LGGs is possible, even in presumed eloquent cortex. Aggressive resection maximizes seizure control and does not necessarily cause permanent neurological deficits. Individualized preoperative neuroimaging evaluation, including tractography and awake craniotomy with intraoperative speech and motor mapping, is an essential tool in achieving these outcomes.
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Progress in morphological imaging has facilitated the diagnosis of low-grade glioma (LGG) and plays a decisive role in therapeutic decisions. To date, the method of choice is contrast-enhanced MRI including T1-/T2-weighted and FLAIR sequences. However, tumor delineation and the differentiation between neoplastic and normal brain tissue can be difficult when using morphological MRI and may complicate the identification of anaplastic foci for biopsy and further treatment planning. ⋯ This tracer has logistical advantages over the widely used PET tracer (11)C-methyl-L-methionine due to the longer half-life of the (18)F-label (109 vs 20 minutes, respectively). Additionally, it has been demonstrated that both tracers provide comparable diagnostic information. The authors provide an overview of the recent literature regarding the value of various clinical applications of (18)F-FET PET in patients with LGG.
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Low-grade gliomas (LGGs) are indolent tumors that have the potential to dedifferentiate into malignant high-grade tumors. Recent studies have demonstrated that cerebellar low-grade tumors have a better prognosis than supratentorial tumors, although no study has focused on the risk factors for poor prognosis in cerebellar LGGs in adults. The authors of the current study aimed to address both of these concerns by using a large cohort derived from a national cancer registry and a smaller cohort derived from their institution's experience. ⋯ Taken together, adults with cerebellar WHO Grade I and II astrocytomas have a much more favorable survival curve than those with similar supratentorial tumors. Research demonstrates that the primary driver of this phenomenon is the improved survival in patients with cerebellar Grade II gliomas.