Maximizing Resection of Diffused Low-Grade Glioma Functional Outcome

Background: most of adults with Diffuse Low Grade Gliomas (DLGGs) are diagnosed with an average age of 39 years and the diagnosis is often made around fully functioning individuals. Currently extent of resection (EOR) is a generally known variable that impacts overall survival (OS), progression free survival and malignant transformation in these gliomas. Aim of the study: this study aimed to evaluate the risks and benefits of maximizing the extent of resection of DLGGS, while preserving neurological function. Methodology and Materials: this was a prospective observational study of group of consecutive 20 patients with initial imaging diagnosis of supratentorial DLGGs. Preoperatively planned for maximal resection even if presuming the proximity of these lesions to eloquent cortex and their relative diffuse nature on imaging. Results: 40 % were near eloquent area and 30 % at eloquent areas. GTR achieved in 10% and STR in 65%. Pre-operative Karnofsky Performance Scale (KPS) was 100 in 10%, 90 in 65%, 72 hours post-operative 70 in 60%. During the first 6 months of follow-up KPS was 100 in 60% of the study cohort while only one patient (5%) died. After 6 months KPS was 100 and represented 95% of the whole study. LOS was the longest (4-16 days) in near eloquent and shortest in eloquent (5-8 days). 30% had pre-operative uncontrolled seizures, which cured post-operative, 50% stopped AED within a year. Average back to work period was 2.5 for eloquent, near eloquent 2.8 and non-eloquent 2.6 months. Conclusion: careful pre-surgical planning based on proper reviewed history, recent imaging techniques and utilizing up-to-date intra-operative technology is helping to maximize safe surgical resection, while saving patient function and quality of life.