Patterns of Interaction Between Diffuse Low-Grade Glioma and Pregnancy: An Institutional Case Series

Abstract BACKGROUND Glioblastoma is the most malignant primary brain tumor. The tumor location and multiplicity plays an important role in surgical and further treatment. The incidence of multiple lesions at the time of diagnosis was known as 1–20%, which showed a poor prognostic factor. Most researches has focused on multiple contrast-enhancing lesions, however, multicentric non-enhancing lesions distant from glioblastoma has been rarely evaluated. The authors reported the case series of the patient who showed multicentric non contrast-enhancing lesions without connection to histologically-proven glioblastoma. MATERIAL AND METHODS Multicentric non contrast-enhancing lesions were defined as areas of FLAIR hyperintensity and mass effect without post-contrast enhancement, separated from the histologically-proven glioblastoma in a newly diagnosed disease. Three patients who showed distant non-enhancing lesions with appearance of a multicentric low-grade glioma were included in this study. The typical enhancing lesions were surgically resected and standard chemo-radiotherapy was followed in all patients. RESULTS All patients were male and their age was 38, 60 and 65 years old respectively. Multicentric tumor location was as follows: Case 1, left frontal lobe with non-enhancing lesion in left parahippocampal gyrus; Case 2, left parietal with non-enhancing lesion in left anteromedial temporal lobe; Case 3, left thalamus with non-enhancing lesions in both basal frontal and right temporal lobe. Pathologically, the resected enhancing tumor revealed glioblastoma in 2 patients and diffuse midline glioma in 1. All tumors were IDH-wild type. The resected enhanced lesion showed no progression but all non-enhancing lesions developed contrast-enhancing tumors at 3, 13 and 17 months after initial treatment, with high tracer uptake on 18FDG-PET or 18FDOPA-PET. Despite multidisciplinary treatment, two patients died from disease progression at 30 and 32 months after diagnosis and one patient is still alive with overall survival of 15 months. CONCLUSION The appearance of multicentric non-enhancing lesions distant from a typically enhancing tumor showed an uncommon finding in glioblastoma and poor prognostic features. These lesions progress faster than expected for a low-grade glioma. These lesions should be distinguished from typical low-grade glioma and should be considered more advanced lesions than their appearances suggest.

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Awake Surgery for Left Posterior Insular Low-Grade Glioma Through the Parietorolandic Operculum: The Need to Preserve the Functional Connectivity. A Case Series

Frontiers in Surgery ◽

10.3389/fsurg.2021.824003 ◽

2022 ◽

Vol 8 ◽

Author(s):

Hugues Duffau

Keyword(s):

White Matter ◽

Functional Connectivity ◽

Case Series ◽

Low Grade Glioma ◽

Awake Surgery ◽

Cortical Mapping ◽

Lateral Part ◽

Low Grade ◽

Left Posterior ◽

Transcortical Approach

Objective: Surgical approach to low-grade glioma (LGG) involving the posterior insula is challenging, especially in the left hemisphere, with a high risk of sensorimotor, language, or visual deterioration. In this study, a case series of 5 right-handed patients harboring a left posterior insular LGG is reported, by detailing a transcorticosubcortical approach.Method: The five surgeries were achieved in awake patients using cortical and axonal electrostimulation mapping. The glioma was removed through the left rolandic and/or parietal opercula, with preservation of the subcortical connectivity.Results: The cortical mapping was positive in the five patients, enabling the selection of an optimal transcortical approach, via the anterolateral supramarginal gyrus in four patients and/or via the lateral retrocentral gyrus in three cases (plus through the left superior temporal gyrus in one case). Moreover, the white matter tracts were identified in all cases, i.e., the lateral part of the superior longitudinal fasciculus (five cases), the arcuate fasciculus (four cases), the thalamocortical somatosensory pathways (four cases), the motor pathway (one case), the semantic pathway (three cases), and the optic tract (one case). Complete resection of the LGG was achieved in two patients and near-total resection in three patients. There were no postoperative permanent sensorimotor, language, or visual deficits.Conclusion: A transcortical approach through the parietorolandic operculum in awake patients represents safe and effective access to the left posterior insular LGG. Detection and preservation of the functional connectivity using direct electrostimulation of the white matter bundles are needed in this cross-road brain region to prevent otherwise predictable postsurgical impairments.

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Neurocognitive Function in Newly Diagnosed Low-grade Glioma Patients Undergoing Surgical Resection With Awake Mapping Techniques

Neurosurgery ◽

10.1227/neu.0000000000000779 ◽

2015 ◽

Vol 77 (3) ◽

pp. 371-379 ◽

Cited By ~ 36

Author(s):

Caroline A. Racine ◽

Jing Li ◽

Annette M. Molinaro ◽

Nicholas Butowski ◽

Mitchel S. Berger

Keyword(s):

Surgical Resection ◽

Cognitive Deficits ◽

Neuropsychological Testing ◽

Case Series ◽

Low Grade Glioma ◽

Neurological Deficits ◽

Low Grade ◽

Newly Diagnosed ◽

Cognitive Screening ◽

Mapping Techniques

Abstract BACKGROUND: Low-grade glioma (LGG) patients have increased life expectancy, so interest is high in the treatments that maximize cognition and quality of life. OBJECTIVE: To examine presurgical baseline cognitive deficits in a case series of LGG patients and determine cognitive effects of surgical resection with awake mapping. METHODS: We retrospectively assessed neurological deficits, subjective concerns from patient or caregiver, and cognitive deficits at baseline and postsurgery for 22 patients with newly diagnosed LGG who underwent baseline neuropsychological evaluation and magnetic resonance imaging before awake surgical resection with mapping. Twelve of the 22 patients returned for postoperative evaluation approximately 7 months after surgery. RESULTS: At baseline, 92% of patients/caregivers reported changes in cognition or mood. Neurological examinations and Montreal Cognitive Assessment Scale scores were largely normal; however, on many tests of memory and language, nearly half of individuals showed deficits. After surgery, 45% had no deficits on neurological examination, whereas 55% had only transient or mild difficulties. Follow-up neuropsychological testing found most performances stable to improved, particularly in language, although some patients showed declines on memory tasks. CONCLUSION: Most LGG patients in this series presented with normal neurological examinations and cognitive screening, but showed subjective cognitive and mood concerns and cognitive decline on neuropsychological testing, suggesting the importance of comprehensive evaluation. After awake mapping, language tended to be preserved, but memory demonstrated decline in some patients. These results highlight the importance of establishing a cognitive baseline before surgical resection and further suggest that awake mapping techniques provide reasonable language outcomes in individuals with LGG in eloquent regions.

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Diffuse Low Grade Glioma - A 10-year single institution case series

Neuro-Oncology ◽

10.1093/neuonc/noz167.064 ◽

2019 ◽

Vol 21 (Supplement_4) ◽

pp. iv15-iv15

Author(s):

Shami Acharya ◽

Priya Sekhon ◽

Jose Pedro Lavrador ◽

Ravindran Visagan ◽

Vijay Narbad ◽

...

Keyword(s):

Treatment Options ◽

Case Series ◽

Tumour Volume ◽

Extent Of Resection ◽

Low Grade Glioma ◽

Subtotal Resection ◽

Low Grade ◽

Single Institution ◽

The Mean ◽

Second Procedure

Abstract Objectives To study clinical features and treatment options between 2007–2018 in a population of diffuse low grade glioma (DLGG) patients (WHO Grade2). Methods Single centre retrospective cohort study. Variables reviewed: demographics, extent of resection (biopsy – Bx, subtotal resection – STR, gross total resection – GTR), molecular genetics and outcome. Results N=104.M=61 F=43, average age, 41.8 yrs. For their first surgery, 40.4% underwent a Bx, 32.7% STR, 26.9% GTR. 50.9% of patients had a second procedure due to clinical progression (13.8% Bx, 38.85% STR, 47.2% GTR). We were more surgically aggressive at the second sitting (p=0.0021). After 2014, we were more aggressive in terms of achieving a resection over a biopsy alone (pre 2013: 26 Bx, 24 resection, post 2013: 15 Bx, 28 resection). 35% had 1p19q co-deletion, 70% had 1DH1 mutation and 44.6% with MGMT methylated. There was no difference in survival and extent of resection in 1p19 co-deletions (HR 0.35), however there was in the IDH 1 group (HR 1.25. Post operatively, 37.9% patients had chemotherapy and 57.3 % radiotherapy. 80.5% (Bx 65,9% alive, resection 95% alive) of patients are still alive (longest survival 11.6 yrs). Amongst those who died, the mean overall survival was 4.0 (range 0–7 - 5 years): Of these 14% had undergone a Bx and 6% STR/GTR. The adjusted analysis revealed that EOR is the only revelant factor for survival in the population when adjusted for IDH, 1p19q, tumour volume, age, gender and surgery year (p=0.44). Conclusion Our data emphasises the importance of achieving maximal resection when possible.

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Neuropsychological impact of trametinib in pediatric low‐grade glioma: A case series

Pediatric Blood & Cancer ◽

10.1002/pbc.28690 ◽

2020 ◽

Vol 67 (12) ◽

Author(s):

Rachel K. Peterson ◽

Tara McKeown ◽

Uri Tabori ◽

Ute Bartels ◽

Eric Bouffet ◽

...

Keyword(s):

Case Series ◽

Low Grade Glioma ◽

Low Grade

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Low-Grade Glioma Case Series: Lessons Learned from an Evolving 10-Year Single-Institution Multidisciplinary Team Practice

World Neurosurgery ◽

10.1016/j.wneu.2021.03.101 ◽

2021 ◽

Author(s):

Shami Acharya ◽

José Pedro Lavrador ◽

Priya Pavninder Sekhon ◽

Ravindran Visagan ◽

Josephine Jung ◽

...

Keyword(s):

Multidisciplinary Team ◽

Case Series ◽

Lessons Learned ◽

Low Grade Glioma ◽

Low Grade ◽

Single Institution ◽

Glioma Case

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TM1-2 Diffuse low grade glioma after the 2016 WHO update, seizure characteristics, imaging correlates and outcomes

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.26 ◽

2019 ◽

Vol 90 (3) ◽

pp. e8.3-e9

Author(s):

M Roberts ◽

C Hayhurst ◽

J Shires ◽

T Northmore

Keyword(s):

Molecular Genetics ◽

Case Series ◽

Tumour Volume ◽

Low Grade Glioma ◽

Awake Craniotomy ◽

Subtotal Resection ◽

Seizure Outcome ◽

Low Grade ◽

Single Institution ◽

Tumour Characteristics

ObjectivesSeizures are a common presenting symptom in patients with low grade glioma (LGG). Exact mechanisms of epileptogenesis are unknown and the influence of radiological and histological characteristics are not well studied, particularly after the 2016 WHO reclassification of gliomas. We aimed to define predictors of seizure development and outcome in patients with LGG.DesignRetrospective single institution case series.Subjects63 patients who underwent resection of supratentorial LGG in a single institution, 45 presented with seizures.MethodsRetrospective analysis of patient records to assess seizure outcome and other demographics including radiological variables, tumour characteristics, type of surgery and histology based on the 2016 WHO update.ResultsAfter surgery, 33 patients (73%) who presented with seizures were Engel class I at median follow up of 43 months. Complete and near total resection were associated with improved Engel class compared to subtotal resection. Awake craniotomy gave improved seizure outcomes compared to under general anaesthesia (84% vs 65%). Molecular genetics did not predict seizure outcome. Updated histology did not predict seizures at diagnosis, only tumour heterogeneousity on initial MRI (p=0.043). Tumour volume at presentation impacted EOR but not seizure outcome.ConclusionsSeizure outcome is directly related to EOR. Tumour histology based on molecular genetics did not predict seizure development or outcome. Use of awake craniotomy results in greater EOR and improved Engel class.

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