scholarly journals 382 Resection of Gliomas Initially Deemed to be Inoperable

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 291-291
Author(s):  
Derek Southwell ◽  
Harjus Birk ◽  
Seunggu Jude Han ◽  
Mitchel S Berger
Keyword(s):  
Functional Outcomes ◽  
Brain Biopsy ◽  
Extent Of Resection ◽  
Karnofsky Performance Scale ◽  
Total Resection ◽  
Scale Scores ◽  
Glioma Resection ◽  
Referring Physicians ◽  
Functional Areas ◽  
Performance Scale

Abstract INTRODUCTION Surgeons and referring physicians may, on the basis of radiologic studies alone, assume a glioma to be unresectable. Because imaging studies, including functional MRI, may not localize eloquent areas with high fidelity, this simplistic approach excludes some patients from what could be a safe resection. Intraoperative direct electrical stimulation (DES) accurately localizes functional areas, thereby enabling maximal resection of tumors. Here we describe the extent of resection and functional outcomes following resections of tumors deemed inoperable at outside hospitals. METHODS We retrospectively examined the cases of 58 adult patients who underwent glioma resection within six months of undergoing a brain biopsy of the same lesion at an outside hospital. All patients exhibited unifocal, supratentorial disease, and pre-operative Karnofsky Performance Scale scores = 70. We characterized the extent of resection and six-month functional outcomes for this population. RESULTS >Intraoperative DES mapping was performed on 96.6% of patients (56 of 58). Overall, the mean extent of resection was 87.6% ± 13.6% (range, 39.0% to 100%). Gross total resection (resection of >99% of the pre-operative tumor volume) was achieved in 29.3% of patients (17 of 58). Sub-total resection (95-99% resection) and partial resection (<95% resection) were achieved in 12.1% (7 of 58) and 58.6% of patients (34 of 58), respectively. Six months after surgery, no patient exhibited a new post-operative neurologic deficit. Most patients (87.9%, 51 of 58) were free of neurologic deficits both pre- and post-operatively. The remainder of patients exhibited either residual but stable deficits (5.2%, 3 of 58), or complete correction of pre-operative deficits (6.9%, 4 of 58). CONCLUSION The use of DES enabled maximal safe resections of gliomas deemed inoperable by referring neurosurgeons. With rare exceptions, tumor resectability cannot be determined solely by radiologic studies.

scholarly journals Safe maximal resection of primary cavernous sinus meningiomas via a minimal anterior and posterior combined transpetrosal approach

2018 ◽  
Vol 44 (4) ◽  
pp. E11 ◽  
Author(s):  
Hiroki Morisako ◽  
Takeo Goto ◽  
Hiroki Ohata ◽  
Sachin Ranganatha Goudihalli ◽  
Keisuke Shirosaka ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Previous Treatment ◽  
Extent Of Resection ◽  
Karnofsky Performance Scale ◽  
Prepontine Cistern ◽  
Suboccipital Craniotomy ◽  
Ocular Movements ◽  
Visual Access ◽  
Scale Scores

OBJECTIVEMeningiomas arising from the cavernous sinus (CS) continue to be a significant technical challenge, and resection continues to carry a relatively higher risk of neurological morbidity in patients with these lesions because of the tumor’s proximity to neurovascular structures. The authors report the surgical outcomes of 9 patients with primary CS meningiomas (CSMs) that were surgically treated using a minimal anterior and posterior combined (MAPC) transpetrosal approach, and they emphasize the usefulness of the approach.METHODSThis retrospective study included 9 patients who underwent surgery for CSM treatment between 2015 and 2016 via the MAPC transpetrosal approach. Two patients were men and 7 were women, with a mean age of 58.5 years (39–72 years). Five patients (55.5%) had undergone previous treatment. The surgical technique consisted of a temporo-occipito-suboccipital craniotomy and exposure of the posterolateral part of the CS via the presigmoidal MAPC approach. After opening Meckel’s cave and identifying the 3rd–5th cranial nerves in the prepontine cistern, Parkinson’s triangle and supratrochlear triangles were opened. Finally, the tumor occupying the posterolateral part of the CS was removed.RESULTSAll lesions were safely and maximally removed, with preservation of external ocular movements and preoperative Karnofsky Performance Scale scores. The mean extent of resection was 77.0% (range 58.7%–95.4%). Six patients underwent adjuvant therapy in the form of stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) during the follow-up period; none of these patients experienced recurrence.CONCLUSIONThe authors conclude that the MAPC transpetrosal approach could be superior to other approaches for CSMs, as it provides direct visual access to the posterolateral portion of the CS. In their experience, this approach is an alternative and better option for safe maximal resection of CSMs.

Outcomes in Reoperated Low-Grade Gliomas

Neurosurgery ◽  
2015 ◽  
Vol 77 (2) ◽  
pp. 175-184 ◽  
Author(s):  
Rohan Ramakrishna ◽  
Adam Hebb ◽  
Jason Barber ◽  
Robert Rostomily ◽  
Daniel Silbergeld
Keyword(s):  
Scale Score ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Karnofsky Performance Scale ◽  
Low Grade ◽  
Free Survival ◽  
First Recurrence ◽  
Karnofsky Performance Scale Score ◽  
Performance Scale

Abstract BACKGROUND: Low-grade gliomas (LGGs) comprise a diverse set of intrinsic brain tumors that correlate strongly with survival. Data on the effect of reoperation are sparse. OBJECTIVE: To evaluate the effect of reoperation on patients with LGG. METHODS: Fifty-two consecutive patients with reoperated LGGs treated at the University of Washington between 1986 and 2004 were identified and evaluated in a retrospective analysis. RESULTS: The average overall survival (OS) for this cohort was 12.95 ± 0.96 years. The overall 10-year survival rate was 57%. The absence of any residual tumor at either the first or second operation was associated with significantly increased OS. Negative prognostic variables for OS included the use of upfront radiation and pathology at recurrence. The average overall progression-free survival to the first recurrence (PFS1) was 6.23 ± 0.51 years. Positive prognostic factors for improved PFS1 included the use of upfront radiation therapy. Variables not associated with differences in PFS1 included the use of upfront chemotherapy, enhancement, pathology, extent of resection, the presence of residual tumor, and Karnofsky Performance Scale score &lt;80. The average overall progression-free survival to the second recurrence was 2.73 ± 0.39 years. Pathology at recurrence was associated with significant differences in progression-free survival to the second recurrence, as was extent of resection at time of first recurrence, and Karnofsky Performance Scale score &lt;80. CONCLUSION: This is among the largest studies to assess variables associated with outcome in patients with reoperated LGG. Reresection appears to provide significant benefit, and extent of resection remains the strongest predictor of OS.

Craniofacial approaches to large juvenile angiofibromas

2011 ◽  
Vol 8 (1) ◽  
pp. 71-78 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Maziyar A. Kalani ◽  
Samuel Kalb ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
...  
Keyword(s):  
Average Duration ◽  
Karnofsky Performance Scale ◽  
Preoperative Embolization ◽  
Large Juvenile ◽  
Csf Leakage ◽  
Scale Scores ◽  
Duration Of Hospitalization ◽  
Performance Scale ◽  
Related Mortality

Object Craniofacial approaches provide excellent exposure to lesions in the anterior and middle cranial fossae. The authors review their experience with craniofacial approaches for resection of large juvenile nasopharyngeal angiofibromas. Methods Between 1992 and 2009, 22 patients (all male, mean age 15 years, range 9–27 years) underwent 30 procedures. These cases were reviewed retrospectively. Results Gross-total resection of 17 (77%) of the 22 lesions was achieved. The average duration of hospitalization was 8.2 days (range 3–20 days). The rate of recurrence and/or progression was 4 (18%) of 22, with recurrences occurring a mean of 21 months after the first resection. All patients underwent preoperative embolization. Nine patients (41%) developed complications, the most common of which was CSF leakage (23%). The average follow-up was 27.7 months (range 2–144 months). The surgery-related mortality rate was 0%. Based on their mean preoperative (90) and postoperative (90) Karnofsky Performance Scale scores, 100% of patients improved or remained the same. Conclusions The authors' experience shows that craniofacial approaches provide an excellent avenue for the resection of large juvenile nasopharyngeal angiofibromas, with acceptable rates of morbidity and no deaths.

Evaluation of Functional Outcome Following Resection of Supratentorial Lesions at Eloquent Brain Areas

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ashraf Al-Abyad ◽  
Hasan Jalalod’din ◽  
Mohamed Nosseir ◽  
Omar El Farouk Ahmed ◽  
Fathi Alahwal
Keyword(s):  
Functional Outcome ◽  
Seizure Control ◽  
Surgical Excision ◽  
Extent Of Resection ◽  
Karnofsky Performance Scale ◽  
Pathology Report ◽  
Karnofsky Performance Score ◽  
Brain Areas ◽  
Performance Scale ◽  
Seizure Attacks

Abstract Objectives Microsurgical management of intrinsic brain tumors aims to maximize the extent of resection and to minimize the postoperative morbidity. The purpose of this study is to evaluate the functional outcome following surgical excision of supratentorial lesions at eloquent brain areas such as language, motor and sensory cortex, regarding the extent of resection, the karnofsky performance scale, the neurological deficit and seizure control. Methods A prospective study of 25 patients aged 15-55 years, 15 females and 10 males underwent surgical excision of supra-tentorial lesions at eloquent brain, The Karnofsky Performance Score (KPS), seizure attacks and neurological deficits were analyzed before and after resection. Functional resection was implemented using preoperative functional magnetic resonance image (fMRI), intraoperative image guidance and electrophysiological monitoring under total intravenous anesthesia (TIVA) or awake craniotomy and the extent of resection was quantified postoperatively. Results Preoperative median KPS was 76.8%. It improved one year post-operatively to 89.2%. One patient died 3 weeks postoperatively due to neurological, cardiac and chest complications. The pathology report revealed recurrent metastatic adenocarcinoma GIII. Preoperatively, twenty-three patients had seizure attacks, 10 were controlled and 13 were uncontrolled on medication. Postoperatively seven patients were Engels classification IC and 17 patients were controlled on anti-epileptics (Engels classification ID). Preoperatively 19 patients had hemiparesis/ hemiplegia, while immediate (one week) postoperatively 13 patients improved, 8 patients experienced initial worsening of the preoperative deficits and 4 patients had the same deficit as preoperatively while at 1-year postoperatively, 24 patients improved. Gross total resection (&gt;95%) was achieved in 19 patients, subtotal resection (&gt;75%) in 4 patients and partial resection (&gt;65%) in 2 patients. Conclusion Functional resection is believed to be a key prognostic factor in supratentorial lesions at eloquent brain regarding improving of karnofsky performance scale, neurological outcome and seizure control.

ASSOCIATION OF SURGICALLY ACQUIRED MOTOR AND LANGUAGE DEFICITS ON OVERALL SURVIVAL AFTER RESECTION OF GLIOBLASTOMA MULTIFORME

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 463-470 ◽  
Author(s):  
Matthew J. McGirt ◽  
Debraj Mukherjee ◽  
Kaisorn L. Chaichana ◽  
Khoi D. Than ◽  
Jon D. Weingart ◽  
...  
Keyword(s):  
Overall Survival ◽  
Glioblastoma Multiforme ◽  
Extent Of Resection ◽  
Motor Deficits ◽  
Karnofsky Performance Scale ◽  
Language Deficits ◽  
Surgically Induced ◽  
Karnofsky Performance Scale Score ◽  
Performance Scale ◽  
New Onset

Abstract OBJECTIVE Balancing the benefits of extensive tumor resection with the consequence of potential postoperative deficits remains a challenge in malignant astrocytoma surgery. Although studies have suggested that increasing extent of resection may benefit survival, the effect of new postoperative deficits on survival remains unclear. We set out to determine whether new-onset postoperative motor or speech deficits were associated with survival in our institutional experience with glioblastoma multiforme (GBM). METHODS We retrospectively reviewed records of all patients (age range, 18–70 years; Karnofsky Performance Scale score, 80–100) who had undergone GBM resection between 1996 and 2006 at a single institution. Survival was compared between patients who had experienced surgically acquired motor or language deficits versus those who did not experience these deficits. RESULTS Three hundred six consecutive patients (age, 54 ± 11 years; median Karnofsky Performance Scale score, 80) underwent primary GBM resection. Nineteen patients (6%) developed surgically acquired motor deficits and 15 (5%) developed surgically acquired language deficits. Median survival was decreased in patients who acquired language deficits (9.6 months; P &lt; 0.05) or motor deficits (9.0 months; P &lt; 0.05) versus patients without surgically acquired deficits (12.8 months). Two-year survival was 8% and 0% for patients with surgically acquired motor or language deficits, respectively, versus 23% for patients without new-onset deficits. CONCLUSION In our experience, the development of new perioperative motor or language deficits was associated with decreased overall survival despite similar extent of resection and adjuvant therapy. Although it is well known that surgically induced neurological deficits affect quality of life, our results suggest that these surgical morbidities may also affect survival. Care should be taken to avoid surgically induced deficits in the management of GBM.

Gamma Knife radiosurgery to the surgical cavity following resection of brain metastases

2009 ◽  
Vol 111 (3) ◽  
pp. 431-438 ◽  
Author(s):  
Jay Jagannathan ◽  
Chun-Po Yen ◽  
Dibyendu Kumar Ray ◽  
David Schlesinger ◽  
Rod J. Oskouian ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Local Tumor Control ◽  
Gross Total Resection ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Total Resection ◽  
Resection Cavity ◽  
The Mean ◽  
Performance Scale

Object This study evaluated the efficacy of postoperative Gamma Knife surgery (GKS) to the tumor cavity following gross-total resection of a brain metastasis. Methods A retrospective review was conducted of 700 patients who were treated for brain metastases using GKS. Forty-seven patients with pathologically confirmed metastatic disease underwent GKS to the postoperative resection cavity following gross-total resection of the tumor. Patients who underwent subtotal resection or who had visible tumor in the resection cavity on the postresection neuroimaging study (either CT or MR imaging with and without contrast administration) were excluded. Radiographic and clinical follow-up was assessed using clinic visits and MR imaging. The radiographic end point was defined as tumor growth control (no tumor growth regarding the resection cavity, and stable or decreasing tumor size for the other metastatic targets). Clinical end points were defined as functional status (assessed prospectively using the Karnofsky Performance Scale) and survival. Primary tumor pathology was consistent with lung cancer in 19 cases (40%), melanoma in 10 cases (21%), renal cell carcinoma in 7 cases (15%), breast cancer in 7 cases (15%), and gastrointestinal malignancies in 4 cases (9%). The mean duration between resection and radiosurgery was 15 days (range 2–115 days). The mean volume of the treated cavity was 10.5 cm3 (range 1.75–35.45 cm3), and the mean dose to the cavity margin was 19 Gy. In addition to the resection cavity, 34 patients (72%) underwent GKS for 116 synchronous metastases observed at the time of the initial radiosurgery. Results The mean radiographic follow-up duration was 14 months (median 10 months, range 4–37 months). Local tumor control at the site of the surgical cavity was achieved in 44 patients (94%), and tumor recurrence at the surgical site was statistically related to the volume of the surgical cavity (p = 0.04). During follow-up, 34 patients (72%) underwent additional radiosurgery for 140 new (metachronous) metastases. At the most recent follow-up evaluation, 11 patients (23%) were alive, whereas 36 patients had died (mean duration until death 12 months, median 10 months). Patients who showed good systemic control of their primary tumor tended to have longer survival durations than those who did not (p = 0.004). At the last clinical follow-up evaluation, the mean Karnofsky Performance Scale score for the overall group was 78 (median 80, range 40–100). Conclusion: Radiosurgery appears to be effective in terms of providing local tumor control at the resection cavity following resection of a brain metastasis, and in the treatment of synchronous and metachronous tumors. These data suggest that radiosurgery can be used to prevent recurrence following gross-total resection of a brain metastasis.

Multiple craniotomies in the management of multifocal and multicentric glioblastoma

2011 ◽  
Vol 114 (3) ◽  
pp. 576-584 ◽  
Author(s):  
Wael Hassaneen ◽  
Nicholas B. Levine ◽  
Dima Suki ◽  
Abhijit L. Salaskar ◽  
Alessandra de Moura Lima ◽  
...  
Keyword(s):  
Postoperative Morbidity ◽  
Extent Of Resection ◽  
Survival Duration ◽  
Karnofsky Performance Scale ◽  
Complication Rates ◽  
Group A ◽  
Group B ◽  
Performance Scale ◽  
Single Lesion

Object Multiple craniotomies have been performed for resection of multiple brain metastases in the same surgical session with satisfactory outcomes, but the role of this procedure in the management of multifocal and multicentric glioblastomas is undetermined, although it is not the standard approach at most centers. Methods The authors performed a retrospective analysis of data prospectively collected between 1993 and 2008 in 20 patients with multifocal or multicentric glioblastomas (Group A) who underwent resection of all lesions via multiple craniotomies during a single surgical session. Twenty patients who underwent resection of solitary glioblastoma (Group B) were selected to match Group A with respect to the preoperative Karnofsky Performance Scale (KPS) score, tumor functional grade, extent of resection, age at time of surgery, and year of surgery. Clinical and neurosurgical outcomes were evaluated. Results In Group A, the median age was 52 years (range 32–78 years); 70% of patients were male; the median preoperative KPS score was 80 (range 50–100); and 9 patients had multicentric glioblastomas and 11 had multifocal glioblastomas. Aggressive resection of all lesions in Group A was achieved via multiple craniotomies in the same session, with a median extent of resection of 100%. Groups A and B were comparable with respect to all the matching variables as well as the amount of tumor necrosis, number of cysts, and the use of intraoperative navigation. The overall median survival duration was 9.7 months in Group A and 10.5 months in Group B (p = 0.34). Group A and Group B (single craniotomy) had complication rates of 30% and 35% and 30-day mortality rates of 5% (1 patient) and 0%, respectively. Conclusions Aggressive resection of all lesions in selected patients with multifocal or multicentric glioblastomas resulted in a survival duration comparable with that of patients undergoing surgery for a single lesion, without an associated increase in postoperative morbidity. This finding may indicate that conventional wisdom of a minimal role for surgical treatment in glioblastoma should at least be questioned.

scholarly journals Resection of gliomas deemed inoperable by neurosurgeons based on preoperative imaging studies

2018 ◽  
Vol 129 (3) ◽  
pp. 567-575 ◽  
Author(s):  
Derek G. Southwell ◽  
Harjus S. Birk ◽  
Seunggu J. Han ◽  
Jing Li ◽  
Jeffrey W. Sall ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Neurological Deficits ◽  
Preoperative Imaging ◽  
Karnofsky Performance Scale ◽  
Subtotal Resection ◽  
Imaging Studies ◽  
Brain Functions ◽  
The Mean ◽  
Referring Physicians ◽  
Radiological Studies

OBJECTIVEMaximal safe resection is a primary objective in the management of gliomas. Despite this objective, surgeons and referring physicians may, on the basis of radiological studies alone, assume a glioma to be unresectable. Because imaging studies, including functional MRI, may not localize brain functions (such as language) with high fidelity, this simplistic approach may exclude some patients from what could be a safe resection. Intraoperative direct electrical stimulation (DES) allows for the accurate localization of functional areas, thereby enabling maximal resection of tumors, including those that may appear inoperable based solely on radiological studies. In this paper the authors describe the extent of resection (EOR) and functional outcomes following resections of tumors deemed inoperable by referring physicians and neurosurgeons.METHODSThe authors retrospectively examined the cases of 58 adult patients who underwent glioma resection within 6 months of undergoing a brain biopsy of the same lesion at an outside hospital. All patients exhibited unifocal supratentorial disease and preoperative Karnofsky Performance Scale scores ≥ 70. The EOR and 6-month functional outcomes for this population were characterized.RESULTSIntraoperative DES mapping was performed on 96.6% (56 of 58) of patients. Nearly half of the patients (46.6%, 27 of 58) underwent an awake surgical procedure with DES. Overall, the mean EOR was 87.6% ± 13.6% (range 39.0%–100%). Gross-total resection (resection of more than 99% of the preoperative tumor volume) was achieved in 29.3% (17 of 58) of patients. Subtotal resection (95%–99% resection) and partial resection (PR; < 95% resection) were achieved in 12.1% (7 of 58) and 58.6% (34 of 58) of patients, respectively. Of the cases that involved PR, the mean EOR was 79.4% ± 12.2%. Six months after surgery, no patient was found to have a new postoperative neurological deficit. The majority of patients (89.7%, 52 of 58) were free of neurological deficits both pre- and postoperatively. The remainder of patients exhibited either residual but stable deficits (5.2%, 3 of 58) or complete correction of preoperative deficits (5.2%, 3 of 58).CONCLUSIONSThe use of DES enabled maximal safe resections of gliomas deemed inoperable by referring neurosurgeons. With rare exceptions, tumor resectability cannot be determined solely by radiological studies.

The relative value of postoperative versus preoperative Karnofsky Performance Scale scores as a predictor of survival after surgical resection of glioblastoma multiforme

2014 ◽  
Vol 121 (2) ◽  
pp. 359-364 ◽  
Author(s):  
Lola B. Chambless ◽  
Heather M. Kistka ◽  
Scott L. Parker ◽  
Laila Hassam-Malani ◽  
Matthew J. McGirt ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Karnofsky Performance Scale ◽  
Relative Value ◽  
Scale Scores ◽  
Performance Scale

Convexity meningiomas: study of recurrence factors with special emphasis on the cleavage plane in a series of 100 consecutive patients

2011 ◽  
Vol 115 (3) ◽  
pp. 491-498 ◽  
Author(s):  
Jorge E. Alvernia ◽  
Nguyen D. Dang ◽  
Marc P. Sindou
Keyword(s):  
Recurrence Rate ◽  
Cleavage Plane ◽  
Extent Of Resection ◽  
Histological Type ◽  
Karnofsky Performance Scale ◽  
Who Grade ◽  
Simpson Grade ◽  
Scale Scores ◽  
Grade Ii

Object Convexity meningiomas are expected to have a low recurrence rate given their classically “easy resectability.” Nonetheless, recurrence can occur. Factors playing a role in their recurrence are analyzed here, including the extent of resection and tumor histological type, among others, with a special emphasis on the cleavage plane. Methods The authors reviewed 100 cases of convexity meningiomas surgically treated between 1987 and 2001 with a median follow-up of 86 months (range 2–16 years). Preoperative and postoperative functional status, Simpson resection grade, histological type, and intraoperative surgical plane with pial vessel invasion were studied and correlated with the recurrence rate. Results The average tumor size was 3.6 ± 0.4 cm. The pre- and postoperative Karnofsky Performance Scale scores were 92.6 ± 4.6 and 97.9 ± 2.2, respectively. Ninety-five lesions were benign (WHO Grade I) and 5 were atypical (WHO Grade II). Ninety-one and 9 tumors were subjected to Simpson Grade 1 and 3 resections (three Grade 3a and six Grade 3b), respectively. Surgical deaths did not occur. After a mean follow-up of 7.2 years, 4 meningiomas recurred; 2 (2.2%) after Simpson Grade 1 resections and 2 after Simpson Grade 3 (3a and 3b) resections (22.2%; p = 0.0034). When just the subgroup of Simpson Grade 1/WHO Grade I was studied, the recurrence rate decreased to 1.2% (1 of 86 cases). The recurrence of WHO Grade I tumors was higher in the subpial group than in the extrapial group (p = 0.025). No difference in recurrence according to the cleavage plane was seen in the WHO Grade II subgroup (p = 0.361). As for the subpial group, no difference in recurrence was noted between the WHO Grade I and II subgroups (p = 0.608). Importantly, however, the extrapial subgroup of WHO Grade II lesions had a higher recurrence rate compared with its counterpart in the WHO Grade I subgroup (p = 0.005). Conclusions Pial and vascular invasion affect the recurrence rate in convexity meningioma surgery. The recurrence rate of WHO Grade I tumors was higher among those with a subpial plane of dissection than among those with an extrapial one. Histological type did not determine the degree of pial invasion in WHO Grade I and II lesions.

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