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

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.

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

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.

Extent of Surgical Resection Predicts Seizure Freedom in Low-Grade Temporal Lobe Brain Tumors

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 921-928 ◽  
Author(s):  
Dario J. Englot ◽  
Seunggu J. Han ◽  
Mitchel S. Berger ◽  
Nicholas M. Barbaro ◽  
Edward F. Chang
Keyword(s):  
Surgical Resection ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Tumor Resection ◽  
Case Series ◽  
Subtotal Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Low Grade ◽  
Glioneuronal Tumors

Abstract BACKGROUND: Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life. OBJECTIVE: To assess how the extent of temporal lobe resection influences seizure outcome. METHODS: We performed a quantitative, comprehensive systematic literature review of seizure control outcomes in 1181 patients with epilepsy across 41 studies after surgical resection of low-grade temporal lobe gliomas and glioneuronal tumors. We measured seizure-freedom rates after subtotal resection vs gross-total lesionectomy alone vs tailored resection, including gross-total lesionectomy with hippocampectomy and/or anterior temporal lobe corticectomy. RESULTS: Included studies were observational case series, and no randomized, controlled trials were identified. Although only 43% of patients were seizure-free after subtotal tumor resection, 79% of individuals were seizure-free after gross-total lesionectomy (OR = 5.00, 95% confidence interval [CI]: 3.33-7.14). Furthermore, tailored resection with hippocampectomy plus corticectomy conferred additional benefit over gross-total lesionectomy alone, with 87% of patients achieving seizure freedom (OR = 1.82, 95% CI: 1.23-2.70). Overall, extended resection with hippocampectomy and/or corticectomy over gross-total lesionectomy alone significantly predicted seizure freedom (OR = 1.18, 95% CI: 1.11-1.26). Age <18 years and mesial temporal location also prognosticated favorable seizure outcome. CONCLUSION: Gross-total lesionectomy of low-grade temporal lobe tumors results in significantly improved seizure control over subtotal resection. Additional tailored resection including the hippocampus and/or adjacent cortex may further improve seizure control, suggesting dual pathology may sometimes allow continued seizures after lesional excision.

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

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

scholarly journals Seizure outcome after radiotherapy and chemotherapy in low-grade glioma patients: a systematic review

2015 ◽  
Vol 17 (7) ◽  
pp. 924-934 ◽  
Author(s):  
Johan A. F. Koekkoek ◽  
Melissa Kerkhof ◽  
Linda Dirven ◽  
Jan J. Heimans ◽  
Jaap C. Reijneveld ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Grade Glioma ◽  
Seizure Outcome ◽  
Low Grade

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

2021 ◽  
Author(s):  
Vasileios K. Kavouridis ◽  
Paola Calvachi ◽  
Charles H. Cho ◽  
Timothy R. Smith
Keyword(s):  
Case Series ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Patterns Of Interaction

scholarly journals Management of low-grade glioma: a systematic review and meta-analysis

2018 ◽  
Vol 6 (4) ◽  
pp. 249-258 ◽  
Author(s):  
Timothy J Brown ◽  
Daniela A Bota ◽  
Martin J van Den Bent ◽  
Paul D Brown ◽  
Elizabeth Maher ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Low Grade Glioma ◽  
World Health ◽  
Subtotal Resection ◽  
Low Grade ◽  
Evidence Based ◽  
Free Survival ◽  
Low Grade Gliomas

Abstract Background Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-type gliomas. Conclusions Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.

scholarly journals Profound hearing loss following surgery in pediatric patients with posterior fossa low-grade glioma

2017 ◽  
Vol 5 (2) ◽  
pp. 96-103 ◽  
Author(s):  
Yahya Ghazwani ◽  
Ibrahim Qaddoumi ◽  
Johnnie K Bass ◽  
Shengjie Wu ◽  
Jason Chiang ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Posterior Fossa ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Low Grade Glioma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Low Grade ◽  
Total Resection ◽  
Profound Hearing Loss

Abstract Background Hearing loss may occur in patients with posterior fossa low-grade glioma who undergo surgery. Methods We retrospectively reviewed 217 patients with posterior fossa low-grade glioma, including 115 for whom results of hearing tests performed after surgery and before chemotherapy or radiation therapy were available. We explored the association of UHL with age at diagnosis, sex, race, tumor location, extent of resection, posterior fossa syndrome, ventriculoperitoneal shunt placement, and histology. Results Of the 115 patients, 15 (13.0%: 11 male, 6 black, 8 white, 1 multiracial; median age 7 years [range, 1.3–17.2 years]) had profound UHL after surgery alone or before receiving ototoxic therapy. Median age at tumor diagnosis was 6.8 years (range, 0.7–14.1 years), and median age at surgery was 6.8 years (range, 0.7–14.1 years). Patients with UHL had pathology characteristic of pilocytic astrocytoma (n = 10), ganglioglioma (n = 4), or low-grade astrocytoma (n = 1). Of these 15 patients, 4 underwent biopsy, 1 underwent gross total resection, 1 underwent near-total resection, and 9 underwent subtotal resection. UHL was more frequent in black patients than in white patients (OR 7.3, P = .007) and less frequent in patients who underwent gross total resection or near-total resection than in those who underwent subtotal resection (OR 0.11, P = .02). Conclusions Children undergoing surgery for posterior fossa low-grade glioma are at risk for UHL, which may be related to race or extent of resection. These patients should receive postoperative audiologic testing, as earlier intervention may improve outcomes.

Adult Supratentorial Low-Grade Glioma: Long-Term Experience at a Single Institution

2009 ◽  
Vol 75 (5) ◽  
pp. 1401-1407 ◽  
Author(s):  
Glenn Bauman ◽  
Barbara Fisher ◽  
Christopher Watling ◽  
J. Gregory Cairncross ◽  
David Macdonald
Keyword(s):  
Low Grade Glioma ◽  
Low Grade ◽  
Single Institution ◽  
Long Term Experience

scholarly journals P14.27 The significance of multicentric noncontrast-enhancing lesions distant from surgically resected glioblastoma: Case series of 3 patients

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii72-iii73
Author(s):  
J Hwang ◽  
H An ◽  
S Yoon ◽  
K Park
Keyword(s):  
Temporal Lobe ◽  
Multidisciplinary Treatment ◽  
Case Series ◽  
Tumor Location ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Post Contrast ◽  
Poor Prognostic Factor ◽  
Prognostic Features ◽  
18Fdg Pet

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.

Sign in / Sign up

Export Citation Format

Share Document