ArticleFrontiers in oncology2025
Patient selection and outcome in low-grade glioma surgery.
Article in Frontiers in oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and objectives: Maximal safe resection is the cornerstone of diffuse low-grade glioma (dLGG) management, although epidemiological data are limited. We aim to explore surgical selection, techniques, and outcomes in a population-based cohort. Materials and methods: This study utilized a multi-center case series (9 out of 10 neurosurgical departments in Norway and Sweden) of all adults (≥18 years) with histopathologically verified supratentorial dLGG, WHO grade 2, undergoing primary surgery from 2012-2017. Complications within 30 days and neurological outcomes at 3 months were assessed. Pre- and postoperative MRIs were reviewed centrally, blinded to patient outcome and center. Results: Of 517 included patients, 217 (41.7%) were female, and the mean (SD) age was 44.5 (15.0) years. Biopsy only was performed in 119 (23.0%) patients (13.8-38.9% across centers), and 398 (77.0%) underwent resection (61.1-86.2%). Intraoperative neurophysiological monitoring (IONM) was used in 142 (35.7%, 0-58.7%) resections. The biopsy-only patients were older (52.7 years vs. 42.1 years, P<.001), had larger tumors (56.6 ml vs. 31.9 ml, P<.001), and these tumors were more often eloquently located (86.6% vs. 56.5%, P<.001). The median (IQR) extent of resection (EOR) was 82.9% (63.3-97.7%), 69.7-100.0% across centers. The median (IQR) residual tumor was 4.6 ml (0.5-19.9 ml), 0.0-14.1 ml across centers. Age and histopathology were the most important predictors of EOR. New/worsened neurological deficits occurred in 165 patients (41.5%), 23.1-66.7% across centers, and persisted in 19 (4.8%, 0-22.7%) at 3 months after surgery. A complication was observed in 87 patients (21.4%, 0-31.7%), with 12 patients (3.1%, 0-9.8%) having grade III-IV complications. Conclusions: We found that surgical selection was associated with age, tumor size, and location. The median EOR in a population-based cohort was 83%, with age and tumor biology being significant predictors. EOR did not correlate with higher risks or worse neurological outcomes. We provide an epidemiological perspective demonstrating a variation in surgical selection and techniques reflecting persistent controversy in dLGG management.
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