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Chapter-065 Intracranial Low-grade Gliomas

BOOK TITLE: Textbook of Contemporary Neurosurgery (2 Volumes)

Author
1. Mittal Sandeep
2. Kupsky William J
3. Barger Geoffrey R
4. Lozen Andrew M
ISBN
9789350252390
DOI
10.5005/jp/books/11681_65
Edition
1/e
Publishing Year
2012
Pages
23
Author Affiliations
1. Wayne State University, Detroit, MI, USA
2. Wayne State University, Detroit, MI, USA
3. Wayne State University, Detroit, MI, USA
4. Wayne State University, Detroit, MI, USA
Chapter keywords

Abstract

The World Health Organization (WHO) classification, the most commonly accepted grading system for brain tumors, first classifies tumors by predominant cell type and then histologically grades them according to degree of malignancy based on nuclear atypia, cellularity, mitotic activity, microvascular proliferation, necrosis and proliferation index. All WHO grade I and II gliomas are considered to be low-grade tumors. The clinical presentation, location, natural history, histology, molecular characteristics and response to treatment of low-grade glial neoplasms are diverse. Non-infiltrating gliomas usually do not require additional treatment and can be followed with serial neuroimaging; they include, among others, pilocytic astrocytomas, variant forms of astrocytoma and dysembryoplastic neuroepithelial tumors; they are covered in the “Gliomas” chapter. The most numerous, and perhaps most troublesome, of these low-grade glial tumors include the supratentorial WHO grade II oligodendrogliomas, oligoastrocytomas and astrocytomas. They are the only adult low-grade tumors which have been systematically studied in randomized clinical trials. We will use the term low-grade glioma (LGG) hereafter to refer to these infiltrating WHO grade II gliomas in adults. These three supratentorial nonoptic pathway glial tumors have similar invasive and malignant potential and are the focus of this chapter. Most modern series report a longer median survival in patients with WHO grade II oligodendrogliomas than low-grade astrocytomas. Patients with oligoastrocytomas have a reported outcome that falls between pure oligodendrogliomas and astrocytomas. Although of low grade and often infiltrating, brainstem and optic gliomas have different clinical presentations and treatments; they are discussed separately in the following two chapters. Much of the work done on high-grade gliomas (HGGs) appears to hold true for LGGs.

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