Abstract
The impact of surgery on outcome of adult patients with low-grade gliomas is controversial. Without prospective randomized treatment trials, one is primarily dependent on retrospective studies to address this issue. This paper reviews the recent clinical series of low-grade gliomas in which the association between extent of resection (EOR) and outcome could be analyzed. Functional stimulation mapping methods will be described to point out their critical role in maximizing the extent of resection while minimizing the risk associated with radical resection of low-grade gliomas. Studies from the CT-era analyzed with multivariate statistical methods were emphasized. The analysis of these studies points out that, for astrocytomas, there is no clear consensus that a greater EOR improves survival, but in most series under review, greater EOR significantly extended the survival of patients with oligodendroglioma. Unfortunately, there is little data which specifically analyzes and stratifies the outcome for other end-points such as time to progression, malignant degeneration, mortality and morbidity, and duration of high quality survival by EOR.
Similar content being viewed by others
References
Rostomily RC, Halligan JB, Keles GE, Spence AM, Berger MS: Management of adult recurrent supratentorial gliomas. Neurosurg Quarterly 3(4): 219–252, 1993
Nicolato A, Gerosa GA, Fina P, Iuzzolino P, Giorgiutti F, Bricolo A: Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients. Surg Neurol 44: 208–223, 1995
Rajan B, Pickuth D, Ashley S, Traish D, Monro P, Elllyan S, Brada M: The management of histologically unverified presumed cerebral gliomas with radiotherapy. Int J Radiat Oncol Biol Phys Vol 28: 4405–4413, 1993
Miralbell R, Balart J, Matias-Guiu X, Molet J, Arisa A, Craven-Baartle J: Radiotherapy for supratentorial low-grade gliomas: results and prognostic factors with special focus on tumour volume parameters. Radiotherapy and Oncology 27: 112–116, 1993
Philippon JH, Clemenceau SH, Foncin JF: Supratentorial low-grade astrocytomas in adults. Neurosurgery Vol 32(4): 554–559, 1993
Shibamoto Y, Kitakabu Y, Takahashi M, Yamachita J, Oda Y, Kikuchi H, Abe M: Supratentorial low-grade astrocytoma. Cancer Vol 72(1): 190–195, 1993
North CA, North RB, Epstein JA, Piantadosi S, Wharam MD: Low-grade astrocytomas: survival and quality of life after radiation therapy. Cancer 66: 6–14, 1990
Sofietti R, Chio A, Giordana MT, Vasario E, Schiffer D: Prognostic factors in well-differentiated cerebral astrocytomas in the adult. Neurosurgery 24: 686–692, 1989
Medbery CA, Straus KL, Steinberg SM, Cotelingam JD, Fisher WS: Low-grade astrocytomas: treatment results and prognostic variables. Int J Radiat Oncol Biol Phys Vol 15: 837–841, 1988
Piepmeier JM: Observations on the current treatment of low-grade astrocytic tumors of the cerebral hemispheres. J Neurosurg 67: 177–181, 1987
Laws ER, Taylor WF, Clifton MB, Okazaki H: Neurosurgical management of low-grade astrocytomas of the cerebral hemispheres. J Neurosurg 61: 665–673, 1984
Kreth FW, Faist M, Warnke PC, Robnner R, Bolk JB, Osstertag CB: Interstitial radiosurgery of low-grade gliomas. J Neurosurg 82: 4418–4429, 1995
Shaw EG, Daumas-Duport C, Scheithauer BW, Gilbertson DT, O'Fallon JR, Earle JD, Laws ER, Okazaki H: Radiation therapy in the management of low-grade supratentorial astrocytomas. J Neurosurg 70: 853–861, 1989
Ito S, Chandler KL, Prados MD, Lamborn K, Wynne J, Malec MK, Wilson CB, Davis RL, Hoshino T: Proliferative potential and prognostic evaluation of low-grade astrocytomas. J Neuro-Oncol 19: 1–9, 1994
Kros JM, Pieterman H, van Eden CG, Avezaat CJJ: Oligodendroglioma: the Rotterdam-Dijkzigt experience. Neurosurgery Vol 34(6): 959–966, 1994
Shaw EG, Scheithauer BW, O'Fallon JR, Tazelaar HD, Davis DH: Oligodendrogliomas: the Mayo Clinic experience. J Neurosurg 76: 428–434, 1992
Vertosick FT, Selker RG, Arena VC: Survival of patients with well-differentiated astrocytomas diagnosed in the era of computed tomography. Neurosurgery 28: 496–501, 1991
Shaw EG, Scheithauer BW, O'Fallon JR, Davis DH: Mixed oligoastrocytomas: a survival and prognostic factor analysis. Neurosurgery Vol 34(4): 577–582, 1994
Celli P, Nofrone I, Palma L, Cantore G, Fortuna A: Cerebral oligodendroglioma: prognostic factors and life history. Neurosurgery Vol 35(6): 1018–1035, 1994
Nazzaro JM, Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg 73: 331–344, 1990
Duong DH, Rostomily RC, Haynor DR, Keles GE, Berger MS: Measurement of tumor resection volumes from computerized images. J Neurosurg 77: 151–154, 1992
Berger MS, Deliganis AV, Dobbins J, Keles GE: The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74: 1784–1791, 1994
Scherer HJ: Cerebral astrocytomas and their derivatives. Am J Cancer 40: 159–198, 1940
Scherer HJ: The forms of growth in gliomas and their practical significance. Brain 63: 1–35, 1940
Kelly PJ, Daumas-Duport C, Kispert DB, Kall BA, Scheithauer BW, Illig JJ: Imaging-based stereotactic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 66: 865–874, 1987
Kelly PJ, Daumas-Duport C, Scheithauer BW, Kall BA, Kispert DB: Stereotactic histologic correlations of computed tomography-and magnetic resonance imaging-defined abnormalities in patients with glial neoplasms. Mayo Clin Proc 62: 450–459, 1987
Johnson PC, Hunt SJ, Drayer BP: Human cerebral gliomas: correlation of postmortem MR imaging and neuropathologic findings. Radiology 170: 211–217, 1989
Earnest F IV, Kelly PJ, Scheithauer BW, Kall BA, Cascino TL, Ehman RL, Forbes GS, Axley PL: Cerebral astrocytomas: correlation of MR and CT contrast enhancement with stereotactic biopsy. Radiology 166: 823–827, 1988
Cairncross JG, Macdonald DR, Pexman JHW, Ives FJ: Steroid-induced CT changes in patients with recurrent malignant glioma. Neurology 38: 7224, 1988
Watling CJ, Lee DH, Macdonald DR, Cairncross JG: Corticosteroid-induced magnetic resonance imaging changes in patients with recurrent malignant glioma. J Clin Oncol 12: 1886–1889, 1994
Jack CR Jr, Thompson RM, Butts RK et al.: Sensory motor cortex: correlation of presurgical mapping with functional MR imaging and invasive cortical mapping. Radiology 190: 85–92, 1994
Maldjian J, Atlas S, Howard RS et al.: Functional magnetic resonance imaging of regional brain activity in patients with intracerebral arteriovenous malformation before surgical or endovascular therapy. J Neurosurg 84: 477–483, 1996
Berger MS, Cohen WA, Ojemann GA: Correlation of the motor cortex using intraoperative brain mapping data with preoperative magnetic resonance imaging anatomy. J Neurosurg 72: 383–387, 1990
Berger MS: Use of magnetic resonance imaging for intraoperative localization. Part V, Chapter 54. In: Wilkins RH, Rengachary S (eds). Neurosurgery, 2nd edition. McGraw-Hill Publishers, 559–562, 1995
Chamberlain MC, Murovic JA, Levin VA: Absence of contrast enhancement on CT brain scans of patients with supratentorial malignant gliomas. Neurology 38: 1371–1374, 1988
Kondziolka D, Lunsford LD, Martinez AJ: Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma. J Neurosurg 79: 533–536, 1993
Chandrasoma PT, Smith MM, Apuzzo MLJ: Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurg 24: 160–165, 1989
Friedman WA, Sceats DJ Jr, Nestok BR, Ballinger WE Jr: The incidence of unexpected pathological findings in an image-guided biopsy series: a review of 100 consecutive cases. Neurosurg 25(2): 180–184, 1989
Ranjan A, Rajshekhar V, Joseph T et al.: Nondiagnostic CT-guided stereotactic biopsies in a series of 407 cases: influence of CT morphology and operator experience. J Neurosurg 79: 839–844, 1993
Recht LD, Lew R, Smith TW: Suspected low-grade glioma: is deferring treatment safe? Ann Neurol 31: 431–436, 1992
Shapiro WR: Treatment of neuroectodermal brain tumors. Ann Neurol 12: 231–237, 1982
Garcia DM, Fulling KH, Marks JE: The value of radiation therapy in addition to surgery for astrocytomas of the adult cerebrum. Cancer 55: 919–927, 1985
Berger MS, Ojemann GA, Lettich E: Neurophysiological monitoring to facilitate resection during astrocytoma surgery. In: Neurosurgery Clinics of America. Vol 1(1): 65–80, 1990
Berger MS, Ojemann GA: Intraoperative brain mapping techiques in neuro-oncology. Stereotact and Funct Neurosurg 58: 153–161, 1992
Berger MS: Functional mapping guided resection of low grade gliomas. In: Loftus CM (ed) Clinical Neurosurgery, Vol 42, Chapter 26. Williams & Wilkins Inc., Publishers, New York 437–452, 1995
Franceschetti S, Binelli S, Casazza M et al.: Influence of surgery and antiepileptic drugs on seizures symptomatic of cerebral tumours. Acta Neurochir 103: 47–51, 1990
Hirsch JF, Sainte Rose C, Pierre-Khan A et al.: Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children. J Neurosurg 70: 568–572, 1989
Berger MS, Ghatan S, Haglund MM, Dobbins J, Ojemann GA: Low grade gliomas associated with intractable epilepsy: seizure outcome utilizing electrocorticography during tumor resection. J Neurosurg 79: 62–69, 1993
Ito S, Hoshino T, Shibuya M et al.: Proliferative characteristics of juvenile pilocytic astrocytomas determined by bromodeoxyuridine labeling. Neurosurg 31(3): 413–419, 1992
Goldring S, Gregori EM: Surgical management of epilepsy using epidural recordings to localize the seizure focus. J Neurosurg 60: 457–466, 1984
Berger MS, Kincaid J, Ojemann GA et al.: Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurg 25: 786–792, 1989
Gregori EM, Goldring S: Localization of function in the excision of lesions from the sensorimotor region. J Neurosurg 61: 1047–1054, 1984
Woolsey CN, Cividosan TC, Gibson WE: Localization in somatosensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg 51: 476–506, 1979
Berger MS: The role of surgery in diagnosis and management. In: Apuzzo MLJ (ed) Benign Cerebral Glioma/Neurosurgical Topic Series, Vol II. AANS Publications Committee Publishers, Chicago 293–307, 1995
Penfield W, Boldrey E: Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60: 389–443, 1937
Cushing H: A note upon the faradic stimulation of the post-central gyrus in conscious patients. Brain 32: 44–53, 1909
Forester O: The motor cortex in man in the light of Hughlings Jackson's doctrines. Brain 59: 135–159, 1936
Berger MS: Lesions in functional ('eloquent') cortex and subcortical white matter. In: Clinical Neurosurgery. Proceedings of the Congress of Neurological Surgeons, Vol 41, Chapter 25, 444–463, 1993
Skirboll SL, Ojemann GA, Berger MS, Lettich E, Winn HR: Functional cortex and subcortical white matter located within grossly infiltrative tumors. Neurosurg 38: 678–685, 1996
Haglund MM, Ojemann GA, Blasdel GG: Optical imaging of bipolor cortical stimulation. J Neurosurg 78: 785–793, 1993
Woods R, Dodrill C, Ojemann GA: Brain injury, handedness and speech lateralization in a series of amobarbital studies. Ann Neurol 23: 510–518, 1988
Wada J, Rasmussen T: Intracarotid injections of sodium amytal for the lateralization of cerebral speech dominance. J Neurosurg 17: 266–282, 1960
Heilman K, Wilder B, Malzone W: Anomic aphasia following anterior temporal lobectomy. Trans Am Neurol Assoc 97: 291–293, 1972
Hermann BP, Wyler AR, Somes G: Language function following anterior temporal lobectomy. J Neurosurg 74: 560–566, 1991
Ranck J: Which elements are excited in electrical stimulation of mammalian central nervous systems: a review. Brain Res 98: 417–440, 1975
Rapport RL, Tan CT, Whitaker HA: Language function and dysfunction among Chinese and English-speaking polyglots: cortical stimulation, WADA testing and clinical studies. Brain Lang 18: 342–366, 1983
Penfield W, Roberts L: Speech and Brain Mechanisms. Princeton University Press, Princeton 1959
Ojemann GA, Dodrill CG: Intraoperative techniques for reducing language and memory deficits with left temporal lobectomy. Advances in Epileptology 16: 327–330, 1987
Haglund MM, Berger MS, Shamseldin M, Lettich E, Ojemann GA: Cortical localization of temporal lobe language sites in patients with gliomas. Neurosurg 34(4): 567–576, 1994
Ojemann GA, Ojemann J, Lettich E et al.: Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 71: 316–326, 1989
Ojemann G, Whitaker H: Language localization and variability. Brain and Language 6: 239–260, 1978
Ojemann GA: Cortical organization of language and verbal memory based on intraoperative investigations. Progress in Sensory Physiology 12: 192–230, 1991
Ojemann GA: Brain organization for language from the perspective of electrical stimulation mapping. Behavioural Brain Sci 6: 189–206, 1983
Lunsford LD, Somaza S, Kondiolka D, Flickinger JC: Survival after stereotactic biopsy and irradiation of cerebral nonanaplastic, nonpilocytic astrocytoma. J Neurosurg 82: 523–529, 1995
Lindegaard K-F, Mork SJ, Eide GE, Halvorsen TB, Hatlevoll R, Solgaard T, Dahl O, Ganz J: Statistical analysis of clinicopathological features, radiotherapy, and survival in 170 cases of oligodendroglioma. J Neurosurg 67: 224–230, 1987
Mork SJ, Lindegaard K-F, Halvorsen TB, Lehmann EH, Solgaard T, Hatlevoll R, Harvei S, Ganz J: Oligodendroglioma: incidence and biological behavior in a defined population. J Neurosurg 63: 881–889, 1985
Whitton AC, Bloom HJ: Low grade glioma of the cerebral hemispheres in adults: a retrospective analysis of 88 cases. Int J Radiat Oncol Biol Phys 18: 783–786, 1990
Recht LD, Lew R, Smith TW: Suspected low-grade glioma: Is deferring treatment safe? Ann Neurol 31: 431–436, 1992
Steiger HJ, Markwalder RV, Swiler RW, Ebeling U, Reulen H-J: Early prognosis of supratentorial grade II astrocytomas in adult patients after resection or stereotactic biopsy. Acta Neurochirurgica 106: 99–105, 1990
Singer JM: Supratentorial low grade gliomas in adults. A retrospective analysis of 43 cases treated with surgery and radiotherapy. Eur J Surg Oncol 21: 198–200, 1995
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Berger, M.S., Rostomily, R.C. Low grade gliomas: Functional mapping resection strategies, extent of resection, and outcome. J Neurooncol 34, 85–101 (1997). https://doi.org/10.1023/A:1005715405413
Issue Date:
DOI: https://doi.org/10.1023/A:1005715405413