Advertisement

Early Detection and Management of Incidental Diffuse Low-Grade Gliomas (IDLGG): Toward a “Prophylactic Oncological Neurosurgery”

  • Hugues DuffauEmail author
Chapter

Abstract

Maximal resection is the first treatment to propose in DLGG, since allowing a delay of malignant transformation with a significant increase of overall survival. The use of intraoperative mapping enabled a minimization of the postsurgical morbidity while increasing the extent of resection. On the basis of these new concepts of “functional neurooncological surgery,” the future step will be to evolve toward a “preventive neurosurgery” in incidentally discovered DLGG. Indeed, because of the development of noninvasive MRI, one can observe an increased number of incidental DLGG (IDLGG) for unrelated complaints (e.g., headaches, traumatic brain injury) or research studies. In the current literature, the incidence of IDLGG ranges from 0.025 to 0.3 %, and its prevalence is evaluated about 0.05–0.2 % in the healthy population.

The natural history of IDLGG was recently analyzed, showing that it was not a benign tumor, but an entity that will grow in all cases (with a growth rate very close to that of symptomatic DLGG), and with a risk of malignant transformation ultimately leading to the death. Thus, because IDLGG likely represents an earlier step in the natural course of a glioma than the symptomatic DLGG, their behavior supports the idea that they should be managed as symptomatic DLGG. In this state of mind, several authors proposed to achieve surgical removal of DLGG diagnosed in asymptomatic patients. The rate of total and supratotal resections was improved in comparison with surgical series of symptomatic DLGG, while the rate of permanent deficit was very low, even in critical areas. Interestingly, microfoci with endothelial proliferation were identified in the middle of the tumor in around a quarter of the cases, demonstrating that beginning of malignant transformation may occur before any symptoms. Therefore, these data plead in favor of an early surgical treatment in asymptomatic patients, to maximize the extent of resection before glioma growth and migration, even in eloquent regions. In summary, the similarity of the natural course of DLGG during the silent and symptomatic periods supports “prophylactic” surgical resection of IDLGG.

Keywords

Incidental DLGG Early detection Surgery Supratotal resection Overall survival Malignant transformation Extent of resection Functional mapping 

References

  1. 1.
    Soffietti R, Baumert B, Bello L, von Deimling A, Duffau H, Frenay M, et al. Guidelines on management of low grade gliomas: report of an EFNS-EANO task force. Eur J Neurol. 2010;17:1124–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008;26:1338–45.PubMedCrossRefGoogle Scholar
  3. 3.
    Capelle L, Fontaine D, Mandonnet E, Taillandier L, Golmard JL, Bauchet L, et al. Spontaneous and therapeutic prognostic factors in adult hemispheric WHO grade II gliomas: a series of 1097 cases. J Neurosurg. (in press).Google Scholar
  4. 4.
    Duffau H. Surgery of low-grade gliomas: towards a “functional neurooncology”. Curr Opin Oncol. 2009; 21:543–9.PubMedCrossRefGoogle Scholar
  5. 5.
    de Witt Hamer PC, Gil Robles S, Zwinderman A, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30(20):2559–65.PubMedCrossRefGoogle Scholar
  6. 6.
    Duffau H, Lopes M, Arthuis F, Bitar A, Sichez JP, van Effenterre R, et al. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry. 2005;76:845–51.PubMedCrossRefGoogle Scholar
  7. 7.
    Duffau H. A new concept of diffuse (low-grade) glioma surgery. Adv Tech Stand Neurosurg. 2012;38:3–27.PubMedCrossRefGoogle Scholar
  8. 8.
    Duffau H. The challenge to remove diffuse low grade gliomas while preserving brain functions. Acta Neurochir (Wien). 2012;154:569–74.CrossRefGoogle Scholar
  9. 9.
    Yordanova Y, Moritz-Gasser S, Duffau H. Awake surgery for WHO grade II gliomas within “noneloquent” areas in the left dominant hemisphere: toward a “supratotal” resection. J Neurosurg. 2011;115:232–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Eskandary H, Sabba M, Khajehpour F, Eskandari M. Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol. 2005;63:550–3.PubMedCrossRefGoogle Scholar
  11. 11.
    Onizuka M, Suyama K, Shibayama A, Hiura T, Horie N, Miyazaki H. Asymptomatic brain tumor detected at brain check-up. Neurol Med Chir (Tokyo). 2011;41:431–4.CrossRefGoogle Scholar
  12. 12.
    Weber F, Knopf H. Incidental findings in magnetic resonance imaging of the brains of healthy young men. J Neurol Sci. 2006;240:81–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Yue NC, Longstreth Jr WT, Elster AD, Jungreis CA, O’Leary DH, Poirier VC. Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study. Radiology. 1997;202:41–6.PubMedGoogle Scholar
  14. 14.
    Katzman GL, Dagher AP, Patronas NJ. Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA. 1999;282:36–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Morris Z, Whiteley WN, Longstreth Jr WT, Weber F, Lee YC, Tsushima Y, et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2009;339:b3016.PubMedCrossRefGoogle Scholar
  16. 16.
    Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, et al. Incidental findings on brain MRI in the general population. N Engl J Med. 2007;357:1821–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Bauchet L, Rigau V, Mathieu-Daude H, Figarella-Branger D, Hugues D, Palusseau L, et al. French brain tumor data bank: methodology and first results on 10,000 cases. J Neurooncol. 2007;84:189–99.PubMedCrossRefGoogle Scholar
  18. 18.
    Olson JD, Riedel E, DeAngelis LM. Long-term outcome of low-grade oligodendroglioma and mixed glioma. Neurology. 2000;54:1442–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Kamiguchi H, Shiobara R, Toya S. Accidentally detected brain tumors: clinical analysis of a series of 110 patients. Clin Neurol Neurosurg. 1996;98:171–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Pallud J, Fontaine D, Duffau H, Mandonnet E, Sanai N, Taillandier L, et al. Natural history of incidental World Health Organization grade II gliomas. Ann Neurol. 2010;68:727–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Potts MB, Smith JS, Molinaro AM, Berger MS. Natural history and surgical management of incidentally discovered low-grade gliomas. J Neurosurg. 2012;116:326–72.Google Scholar
  22. 22.
    Duffau H. Awake surgery for incidental WHO grade II gliomas involving eloquent areas. Acta Neurochir. 2012;154:757–84.Google Scholar
  23. 23.
    Duffau H, Gatignol P, Mandonnet E, Capelle L, Taillandier L. Contribution of intraoperative subcortical stimulation mapping of language pathways: a consecutive series of 115 patients operated on for a WHO grade II glioma in the left dominant hemisphere. J Neurosurg. 2008;109:461–71.PubMedCrossRefGoogle Scholar
  24. 24.
    Gil Robles S, Duffau H. Surgical management of World Health Organization Grade II gliomas in eloquent areas: the necessity of preserving a margin around functional structures. Neurosurg Focus. 2010;28:E8.PubMedCrossRefGoogle Scholar
  25. 25.
    Kelly PJ. Gliomas: survival, origin and early detection. Surg Neurol Int. 2010;1:96.PubMedCrossRefGoogle Scholar
  26. 26.
    Klein M, Duffau H, De Witt Hamer PC. Cognition and resective surgery for diffuse infiltrative glioma: an overview. J Neurooncol. 2012;108:309–18.PubMedCrossRefGoogle Scholar
  27. 27.
    Pallud J, Taillandier L, Capelle L, Fontaine D, Peyre M, Ducray F, et al. Quantitative morphological MRI follow-up of low-grade glioma: a plead for systematic measurement of growth rates. Neurosurgery. 2012;71(3):729–39.PubMedCrossRefGoogle Scholar
  28. 28.
    Duffau H, Pallud J, Mandonnet E. Evidence for the genesis of WHO grade II glioma in an asymptomatic young adult using repeated MRIs. Acta Neurochir (Wien). 2011;153:473–7.CrossRefGoogle Scholar
  29. 29.
    Gerin C, Pallud J, Grammaticos B, Mandonnet E, Deroulers C, Varlet P, et al. Improving the time-­machine: estimating date of birth of grade II gliomas. Cell Prolif. 2012;45:76–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Gozé C, Rigau V, Gibert L, Maudelonde T, Duffau H. Lack of complete 1p19q deletion in a consecutive series of 12 WHO grade II gliomas involving the insula: the marker of worse prognosis? J Neurooncol. 2009;91:1–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Laigle-Donadey F, Martin-Duverneuil N, Lejeune J, Crinière E, Capelle L, Duffau H, et al. Correlations between molecular profile and radiologic pattern in oligodendroglial tumors. Neurology. 2004;63:2360–2.PubMedCrossRefGoogle Scholar
  32. 32.
    Vergani F, Martino J, Gozé C, Rigau V, Duffau H. WHO grade II gliomas and subventricular zone: anatomical, genetic and clinical considerations. Neurosurgery. 2011;68:1293–9.PubMedGoogle Scholar
  33. 33.
    Duffau H. The rationale to perform early resection in incidental diffuse low-grade glioma: toward a “preventive surgical neurooncology”. World Neurosurg. (in press).Google Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Neurosurgery, Gui de Chauliac HospitalMontpellier University Medical CenterMontpellier Cedex 5France
  2. 2.National Institute for Health and Medical Research (INSERM), U1051 Laboratory, Team “Brain Plasticity, Stem Cells and Glial Tumors”, Institute for Neurosciences of MontpellierMontpellier University Medical CenterMontpellierFrance

Personalised recommendations