Skip to main content
SpringerLink
Log in

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

  • Chapter
  • First Online:
Diffuse Low-Grade Gliomas in Adults

  • 1270 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. Duffau H. Surgery of low-grade gliomas: towards a “functional neurooncology”. Curr Opin Oncol. 2009; 21:543–9.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  7. Duffau H. A new concept of diffuse (low-grade) glioma surgery. Adv Tech Stand Neurosurg. 2012;38:3–27.

    Article  PubMed  CAS  Google Scholar 

  8. Duffau H. The challenge to remove diffuse low grade gliomas while preserving brain functions. Acta Neurochir (Wien). 2012;154:569–74.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  14. Katzman GL, Dagher AP, Patronas NJ. Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA. 1999;282:36–9.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  18. Olson JD, Riedel E, DeAngelis LM. Long-term outcome of low-grade oligodendroglioma and mixed glioma. Neurology. 2000;54:1442–8.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. Duffau H. Awake surgery for incidental WHO grade II gliomas involving eloquent areas. Acta Neurochir. 2012;154:757–84.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  25. Kelly PJ. Gliomas: survival, origin and early detection. Surg Neurol Int. 2010;1:96.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France

    Hugues Duffau MD, PhD

  2. National Institute for Health and Medical Research (INSERM), U1051 Laboratory, Team “Brain Plasticity, Stem Cells and Glial Tumors”, Institute for Neurosciences of Montpellier, Montpellier University Medical Center, 34091, Montpellier, France

    Hugues Duffau MD, PhD

Authors
  1. Hugues Duffau MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hugues Duffau MD, PhD .

Editor information

Editors and Affiliations

  1. , INSERM U1051, Institute for Neurosciences of Montpelli, av. Augustin Fliche 80, Montpellier, 34295, France

    Hugues Duffau

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Duffau, H. (2013). Early Detection and Management of Incidental Diffuse Low-Grade Gliomas (IDLGG): Toward a “Prophylactic Oncological Neurosurgery”. In: Duffau, H. (eds) Diffuse Low-Grade Gliomas in Adults. Springer, London. https://doi.org/10.1007/978-1-4471-2213-5_31

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2213-5_31

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2212-8

  • Online ISBN: 978-1-4471-2213-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation