Skip to main content
SpringerLink
Log in

Surgical Management of Incidentally Discovered Diffuse Low-Grade Gliomas

  • Chapter
  • First Online:
Tumors of the Central Nervous System, Volume 11

Part of the book series: Tumors of the Central Nervous System ((TCNS,volume 11))

  • 1300 Accesses

Abstract

An incidental diffuse low-grade glioma (DLGG) is a previously undetected and asymptomatic tumor at the time of imaging diagnosis that was unexpectedly discovered and unrelated to the purpose of the MR examination. The reported prevalence of incidental DLGGs ranges from 0.025 to 0.2 %. The occurrence of incidentally discovered DLGGs will increase in the future due to the rising frequency of brain imaging in addition to recent advances in imaging technology. Incidental DLGGs are progressive tumors that develop at a similar rate to those for the symptomatic DLGGs, and represent an earlier step than symptomatic DLGGs in the tumor natural course. Incidental diffuse gliomas can remain silent until malignant transformation occurs. Thus, incidental DLGGs should be considered as progressive tumors with the same potential for progression than that for symptomatic DLGGs. Because incidental DLGGs are not benign tumors and because the natural course of DLGGs during the silent and symptomatic periods are similar, incidental DLGGs should be managed as symptomatic DLGGs. Surgical resection of incidental DLGGs is feasible with a minimal morbidity and larger amount of resection can be carried out comparing with that from symptomatic DLGGs. These data argue for an early surgical treatment in asymptomatic patients to maximize the extent of DLGG resection before glioma growth and migration, even in critical brain regions. Hence, surgical removal with functional intraoperative mapping should be proposed as soon as progression is demonstrated on close imaging follow-up.

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 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Bauchet L, Rigau V, Mathieu-Daudé H, Figarella-Branger D, Duffau H, Palusseau L, Bauchet F, Fabbro M, Campello C, Capelle L, Durand A, Trétarre B, Frappaz D, Hénin D, Menei P, Honnorat J, Segnarbieux F (2007) French brain tumor data bank: methodology and first results on 10,000 cases. J Neuro Oncol 84(2):189–199

    Article  Google Scholar 

  • Bristol RE (2009) Low-grade glial tumors: are they all the same? Semin Pediatr Neurol 16(1):23–26

    Article  PubMed  Google Scholar 

  • Davis FG, Kupelian V, Freels S, McCarthy B, Surawicz T (2001) Prevalence estimates for primary brain tumors in the United States by behavior and major histology groups. Neuro Oncol 3(3):152–158

    PubMed Central  PubMed  CAS  Google Scholar 

  • Duffau H (2009) Surgery of low-grade gliomas: towards a ‘functional neurooncology’. Curr Opin Oncol 21(6):543–549

    Article  PubMed  Google Scholar 

  • Duffau H (2012a) The rationale to perform early resection in incidental diffuse low-grade glioma: towards a ‘preventive surgical neurooncology’. World Neurosurg, 2012 Jun 25. doi:pii: S1878-8750(12)

    Google Scholar 

  • Duffau H (2012b) Awake surgery for incidental WHO grade II gliomas involving eloquent areas. Acta Neurochir 154(4):575–584

    Article  PubMed  Google Scholar 

  • Duffau H, Pallud J, Mandonnet E (2011) Evidence for the Genesis of WHO Grade II Glioma in an asymptomatic young adult using repeated MRIs. Acta Neurochir 153(3):473–477

    Article  PubMed  Google Scholar 

  • Floeth FW, Sabel M, Stoffels G, Pauleit P, Hamacher K, Steiger HJ, Langen KJ (2008) Prognostic value of 18F-Fluoroethyl-L-Tyrosine PET and MRI in small nonspecific incidental brain lesions. J Nucl Med 49(5):730–737

    Article  PubMed  Google Scholar 

  • Gérin C, Pallud J, Grammaticos B, Mandonnet E, Deroulers C, Varlet P, Capelle L, Taillandier L, Bauchet L, Duffau H, Badoual M (2011) Improving the time-machine: estimating date of birth of grade II gliomas. Cell Prolif 45(1):76–90

    Article  PubMed  Google Scholar 

  • Kamiguchi H, Shiobara R, Toya S (1996) Accidentally detected brain tumors: clinical analysis of a series of 110 patients. Clin Neurol Neurosurg 98(2):171–175

    Article  PubMed  CAS  Google Scholar 

  • Katzman GL, Dagher AP, Patronas NJ (1999) Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 82(1):36–39

    Article  Google Scholar 

  • Kelly PJ (2010) Gliomas: survival, origin and early detection. Surg Neurol Int 1:96

    Article  PubMed Central  PubMed  Google Scholar 

  • Klein M, Engelberts N, van der Ploeg HM, Kasteleijn-Nolst Trenité D, Aaronson N, Taphoorn M, Baaijen H, Vandertop WP, Muller M, Postma TJ, Heimans JJ (2003) Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol 54(4):514–520

    Article  PubMed  Google Scholar 

  • Mandonnet E, Delattre JY, Tanguy ML, Swanson KR, Carpentier AF, Duffau H, Cornu P, Van Effenterre R, Alvord EC, Capelle L (2003) Continuous growth of mean tumor diameter in a subset of grade II gliomas. Ann Neurol 53(4):524–528

    Article  PubMed  Google Scholar 

  • Mcgirt MJ, Chaichana KJ, Attenello FJ, Weingart JD, Than K, Burger PC, Olivi A, Brem H, Quinoñes-Hinojosa A (2008) Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 63(4):700–707

    Article  PubMed  Google Scholar 

  • Morris Z, Whiteley WN, Longstreth WT, Weber F, Lee YC, Tsushima Y, Alphs H, Ladd SC, Warlow C, Wardlaw JM, Al-Shahi Salman R (2009) Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 339:b3016

    Article  PubMed Central  PubMed  Google Scholar 

  • Nobusawa S, Watanabe T, Kleihues P, Ohgaki H (2009) IDH1 mutations as molecular signature and predictive factor of secondary glioblastomas. Clin Cancer Res 15(19):6002–6007

    Article  PubMed  CAS  Google Scholar 

  • Olson JD, Riedel E, DeAngelis LM (2000) Long-term outcome of low-grade oligodendroglioma and mixed glioma. Neurology 54(7):1442–1448

    Article  PubMed  CAS  Google Scholar 

  • Onizuka M, Suyama K, Shibayama A, Hiura T, Horie N, Miyazaki H (2001) Asymptomatic brain tumor detected at brain check-up. Neurol Med Chir 41(9):431–434

    Article  CAS  Google Scholar 

  • Pallud J, Mandonnet E (2011) Chapter 18. In: Hayat MA (ed) Quantitative approach of the natural course of diffuse low-grade gliomas. Tumors of the central nervous system, vol 2. Springer, Dordrecht

    Google Scholar 

  • Pallud J, Mandonnet E, Duffau H, Kujas M, Guillevin R, Galanaud D, Taillandier L, Capelle L (2006) Prognostic value of initial magnetic resonance imaging growth rates for world health organization grade ii gliomas. Ann Neurol 60(3):380–383

    Article  PubMed  Google Scholar 

  • Pallud J, Capelle L, Taillandier L, Fontaine D, Mandonnet E, Guillevin R, Bauchet L, Peruzzi P, Laigle-Donadey F, Kujas M, Guyotat J, Baron MH, Mokhtari K, Duffau H (2009) Prognostic significance of imaging contrast enhancement for who grade ii gliomas. Neuro Oncol 11(2):176–182

    Article  PubMed Central  PubMed  Google Scholar 

  • Pallud J, Varlet P, Devaux B, Geha S, Badoual M, Deroulers C, Page P, Dezamis E, Daumas-Duport C, Roux FX (2010a) Diffuse low-grade oligodendrogliomas extend beyond MRI-defined abnormalities. Neurology 74(21):1724–1731

    Article  PubMed  CAS  Google Scholar 

  • Pallud J, Fontaine D, Duffau H, Mandonnet E, Sanai N, Taillandier L, Peruzzi P, Guillevin R, Bauchet L, Bernier V, Baron MH, Guyotat J, Capelle L (2010b) Natural history of incidental world health organization grade ii gliomas. Ann Neurol 68(5):727–733

    Article  PubMed  Google Scholar 

  • Pallud J, Capelle L, Mandonnet E (2010c) Comment on parameters of low-grade glioma as predictors. Radiology 256(3):1014

    Article  PubMed  Google Scholar 

  • Pallud J, Taillandier L, Capelle L, Fontaine D, Peyre M, Ducray F, Duffau H, Mandonnet E (2012) Quantitative morphological magnetic resonance imaging follow-up of low-grade glioma. Neurosurgery 71(3):729–740

    Article  PubMed  Google Scholar 

  • Potts MB, Smith JS, Molinaro AM, Berger MS (2012) Natural history and surgical management of incidentally discovered low-grade gliomas. J Neurosurg 116(2):365–372

    Article  PubMed  Google Scholar 

  • Sanai N, Berger MS (2008) Glioma extent of resection and its impact on patient outcome. Neurosurgery 62(4):753–764

    Article  PubMed  Google Scholar 

  • Sanai N, Mirzadeh Z, Berger MS (2008) Functional outcome after language mapping for glioma resection. N Engl J Med 358(1):18–27

    Article  PubMed  CAS  Google Scholar 

  • Shah AH, Madhavan K, Sastry A, Komotar RJ (2012) Managing intracranial incidental findings suggestive of low-grade glioma: learning from experience. World Neurosurg, Jun 19. doi:pii: S1878-8750(12)

    Google Scholar 

  • Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, Tihan T, Vandenberg S, McDermott MW, Berger MS (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26(8):1338–1345

    Article  PubMed  Google Scholar 

  • Soffietti R, Baumert BG, Bello L, Von Deimling A, Duffau H, Frénay M, Grisold W, Grant R, Graus F, Hoang-Xuan K, Klein M, Melin B, Siegal T, Smits A, Stupp R, Wick W (2010) Guidelines on management of low-grade gliomas: report of an EFNS-EANO* task force. Eur J Neurol 7(9):1124–1133

    Article  Google Scholar 

  • Vernooij M, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, Niessen WJ, Breteler MM, van der Lugt A (2007) Incidental findings on brain mri in the general population. N Engl J Med 357(18):1821–1828

    Article  PubMed  CAS  Google Scholar 

  • Weber F, Knopf H (2006) Incidental findings in magnetic resonance imaging of the brains of healthy young men. J Neurol Sci 240(1–2):81–84

    Article  PubMed  Google Scholar 

  • Yordanova YN, Moritz-Gasser S, Duffau H (2011) Awake surgery for who grade ii gliomas within “noneloquent” areas in the left dominant hemisphere: toward a ‘supratotal’ resection. Clinical article. J Neurosurg 115(2):232–239

    Article  PubMed  Google Scholar 

  • Zouaoui S, Rigau V, Mathieu-Daudé H, Darlix A, Bessaoud F, Fabbro-Peray P, Bauchet F, Kerr C, Fabbro M, Figarella-Branger D, Taillandier L, Duffau H, Trétarre B, Bauchet L (2012) French brain tumor database: general results on 40,000 cases, main current applications and future prospects. Neurochirurgie 58(1):4–13

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments 

Johan Pallud and Emmanuel Mandonnet want to thanks all the members of the French Glioma Network (REG, Réseau d’Etude des Gliomes) and particularly Hugues Duffau.

Johan Pallud wants to thank Bertrand Devaux and François-Xavier Roux of the department of Neurosurgery, Pascale Varlet and Fabrice Chrétien of the department of Neuropathology and Catherine Oppenheim and Jean-François Meder of the department of Neuroradiology of the Sainte-Anne Hospital Center, Paris, France.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Paris Descartes – Sainte-Anne Hospital Center, 1 rue Cabanis, 75674, Paris cedex 14, France

    Johan Pallud

  2. Department of Neurosurgery, Lariboisière Hospital, 2 rue Ambroise Parè, 75010, Paris, France

    Emmanuel Mandonnet

Authors
  1. Johan Pallud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emmanuel Mandonnet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johan Pallud .

Editor information

Editors and Affiliations

  1. Kean University, Room 213, Library building, Union, New Jersey, USA

    M.A. Hayat

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Pallud, J., Mandonnet, E. (2014). Surgical Management of Incidentally Discovered Diffuse Low-Grade Gliomas. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 11. Tumors of the Central Nervous System, vol 11. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7037-9_11

Download citation

  • DOI: https://doi.org/10.1007/978-94-007-7037-9_11

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-7036-2

  • Online ISBN: 978-94-007-7037-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation