Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 7662  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (540 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this Article

 Article Access Statistics
    PDF Downloaded40    
    Comments [Add]    

Recommend this journal


Table of Contents    
Year : 2020  |  Volume : 68  |  Issue : 4  |  Page : 813-814

Early and Maximal Personalized Surgical Resection Improves Survival and Quality of Life in Low-grade Gliomas Patients

Department of Neurosurgery, Montpellier University Medical Center; Institute of Functional Genomics, INSERM U-1191, University of Montpellier, Montpellier, France

Date of Web Publication26-Aug-2020

Correspondence Address:
Prof. Hugues Duffau
Department of Neurosurgery, Gui de Chauliac Hospital, CHU Montpellier, 80 Avenue Augustin Fliche, 34295 Montpellier
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.293449

Rights and Permissions

How to cite this article:
Duffau H. Early and Maximal Personalized Surgical Resection Improves Survival and Quality of Life in Low-grade Gliomas Patients. Neurol India 2020;68:813-4

How to cite this URL:
Duffau H. Early and Maximal Personalized Surgical Resection Improves Survival and Quality of Life in Low-grade Gliomas Patients. Neurol India [serial online] 2020 [cited 2021 May 18];68:813-4. Available from:

Diffuse low-grade glioma (LGG), i.e., WHO grade II glioma, is a primary brain tumor which grows and migrates constantly within the central nervous system, and which ultimately progress to high-grade glioma, resulting in neurological worsening and death. However, because these neoplasms are very heterogeneous, it remains difficult to predict when the malignant transformation will occur at the individual level. Recently, Keshriet al. reported their preliminary experience with 130 LGG patients and observed that decreased overall survival (OS) was associated with age >50 years, tumor size >5cm, MIB index >5%, Karnofksy performance index (KPS) score <70 and gemistocytic pathology.[1] Although this is a nice confirmation of the fact that older LGG patients, with a poor clinical status, a more voluminous and a more aggressive tumor have a worse prognosis, several results need nonetheless to be more extensively discussed.

From an oncological perspective, the OS in this series is 4.9 years, while OS in the modern literature is about 14 years (see[2] for a recent review). Especially, it has been evidenced that the prognosis was significantly correlated with the extent of surgical resection, with a longer OS when a complete glioma removal (or even a supracomplete removal, that is, by resecting a margin beyond the signal abnormality visible on preoperative MRI) was achieved according to the objective evaluation on the postoperative FLAIR-weighted MRI. For example, these favorable results have been supported by a large experience from the French Glioma Network with over 1000 LGG patients who underwent early and maximal resection.[3] Yet, Keshriet al. reported that “the type of surgery had no influence on the survival of LGG patients”.[1] This could be due to the fact that they did not perform a volumetric calculation of the tumor before and after surgery since their proposal of risk stratification seems to be based on the size and not on the volume of the glioma. A better radiological characterization would have been helpful, including with regard to the tumor location. Indeed, it is surprising to see that this series does not comprise any insular glioma, whereas the insular/paralimbic localization is one of the most frequent (with the supplementary motor area) in the literature.[4] In addition, regarding histomolecular considerations, only a few cases have been analyzed according to the WHO 2016 classification.

From a functional point of view, no detailed neurological and neurocognitive information has been provided in addition to the KPS score. However, LGG patients are usually young and enjoy a normal life at diagnosis. Therefore, because OS is now prolonged, their quality of life (QoL) should also be preserved, in order to give them the opportunity to resume an active familial, social and professional life. Interestingly, with the goal of optimizing the extent of resection while minimizing surgical morbidity, awake surgery with intraoperative electrical mapping of sensorimotor, visual, spatial, language, cognitive, emotional and behavioral functions became the gold standard for the management of LGG patients - with a risk to induce severe permanent impairment <2%, even in so-called “eloquent areas”.[5] Unfortunately, Keshriet al. did not describe their surgical methodology, and did not provide neuropsychological assessments before and after each treatment (surgery, radiotherapy, chemotherapy), preventing to draw any reliable conclusion about the benefit-to-risk ratio of each therapy with a long-term follow-up.[1]

In conclusion, currently, the first treatment to consider in LGG patient is maximal safe surgical resection(s), and then to adapt the personalized therapeutic management over years according to the evolution of individual clinical, neurocognitive, radiological and histomolecular parameters, allowing an optimization of the onco-functional balance.[4] To this end, the risk stratification proposed by Keshriet al. could be of great interest.[1]

  References Top

Keshri V, Deshpande RP, Chandrasekhar YBVK, Panigrahi M, Rao S, Babu PP. Risk stratification in low grade glioma: A single institutional experience. Neurol India 2020;68:803-12.  Back to cited text no. 1
  [Full text]  
Duffau H. Diffuse low-grade glioma, oncological outcome and quality of life: A surgical perspective. Curr Opin Oncol 2018;30:383-9.  Back to cited text no. 2
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 2013;118:1157-68.  Back to cited text no. 3
Duffau H. Diffuse low-grade gliomas in adults. In: Duffau H, editor. Diffuse Low-Grade Gliomas in Adults, 2nd ed. London: Springer; 2017.  Back to cited text no. 4
Duffau H. Stimulation mapping of white matter tracts to study brain functional connectivity. Nat Rev Neurol 2015;11:255-65.  Back to cited text no. 5


Print this article  Email this article
Online since 20th March '04
Published by Wolters Kluwer - Medknow