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Predictive Evolution Factors of Incidentally Discovered Suspected Low-Grade Gliomas: Results From a Consecutive Series of 101 Patients
- Source :
- Neurosurgery, Neurosurgery, Lippincott, Williams & Wilkins, 2021, 88 (4), pp.797-803. ⟨10.1093/neuros/nyaa532⟩
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- International audience; Background: Incidentally discovered suspected diffuse low-grade gliomas (LGGs) on brain imaging pose a challenge to neurosurgeons. Modern surgical series of LGGs favor early prophylactic surgery with a maximal extent of resection. However, some nonevolutive lesions may mimic LGGs on magnetic resonance imaging (MRI).Objective: To determine objective criteria to advocate surgical resection of an incidentally discovered suspected LGG based upon MRI findings.Methods: The prospective cohort of patients referred to our institution for an incidental finding suggestive of LGG was retrospectively reviewed. Stable lesions underwent systematic serial MRI follow-up, while evolutive lesions underwent prophylactic surgery under awake conditions. Initial clinico-radiological features were compared between stable and evolutive lesions in order to determine predictive criteria of further evolution.Results: Among 101 patients referred for surgical resection of incidentally discovered suspected LGG in our center, 19 patients (18.8%) had nonevolutive MRI lesions after a mean follow-up of 46.9 ± 34.9 mo. Insular topography (P = .003), higher mean volume at discovery (19.2 vs 5.2 cm3, P < .001), and adjacent sulcal effacement (P = .001) were associated with evolutive lesions. Histopathological diagnosis of LGG was confirmed in all surgical cases.Conclusion: Increasing volume is an effective predictor of LGG diagnosis in incidental MRI findings, as all patients who subsequently underwent surgery had confirmed histopathological diagnosis of diffuse glioma. Approximately 18.8% of incidental findings were stable over time. Insular topography, adjacent sulcal effacement, and volume greater than 4.5 cm3 were predictive of further radiological progression. These significant elements will help neurosurgeons to define personalized strategies in this complex setting of incidental discovery.
- Subjects :
- Adult
Male
Surgical resection
medicine.medical_specialty
[SDV]Life Sciences [q-bio]
Low-grade glioma
Incidental finding
Cohort Studies
03 medical and health sciences
Magnetic resonance imaging
0302 clinical medicine
Neuroimaging
Predictive Value of Tests
Glioma
medicine
Humans
Prospective Studies
Wakefulness
Prospective cohort study
Retrospective Studies
Incidental Findings
medicine.diagnostic_test
Brain Neoplasms
business.industry
Incidental Discovery
Middle Aged
medicine.disease
Prophylactic Surgery
3. Good health
030220 oncology & carcinogenesis
Female
[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]
Surgery
Neurology (clinical)
Radiology
Neoplasm Grading
business
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
030217 neurology & neurosurgery
Mri findings
Subjects
Details
- ISSN :
- 15244040 and 0148396X
- Volume :
- 88
- Database :
- OpenAIRE
- Journal :
- Neurosurgery
- Accession number :
- edsair.doi.dedup.....dc432863bc571109229015f0716af7d8