Management of Supratentorial Low-Grade Gliomas in Children

Initial Management at Presentation

The ideal treatment for LGGs remains controversial. Management can range from a conservative, wait-and-see approach, to a closed needle biopsy using either frame-based stereotaxy or computer-assisted neuronavigation, open surgery for an excisional biopsy or even radical tumor resection. Sometimes the conservative approach is taken due to the extremely slow growth of these tumors. Usually, however, initial management consists of some form of surgery.

Aims of surgery

• Diagnosis: The tumor histology should be confirmed with biopsy at the time of surgery.
• Debulking: As many tumor cells as possible should be removed without compromising the patient’s function.
• Decompression: The healthy brain should be relieved of pressure being placed on it by the tumor.
• Restoration of CSF pathways: If possible, any CSF pathways that may be compromised should be restored.

Surgical resection and survival

• Survival is related to resection: The relationship between survival and the extent of surgical resection is clear and is widely documented (10). Consequently, total surgical resection is the primary treatment for most children, and, in fact, many benign tumors in children can be treated with surgical removal alone.

Adjunctive Therapies

• Occasional radiation and or chemotherapy: It is sometimes is necessary to administer radiation and/or chemotherapy when complete resection of the tumor is not possible.

Follow-up

• Every 6 months: Patients with LGGs should be seen in the out-patient clinic every 6 months for neurological examination and MRI.