Presentation of Supratentorial Low-Grade Gliomas in Children

Symptoms

• Seizures: Seizures are the most common presenting feature, occurring in more than 80% of patients. This is due to the fact that these tumors are located near the cerebral cortex and are often associated with cortical dysplasias (11). Seizures are very frequent in patients with tumors located in the frontal and/or temporal lobe and are sometimes chronic. Most seizures are either focal or complex partial seizures. Usually, they cannot be controlled with drugs, but rather through the extirpation of the tumor and the epileptogenic zone.
• Intracranial hypertension: Signs and symptoms attributable to intracranial hypertension are commonly seen because these are slow-growing tumors that can reach large sizes.  
• Focal neurological deficits: Focal signs of neurological dysfunction can occur based on the location of the tumor. 

Patterns of evolution

• Seizures and subtle neurological findings: Most patients with LGGs have seizures as the first symptom, and the neurological examination is normal. However, if a complex neurological examination is performed (neuropsychological examination) loss of memory, problems with language, character disturbances and visual spatial disorders may be found.

Time for evolution

• Slow progression: The presentation of symptoms is very slow except for seizures, which can appear suddenly. The other symptoms, e.g., weakness, language problems, develop slowly.

Evaluation at Presentation

• MRI: Imaging is the most effective means at arriving at the diagnosis, and the MRI is the most sensitive.

Intervention

Stabilization

• Airway, seizure, and ICP management: Rarely do these patient present in a clinically threatened state. In such cases one should evaluate the airway and intubate if necessary. This procedure is followed by insertion of the appropriate intravenous catheter for drug administration for seizures and for treating ICP if it is present.

Preparation for definitive intervention, nonemergent

• Imaging: MRI is the image of choice.
• Preoperative testing: The appropriate blood tests are ordered in anticipation of the need for surgery.

Preparation for definitive intervention, emergent

• Imaging: An emergency CT or MRI is obtained to understand the situation creating the patient’s distressed state.
• Treatment of elevated ICP: An EVD or emergency ETV is considered when there is hydrocephalus or decompressive craniectomy.

Admission Orders

• Routine: Routine admission orders are written.