gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Supratentorial low grade gliomas: a 5 years longitudinal study in a population with incomplete tumor removal

Meeting Abstract

  • corresponding author G. Tomei - Clinica Neurochirurgica, Università dell’Insubria, Ospedale di Circolo, Varese, Italy
  • A. De Santis - Unità di Neurochirurgia, Università di Milano, Ospedale Galeazzi, Milano, Italy
  • L. Bello - Unità di Neurochirurgia Ospedale Policlinico IRCCS, Milano, Italy
  • J. Casagrande - Clinica Neurochirurgica, Università dell’Insubria, Ospedale di Circolo, Varese, Italy
  • M. Caroli - Unità di Neurochirurgia Ospedale Policlinico IRCCS, Milano, Italy
  • S. M. Gaini - Unità di Neurochirurgia Ospedale Policlinico IRCCS, Milano, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 014

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Tomei et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: To evaluate the outcome of patients with diffuse low grade gliomas (LGG, WHO grade II) operated on and incompletely removed.

Methods: Ninety-two patients with LGG have been prospectively collected and followed-up from 2001 to 2005. Forty-two were astrocytomas [34 fibrillary (FA), 5 protoplasmatic (PA) 3 gemistocitic(GA)], 4 were mixed gliomas (MG), 45 were oligodendrogliomas (OL) and 1 a pleomorphic astrocytoma (PLA). Patients with tumor located in critical areas were operated in asleep-awake anesthesia, with cortical-subcortical stimulation or with other methods (echography, brain mapping, fMRI). In all cases, the site and size of the tumor and the amount of radicality was verified on MR imagings.

Results: Forty-three (46.7%) out of 92 cases had a subtotal (residue: 10-15%) and 49 (53.3%) a partial removal (<60%) of the tumor. Forty-six patients (50%) had a tumor located in critical areas and 16 (18%) had a tumor involving the temporal and insular lobes with some extension to the frontal lobe. During the 5 years observation, 32 patients (35%) were reoperated and tumor progression was accompanied by malignant transformation in 18 (56%) that reached 72.2% (13 cases out of 18) in patients with FA and 35.7% (5 cases out of 14) in patients with OL. Seven of these latter died with a mean OS of 5.2 years (range: 3-11 years). Six tumors were FA and 1 a MG. Another patient, that with PLA was reoperated 2 years after first approach and died 33 months after first surgical treatment. Of the remaining 60 patients followed up as in or outpatients, 31 (21 OL and 10 FA) do not present clinical or radiological progression, 15 had a clinical worsening, 7 a radiological progression and 3 clinical and radiological progression. Four patients with FA with radiological progression and not re-operated were submitted to radiotherapy and 2 to chemiotherapy too. Among the group of patients with OL, 4 with tumor progression not re-operated were submitted to chemiotherapy (2) and radiotherapy (2).

Conclusions: Results of our study indicate that almost two-third of patients with FA incompletely removed have a progression toward a malignant transformation (mean OS of 5.2 yrs). Patients with OL have a risk of 35.7% to anaplasia development in the course of 5 years post-operatively. Re-operation in patients with LGG incompletely removed seems feasible when tumor progression is responsible for ICP increase and/or clinical worsening and in many instances is able to ameliorate QOL.