Overview
Low-grade gliomas (LGG) are slow-growing brain tumors that can occur in various age groups, including older adults, with implications for cognitive and motor functions depending on tumor location 12.Diagnosis
Clinical presentation includes seizures, focal neurological deficits, and cognitive changes 2.
Imaging studies (MRI) essential for tumor localization and characterization 2.
Biopsy or resection for definitive histopathological diagnosis 2.
Grading based on WHO classification, typically grades I and II 2.Management
Surgical resection is a primary treatment, with awake craniotomy recommended for functional preservation, especially in eloquent areas 1.
Radiation therapy considered for recurrent or progressive disease 2.
Chemotherapy, particularly temozolomide, may be used in recurrent or progressive cases, though specific dosing is not detailed in abstracts 2.
Prognostic factors influencing management include younger age, seizure presentation, and radiation treatment 2.Special Populations
Elderly: Older patients (≥60 years) have similar management principles but may have different prognostic factors; survival can extend beyond 2 years with prolonged progression-free periods 2.
Comorbidities: Specific management adjustments for comorbidities are not detailed in provided abstracts 2.Key Recommendations
Consider awake craniotomy with cortico-subcortical stimulation mapping for optimal functional preservation, particularly in eloquent regions of the brain (Evidence: Moderate) 1.
Younger age, seizure presentation, and radiation therapy are significant prognostic factors influencing overall survival in older LGG patients; tailor management accordingly (Evidence: Moderate) 2.
Prospective studies are needed to further define optimal management strategies specifically for older patients with LGG (Evidence: Expert opinion) 2.References
1 Vilasboas T, Herbet G, Duffau H. Challenging the Myth of Right Nondominant Hemisphere: Lessons from Corticosubcortical Stimulation Mapping in Awake Surgery and Surgical Implications. World neurosurgery 2017. link
2 Pouratian N, Mut M, Jagannathan J, Lopes MB, Shaffrey ME, Schiff D. Low-grade gliomas in older patients: a retrospective analysis of prognostic factors. Journal of neuro-oncology 2008. link
3 Millar B. Brain storm. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2005. link