• Manish K Aghi, Brian V Nahed, Andrew E Sloan, Timothy C Ryken, Steven N Kalkanis, and Jeffrey J Olson.
• Department of Neurosurgery, University of California, 505 Parnassus Avenue, Room M779, San Francisco, CA, 94143-0112, USA. aghim@neurosurg.ucsf.edu.
• J. Neurooncol. 2015 Dec 1; 125 (3): 503-30.

QuestionShould patients with imaging suggestive of low grade glioma (LGG) undergo observation versus treatment involving a surgical procedure?Target PopulationThese recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).RecommendationsSurgical resection is recommended over observation to improve overall survival for patients with diffuse low-grade glioma (Level III) although observation has no negative impact on cognitive performance and quality of life (Level II).QuestionWhat is the impact of extent of resection on progression free survival (PFS) or overall survival (OS) in LGG patients?Target PopulationThese recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).RecommendationsIMPACT OF EXTENT OF RESECTION ON PFS:Level IiIt is recommended that GTR or STR be accomplished instead of biopsy alone when safe and feasible so as to decrease the frequency of tumor progression recognizing that the rate of progression after GTR is fairly high.Impact Of Extent Of Resection On OsLevel IiiGreater extent of resection can improve OS in LGG patients.QuestionWhat tools are available to increase extent of resection in LGG patients?Target PopulationThese recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).RecommendationsINTRAOPERATIVE MRI DURING SURGERY:Level IiiThe use of intraoperative MRI should be considered as a method of increasing the extent of resection of LGGs.QuestionWhat is the impact of surgical resection on seizure control and accuracy of pathology in low grade glioma patients?Target PopulationThese recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).RecommendationsSURGICAL RESECTION AND SEIZURE CONTROL:Level IiiAfter taking into account the patient's clinical status and tumor location, gross total resection is recommended for patients with diffuse LGG as a way to achieve more favorable seizure control.Accuracy Of DiagnosisLevel IiiTaking into account the patient's clinical status and tumor location, surgical resection should be carried out to maximize the chance of accurate diagnosis.QuestionWhat tools can improve the safety of surgery for LGGs in eloquent locations?Target PopulationThese recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).RecommendationsPREOPERATIVE IMAGING:Level IiiIt is recommended that preoperative functional MRI and diffusion tensor imaging be utilized in the appropriate clinical setting to improve functional outcome after surgery for LGG.Intraoperative Mapping Of Tumors In Eloquent AreasLevel IiiIntraoperative mapping is recommended for patients with diffuse LGGs in eloquent locations compared to patients with non-eloquently located diffuse LGGs as a way of preserving function.

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