Professor Ju Yan: Is Surgery Necessary for Low-Grade Gliomas?

Professor Ju Yan: Is Surgery Necessary for Low-Grade Gliomas?

In our Q&A column about pediatric gliomas, we invite experts in the field of childhood brain tumors to answer all aspects of questions concerning pediatric gliomas. Today, we bring you the 10th issue.

1. How long is postoperative prophylactic antiepileptic treatment required?

For patients who have never had seizures, antiepileptic medication can be stopped two weeks after surgery. For children who have had a single seizure, it is recommended to continue medication for six months and monitor with an electroencephalogram for any abnormalities. For children who have had recurrent seizures, antiepileptic treatment post-surgery should follow the standard protocols for epilepsy, with the possibility of reducing or stopping medication only after the patient has been seizure-free for at least two years.

2. What complications might arise after surgery?  

Postoperative complications can be broadly classified into two categories:  

(1) Complications related to the surgical procedure, such as neurological damage from operating in functional areas, cerebral infarction due to vascular occlusion, hydrocephalus caused by impaired cerebrospinal fluid circulation, infections related to wounds, poor wound healing, fluid accumulation, bleeding at the incision site or distant sites, seizures, and metabolic imbalances.  

(2) Complications related to the systemic condition, such as pneumonia, malnutrition, or exacerbation of pre-existing systemic diseases.

3. Will surgery definitely relieve preoperative symptoms?

It is essential to clarify the origin of the preoperative symptoms. If they are due to compression or irritation causing functional impairment, there is a high probability that symptoms will improve after removing the lesion. However, if irreversible damage has already occurred due to the lesion, the chances of improvement post-surgery are significantly reduced.

4. What sequelae might occur after surgery for pediatric gliomas?  

Sequelae can be categorized based on their causes:  

(1) If the lesion is located in a functional area, surgical intervention might lead to damage to adjacent nerves or conduction pathways, resulting in sequelae such as motor, sensory, reflex, or bowel control issues.  

(2) The disease or surgery may lead to episodic symptoms (like seizures), which can result in neurological deficits.  

(3) Associated conditions like intracranial hypertension and hydrocephalus can impair a child's growth and development.

5. Is surgery necessary for low-grade gliomas?

Most low-grade gliomas should be actively treated with surgery, but whether surgery is necessary depends on the specific situation:  

If the tumor has clear boundaries and is benign, surgical resection is feasible with lower risks, and surgery can lead to a cure. Low-grade gliomas located in the cerebral hemispheres or cerebellum with clear boundaries generally have good surgical outcomes.  

For low-grade gliomas located deeper within functional areas, surgery may still be an option. For example, a visual pathway glioma located deep could be partially resected while preserving the patient’s vision, followed by aggressive chemotherapy to manage residual tumors, which can also yield good results.  

For small, deep tumors like tectal gliomas or brainstem gliomas where the patient shows no symptoms, regular follow-up and monitoring every 3-6 months with MRI scans may be advised. If the tumor remains unchanged and the patient has no specific symptoms, surgery can be deferred. Should there be any tumor growth or the onset of related symptoms, more aggressive surgical treatment can be considered.

Formatting by: Xia Yu  

Proofread by: A Dou Dou