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Nader Sanai, Susan Chang and Mitchel S. Berger

these many issues. Epidemiology Low-grade gliomas are not uncommon, representing 15% of all primary brain tumors diagnosed in adults each year. They are most frequent among Caucasian men and typically affect patients at a younger age than high-grade gliomas (4th vs 6th decade of life). While LGGs are diffusely distributed along a variety of supratentorial regions, they have a particular predilection for the insula and supplementary motor area. In contrast, in adults these lesions rarely involve the cerebellum, brainstem, or spinal cord, as they commonly do in

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Nader Sanai, Susan Chang and Mitchel S. Berger

many issues. Epidemiology Low-grade gliomas are not uncommon, representing 15% of all primary brain tumors diagnosed in adults each year. They are most frequent among Caucasian men and typically affect patients at a younger age than high-grade gliomas (4th vs 6th decade of life). While LGGs are diffusely distributed along a variety of supratentorial regions, they have a particular predilection for the insula and supplementary motor area. In contrast, in adults these lesions rarely involve the cerebellum, brainstem, or spinal cord, as they commonly do in children

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Barbara J. Fisher, Glenn S. Bauman, Christopher E. Leighton, Larry Stitt, J. Gregory Cairncross and David R. Macdonald

L ow -grade gliomas comprise the most common type of brain tumor in children. The role of radiation therapy in the management of low-grade gliomas remains controversial, although incompletely resected or recurrent low-grade gliomas are frequently treated with radiotherapy. Low-grade glioma cell lines demonstrate in vitro radiosensitivity, 23 and authors of retrospective clinical studies 11 have described radiotherapy as being effective in producing long-term survival and control of low-grade gliomas in children. However, the commonly held belief is that low-grade

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Meic H. Schmidt, Mitchel S. Berger, Kathleen R. Lamborn, Ken Aldape, Michael W. McDermott, Michael D. Prados and Susan M. Chang

. Cancer 74: 1784–1791, 1994 4. Bernstein M , Bampoe J : Low-grade gliomas , in Bernstein M , Berger MS (eds): Neuro-Oncology: The Essentials. New York : Thieme , 2000 , pp 302 – 308 Bernstein M, Bampoe J: Low-grade gliomas, in Bernstein M, Berger MS (eds): Neuro-Oncology: The Essentials. New York: Thieme, 2000, pp 302–308 5. Burton EC , Lamborn KR , Forsyth P , et al : Aberrant p53, mdm2, and proliferation differ in glioblastomas from long-term compared with typical

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Michael Opoku-Darko, Stefan T. Lang, James Artindale, J. Gregory Cairncross, Robert J. Sevick and John J. P. Kelly

Pallud et al. have demonstrated that surgical excision of incidental low-grade gliomas (iLGGs) increases survival. 19 Also, in their most recent case report, Cochereau et al. illustrate the fact that there can be acute malignant transformation of iLGGs even when the patient remains symptom free. 7 We set out to review a series of cases of iLGGs treated during a period when the general approach at our institution was “watch-and-wait” to determine the characteristics of these tumors and treatment outcomes. Methods This study was approved by the Health Research Ethics

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Kaisorn L. Chaichana, Matthew J. McGirt, John Laterra, Alessandro Olivi and Alfredo Quiñones-Hinojosa

P atients with hemispheric low-grade gliomas often have a better prognosis than patients harboring higher grade tumors. 8 , 9 , 11 , 13 , 19 , 28 The median survival for patients with low-grade gliomas is between 5 and 10 years 8 , 9 , 11 , 13 , 19 , 28 compared with ~ 14 months for patients with glioblastomas. 36 Despite this more favorable prognosis, 50–75% of patients with low-grade gliomas eventually die of either tumor progression or degeneration to a higher malignant grade. 13 This tendency for low-grade gliomas to progress and develop into more

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Michael M. Haglund, Mitchel S. Berger, Dennis D. Kunkel, JoAnn E. Franck, Saadi Ghatan and George A. Ojemann

T he majority of patients (50% to 90%) 20, 29 with supratentorial low-grade gliomas initially present with seizures. Intraoperative electrocorticography in these patients reveals epileptic foci separate from the tumor nidus. 12 Histologically, these epileptic foci are commonly devoid of tumor infiltration. To understand the neurochemical basis of tumor-associated epileptiform activity, resected tissue from both epileptogenic and nonepileptogenic areas in patients undergoing electrocorticography during glioma surgery have been analyzed. Our investigation has

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Roger J. Packer, Joanne Ater, Jeffrey Allen, Peter Phillips, Russell Geyer, H. Stacy Nicholson, Regina Jakacki, Elizabeth Kurczynski, Michael Needle, Jonathan Finlay, Gregory Reaman and James M. Boyett

G liomas comprise more than 50% of all childhood brain tumors and approximately 80% of these lesions are low grade at the time of diagnosis. 8 The light microscopic features of childhood low-grade gliomas vary significantly. The most common subtypes are pilocytic and fibrillary, although histologically more complex tumors with mixed glial elements and/or ganglionic components (ganglioglioma) frequently occur. 6, 8, 13 The cerebellum is the most frequent site of origin of childhood low-grade gliomas, but a significant proportion of tumors will arise in other

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Mitchel S. Berger, Saadi Ghatan, Michael M. Haglund, Jill Dobbins and George A. Ojemann

may account for an adverse effect of the tumor on surrounding cortical neurons, 32 both morphologically and biochemically in the form of neurotransmitter alterations. 11, 24, 27, 37 It has recently been demonstrated that the hyperexcitable cortex surrounding the tumor nidus in low-grade gliomas has a significantly decreased population of gamma-aminobutyric acid and somatostatin-containing neurons, when compared to adjacent nontumor nonepileptogenic cortex from the same patient. 23 Although evidence exists to support the concept of separate seizure foci

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Andrew M. Heitzer, Kimberly Raghubar, M. Douglas Ris, Charles G. Minard, Marsha N. Gragert, Heather H. Stancel, Jessica Orobio, Judy Xue, William Whitehead, M. Fatih Okcu, Murali Chintagumpala and Lisa S. Kahalley

B rain tumors are the second most frequent cancer in childhood, with low-grade gliomas (LGGs) composing approximately 40% of CNS tumors in children. 23 Because of improvements in treatment, the survival rates of affected patients have significantly increased. 44 Pediatric patients with LGG have a 10-year survival rate over 85%. 1 Improving survival rates have led to an increased emphasis on functional outcomes in survivors and on the impact of the tumor and treatment on neuropsychological outcomes. However, research has predominately focused on the late