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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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Friedrich W. Kreth, Michael Faist, Peter C. Warnke, Reinhard Roβner, Benedikt Volk, and Christoph B. Ostertag

T he optimum treatment for low-grade gliomas remains a controversial subject in the absence of prospective randomized trials. Standard treatments, that is, operative resection and/or percutaneous radiotherapy, are generally not curative. 3, 21–25, 28, 37, 38, 42, 45, 51 This explains the growing interest in newer therapeutic methods such as radiosurgery, stereotactic radiotherapy, and interstitial radiosurgery (brachytherapy). 19, 29, 31 We have already presented preliminary results after interstitial radiosurgery of gliomas. 31 These were in the same range

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Alexander F. Haddad, Jacob S. Young, Jun Yeop Oh, Hideho Okada, and Manish K. Aghi

low tumor-infiltrating lymphocyte levels in LGG relative to glioblastoma and brain metastasis. 19 , 20 These findings suggest that LGGs, HGGs, and brain metastases lie on a spectrum of immunogenicity and T-cell infiltration, with brain metastases demonstrating the most T-cell–inflamed immune phenotype and LGGs the least-inflamed phenotype, with HGGs falling in between the two. Interestingly, similar trends have also been seen in the context of regulatory T cells (Tregs), whereby Treg infiltration positively correlated with the glioma tumor grade. 20 , 21 Friebel

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Hydrocephalus associated with intramedullary low-grade gliomas

Illustrative cases and review of the literature

Giuseppe Cinalli, Christian Sainte-Rose, Arielle Lellouch-Tubiana, Guy Sebag, Dominique Renier, and Alain Pierre-Kahn

pressure. 31, 37, 46, 48 On the contrary, the causative relationship between benign lesions, in particular intramedullary spinal cord low-grade gliomas, and hydrocephalus is much more controversial. Several pathophysiological explanations 2, 3, 19, 21, 46 have been proposed, with no clear evidence of their validity. In a recent report, Rifkinson-Mann and colleagues 46 tried to further the understanding of the underlying pathology of these coexisting disorders. These authors' research was based on a unique series of 151 consecutive cases of low-grade intramedullary

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David D. Gonda, Vincent J. Cheung, Karra A. Muller, Amit Goyal, Bob S. Carter, and Clark C. Chen

without the G-CIMP phenotype. 20 Our observation that oligodendrogliomas are more likely to harbor the G-CIMP phenotype is largely consistent with the more favorable prognosis of this LGG relative to low-grade astrocytic tumors. Five-year survival for patients with astrocytic LGGs is 56% compared with 74% in those with predominantly oligodendritic gliomas. 33 Some oligodendrogliomas with 1p/19q deletions are still slower growing tumors with even more indolent courses. 25 The increased expression of mRNAs related to mitosis and inflammation in low-grade astrocytomas

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Elizabeth B. Claus, Kyle M. Walsh, John K. Wiencke, Annette M. Molinaro, Joseph L. Wiemels, Joellen M. Schildkraut, Melissa L. Bondy, Mitchel Berger, Robert Jenkins, and Margaret Wrensch

G liomas are classified as Grades I to IV based on histology and clinical criteria. 43 Grade I tumors are generally benign and frequently curable with complete resection, occur primarily in children, and are believed to represent an entity separate from Grade II–IV tumors (seen primarily in adults). Adult Grade II tumors (low-grade gliomas [LGGs]) include: 1) astrocytomas, 2) oligo-astrocytomas or mixed gliomas, and 3) oligodendrogliomas. 43 Astrocytomas and oligodendrogliomas consist of astrocytes or oligodendrocytes, respectively, while mixed gliomas

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Gabriela Simonová, Josef Novotny Jr., and Roman Liscák

The role of postoperative radiotherapy in the treatment of the low grade gliomas remains debated. Nonetheless, a randomized trial of the EORTC Study No. 22845 documented that early postoperative conventional external-beam radiotherapy appears to increase the time to progression or the PFS; however, an increase in overall survival time for patients with LGGs was not documented. 11–13 The long-term follow up of the patients in this study continues, and the final analysis will be reported later. 11–13 External-beam radiotherapy is generally reserved for older

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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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Andrew J. Gogos, Jacob S. Young, Matheus P. Pereira, Ramin A. Morshed, Matthew B. Potts, Shawn L. Hervey-Jumper, and Mitchel S. Berger

A lthough most patients with low-grade glioma (LGG) present after a seizure, 1 , 2 a small proportion presents after imaging is performed for a sign or symptom unrelated to the tumor. Once incidental, asymptomatic lesions are found, some argue for the safety of a watchful waiting approach, in which surgical intervention is deferred until the patient experiences symptoms or has imaging findings suggestive of growth or high-grade features. 3 , 4 However, studies have demonstrated that observation of incidental LGG (iLGG) is invariably associated