An Analysis of the Differing Management Approaches to Low and High Grade Gliomas

Ismail Ughratdar, MB ChB
Department of Neurosurgery
Hope Hospital
Manchester, United Kingdom
 

PL Richardson, FRCS
Department of Neurosurgery
Hope Hospital
Manchester, United Kingdom

Abstract
   This is study was undertaken to investigate if opinions differ among neurosurgeons in the management of gliomas.
   A questionnaire was devised de novo and subsequently answered by the surgeons within one neurosurgical unit and analyzed. The questionnaire was divided into three sections: i) The first, contained questions on the role of surgery and adjuvant therapy in managing low grade gliomas (LGGs), ii) the second section followed a similar structure to the first but instead related to high grade gliomas (HGGs) only, and iii) The final section contained two case scenarios.
   The results show that there is a significant variability in the approach to managing LGGs within one neurological center. More than half the surgeons adopt a ‘wait and see’ policy in managing a patient with an LGG. Two out of nine surgeons tend to biopsy the lesion whilst the same number take an aggressive surgical approach. Contrary to the variability seen in the approach to managing LGGs, generally there seems to be more accord in managing HGGs. All the surgeons except one take an aggressive approach and debulk such tumors. The remaining individual tends to be more inclined to biopsy such lesions only.
   This study has established a pattern of considerable variability in the management of LGGs whilst demonstrating a general consensus of opinion in the management of the higher grade lesions.
   KeyWords: brain tumor, craniotomy, glioma