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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 266-271
DOI: 10.4103/ajns.AJNS_296_19
Review Article

The ethical dilemma in the surgical management of low grade gliomas according to the variable availability of resources and surgeon experience

Marshall Lahiff
1   School of Law, University of Miami
2   Walton Lantaff Schoreder and Carson LLP, Miami, Florida
,
Michael Ghali
3   Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
4   Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Low grade gliomas (LGGs) affect young individuals in the prime of life. Management may alternatively include biopsy and observation or surgical resection. Recent evidence strongly favors maximal and supramaximal resection of LGGs in optimizing survival metrics. Awake craniotomy with cortical mapping and electrical stimulation along with other preoperative and intraoperative surgical adjuncts, including intraoperative magnetic resonance and diffusion tensor imaging, facilitates maximization of resection and eschews precipitating neurological deficits. Intraoperative imaging permits additional resection of identified residual to be completed within the same surgical session, improving extent of resection and consequently progression free and overall survival. These resources are available in only a few centers throughout the United States, raising an ethical dilemma as to where patients harboring LGGs should most appropriately be treated.

Key-words:

Gliomas - intraoperative - magnetic resonance imaging - neuronavigation - supratotal resection - surgeon experience - survival - technology

Financial support and sponsorship

Nil.




Publication History

Received: 26 September 2019

Accepted: 20 December 2019

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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