Asymptomatic Brain Tumor Detected at Brain Check-up.

Onizuka, Masanari; Suyama, Kazuhiko; Shibayama, Akira; Hiura, Takeshi; Horie, Nobutaka; Miyazaki, Hisaya

doi:10.2176/nmc.41.431

Cited by 53 publications

(30 citation statements)

References 12 publications

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“…19,28 Among the patients whose incidental LGGs were discovered due to trauma, there were no reported recurrences, and only 1 patient with a tectal glioma had a KPS score < 100 at follow-up.…”

Section: Discussionmentioning

confidence: 99%

The management of incidental low-grade gliomas using magnetic resonance imaging: systematic review and optimal treatment paradigm

Shah

Madhavan

Heros

et al. 2011

FOC

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Object The discovery of incidental low-grade gliomas (LGGs) on MR imaging is rare, and currently there is no existing protocol for management of these lesions. Various studies have approached the dilemma of managing patients with incidental LGGs. While some advocate surgery and radiotherapy, others reserve surgery until there is radiological evidence of growth. For neurosurgeons and radiologists, determining the course of action after routine brain imaging poses not only a medical but also an ethical dilemma. The authors conducted a systematic review of case reports and case series in hopes of enhancing the current understanding of the management options for these rare lesions. Methods A PubMed search was performed to include all relevant MR imaging studies in which management of suspected incidental LGG was reported. Comparisons were made between the surgical treatment arm and the active surveillance arm in terms of outcome, mode of discovery, reasons for treatment, and histology. Results Nine studies with 72 patients were included in this study (56 in the surgical arm and 16 in the active surveillance arm). Within the surgical arm, 49% remained deficit free after treatment, 25% showed evidence of tumor progression, 13% underwent a second treatment, and 7% died. The active surveillance group resulted in no unanticipated adverse events, with serial imaging revealing no tumor growth in all cases. Lesion regression was reported in 31% of this group. The surgical arm's mortality rate was 7% compared with 0% in the active surveillance arm. Conclusions Treatment decisions for incidental LGG should be individualized based on presenting symptoms and radiological evidence of growth. The asymptomatic patient may be monitored safely with serial MR imaging and occasionally PET scanning before treatment is initiated. In patients presenting with nonspecific symptoms or concurrent symptomatic lesions, treatment may be initiated earlier to reduce potential morbidity. All treatment decisions must be tempered by patient factors and expectations of anticipated benefit.

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Section: Discussionmentioning

confidence: 99%

The management of incidental low-grade gliomas using magnetic resonance imaging: systematic review and optimal treatment paradigm

Shah

Madhavan

Heros

et al. 2011

FOC

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“…In particular, brain screening with computed tomography (CT) and magnetic resonance imaging (MRI) is easily performed for nonspecific complaints and 'neurological checkups' are performed frequently in Japan (3). Thus, an increasing number of intracranial meningiomas are identified incidentally (4,5). However, few studies have reported the outcome of surgical resection of intracranial meningiomas in the elderly (6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Clinical features and surgical management of intracranial meningiomas in the elderly

et al. 2017

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Abstract. Meningioma accounts for ~25% of all primary intracranial neoplasms and the incidence increases with age. Prvios population-based studies demonstrated that the annual incidence of intracranial meningiomas was 1.2-3.1/100,000 population. In particular, the incidence of this disease among the elderly is high. Recently, increased life expectancy and greater use of diagnostic radiological imaging led to an increased incidence in the diagnosis of intracranial meningiomas, both symptomatic and asymptomatic, in the elderly. Thus, neurosurgeons may be increasingly confronted with the management of intracranial meningiomas in the elderly. In practice, it is often difficult for physicians to determine whether traditional surgical resection is the optimal management strategy for intracranial meningiomas in the elderly. However, reported clinical studies about the outcome of surgical resection of intracranial meningiomas in the elderly are limited. Increased risk of mortality and morbidity associated with surgical treatment for intracranial meningiomas in the elderly compared with younger patients have been controversial. In the present study, the clinical features of intracranial meningiomas in 70 consecutive intracranial meningioma patients that underwent surgical treatment at the affiliated hospital of University of Occupational and Environmental Health between 2007 and 2013 were assessed. In addition, patient selection and surgical management of intracranial meningioma in elderly patients was discussed. Preoperative factors, including symptoms, tumor location, tumor size, Karnofsky Performance Scale (KPS) score and American Society of Anesthesiology (ASA) score, and postoperative factors, including pathological diagnosis, tumor proliferation index (Ki-67), resection rate (Simpson grade), length of hospital stay and discharge destination were retrospectively analyzed in patients aged ≥75 years (n=16; elderly group) and <75 years (n=54; younger group). Outcomes were assessed 6 months after surgery. Multivariate logistic regression revealed that tumor resection rate (Simpson grade III-V) was an important predictor of surgical complications (odds ratio, 5.662; 95% confidence interval, 1.323-24.236; P= 0.0194). Perioperative morbidity was not correlated with age (>75 years), tumor location, tumor size, KPS score or ASA score. Thus, the present study indicated that age is not associated with surgical outcome in elderly meningioma patients. Regardless of patient age, the decision to perform surgical resection should be made on an individual basis wherein tumor characteristics and the general health of the patient are considered.

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“…In the healthy population, the incidence of ILGG is currently estimated to be between 0.025% and 0.3%. 23,35,53,54 In a series of 4309 gliomas from the French Brain Tumor Databank, 130 cases of incidentally diagnosed gliomas (3%) have been reported. 2 Due to the rapid development of neuroimaging, the probability of encountering ILGG will increase in the near future.…”

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confidence: 99%

Is there a risk of seizures in “preventive” awake surgery for incidental diffuse low-grade gliomas?

Lima

Duffau

2015

JNS

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A WHO Grade II glioma (diffuse low-grade glioma [LGG]) is a continuously growing lesion that migrates along white matter pathways and that will inescapably evolve toward a higher grade of malignancy. 39This tumor is usually revealed by inaugural seizures in young adults with no or only mild neurological deficits. 11Despite the lack of prospective randomized trials, a large amount of data reported in the modern literature strongly supports the impact of early and maximal resection on the natural history of the disease, by delaying malignant transformation and thus by significantly increasing survival. 1,15,20,21,30,46,49 Recently the French Glioma Network published the largest surgical series of LGG ever reported, in which multivariate analysis was used to show that extent abbreviatioNs AED = antiepileptic drug; EOR = extent of resection; ILGG = incidental low-grade glioma; KPS = Karnofsky Performance Scale. submitted June 22, 2014. accepted September 10, 2014. iNclude wheN citiNg Published online February 27, 2015; DOI: 10.3171/2014.9.JNS141396. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.Is there a risk of seizures in "preventive" awake surgery for incidental diffuse low-grade gliomas? obJect Although a large amount of data supports resection for symptomatic diffuse low-grade glioma (LGG), the therapeutic strategy regarding incidental LGG (ILGG) is still a matter of debate. Indeed, early "preventive" surgery has recently been proposed in asymptomatic patients with LGG, after showing that the extent of resection was larger than in symptomatic patients with LGG. However, the quality of life should be preserved by avoiding both neurological deficit and epilepsy. The aim of this study was to determine the risk of seizures related to such a prophylactic surgical treatment in ILGG. methods The authors report a prospective series of 21 patients with ILGG who underwent awake surgery with a minimum follow-up of 20 months following resection. Data regarding clinicoradiological features, surgical procedures, and outcomes were collected and analyzed. In particular, the eventual occurrence and type of seizures in the intra- and postoperative periods were studied, as follows: early (< 3 months) and long-term (until last follow-up) periods. results There were no intraoperative seizures in this series. During the early postoperative period, the authors observed only a single episode of partial seizures in a patient with no antiepileptic drug (AED) prophylaxis-all other patients were given antiepileptic treatment following resection. The AEDs were discontinued in all cases, with a mean delay of 8 months after surgery (range 3-24 months). No patient had permanent neurological deficits. All 21 patients returned to an active familial, social, and professional life (working full time in all cases). Total or even "supratotal" resection (the latter meaning that a margin around the tumor visible on FLAIR-weighted MRI was removed) ...

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Asymptomatic Brain Tumor Detected at Brain Check-up.

Cited by 53 publications

References 12 publications

The management of incidental low-grade gliomas using magnetic resonance imaging: systematic review and optimal treatment paradigm

The management of incidental low-grade gliomas using magnetic resonance imaging: systematic review and optimal treatment paradigm

Clinical features and surgical management of intracranial meningiomas in the elderly

Is there a risk of seizures in “preventive” awake surgery for incidental diffuse low-grade gliomas?

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