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REVIEW ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 266-271

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


1 School of Law, University of Miami; Walton Lantaff Schoreder and Carson LLP, Miami, Florida, USA
2 Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA

Correspondence Address:
Michael George Zaki Ghali
Department of Neurosurgery Surgery, Houston Methodist Hospital, 6560 Fannin Street, Houston, TX 77030
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajns.AJNS_296_19

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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.


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