The dilemma of low grade glioma.

Correspondence to: Professor Ian R Whittle, Department of Clinical Neuroscience, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; [email protected] _________________________ T he management of low grade glioma is one of the most controversial areas in clinical neurooncology. There are numerous reviews and editorials outlining the difficulties in management of these lesions. Indeed, the pivotal questions about their management remain unanswered. However, the concept of management of low grade gliomas is not unitary but much more a composite of different challenges depending on the clinical presentation, signs, neuroradiology, perspectives of neurologists, the opinion of the neurosurgeon, and perhaps most importantly, the aspirations of the patient. It is true therefore that in many patients there will be a dilemma about what is considered optimal management since there is no good evidence base to underpin any single management undertaken. Conversely, however, there are many groups of patients with various low grade gliomas in whom management decisions are made more easily and pragmatically. In this review, the current approaches to different low grade gliomas presenting with different symptom complexes in different regions of the brain will be reviewed and the rationale for decision making discussed.