Analysis of Legal, Cultural, and Socioeconomic Parameters in Low-Grade Glioma Management: Variability Across Countries and Implications for Awake Surgery.

Low-grade glioma (LGG) usually occurs in young patients who enjoy an active family, social, and professional life. Because awake surgery for patients with LGG has resulted in significant improvement in both functional and oncological outcomes and because the surgery per se is not very expensive, it is currently performed in many countries worldwide. Nonetheless, in addition to the necessity of tailoring the surgical strategy to the patient (e.g., neurological and cognitive status) and tumor (e.g., brain location and volume) characteristics, the legal, cultural, and socioeconomic parameters could also play a key role in the therapeutic strategy. These include clear information to the patient and relatives during the first meeting, the adapted selection of tasks for awake mapping, and active collaboration of the patient throughout the resection and during the early postoperative rehabilitation. In the present study, our goal was to analyze these socioenvironmental aspects, which have been neglected for many decades, in LGG management, with a special emphasis on epilepsy and the awake procedure. These criteria are relevant with respect to the diagnosis, surgery, functional remediation, and long-term follow-up for patients who now benefit from a longer life expectancy. However, although such factors are essential to resume an active life, including returning to work, they vary greatly across countries. Therefore, they should be considered more systematically to allow for greater reproducibility of results of awake surgery worldwide.