Surgery for low-grade glioma: rationale for early intervention.

We feel that early surgical intervention is appropriate in the patient who presents with a clinical picture suggesting a low-grade glioma. Neuroimaging is not adequate to make an accurate diagnosis of the underlying pathology. Tumor tissue sampling allows a more specific diagnosis and testing for biologic factors such as the proliferative potential of the lesion. Surgical diagnosis allows a disease-specific therapy to be more appropriately prescribed to the patient, including the option for no further treatment, radiotherapy, and/or chemotherapy. There is compelling early data that suggest that the extent of surgery and the postoperative tumor volume will be predictive of outcome in at least some tumor types. We encourage participation of physician and patients in well-designed clinical trails that will ultimately answer the many questions that remain about these unique diseases.