Abstract
Diffuse low-grade gliomas (DLGG) are slow-growing brain tumors that in spite of an indolent behavior at onset show a continuous expansion over time and inevitably transform into malignant gliomas. Extensive tumor resections may be performed with preservation of neurological function due to neuroplasticity that is induced by the slow tumor growth. However, DLGG prefer to migrate along subcortical pathways, and white matter plasticity is considerably more limited than gray matter plasticity. Whether signs of functional decompensating white matter that may be found as early as at disease presentation has not been systematically studied. Here, we examined 52 patients who presented with a DLGG at the time of radiological diagnosis. We found a significant correlation between neurological impairment and eloquent cortico-subcortical tumor localization, but not between neurological function and tumor volume. These results suggest that even small tumors invading white matter pathways may lack compensatory mechanisms for functional reorganization already at disease presentation.
Highlights
Diffuse low-grade gliomas (DLGG) are slow growing primary brain tumors occurring mainly in young adults
We studied a cohort of 52 patients with DLGG at the time of radiological diagnosis and correlated their clinical parameters to tumor volume and tumor location
The distribution of neurological function, seizure as first symptoms, and seizure control is illustrated in the Figure S1 in Supplementary Material
Summary
Diffuse low-grade gliomas (DLGG) are slow growing primary brain tumors occurring mainly in young adults. DLGG are classified as gliomas WHO (World Health Organization) Grade II and characterized by extensive invasion but low proliferation [1]. In spite of advances in diagnostic methods and surgical techniques, allowing extensive and safe tumor resections as well as the introduction of molecular tumor markers guiding therapeutic decisions, the clinical management of DLGG remains challenging [2]. Sequential magnetic resonance imaging (MRI) studies of DLGG have demonstrated a linear growth in diameter of the bulky tumor mass before first-line treatment [3]. In parallel with a continuous expansion over time, DLGG migrate along the white matter pathways where the invasion rate is estimated to be about five times higher than in the gray matter [4].
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