The Never-Ending Struggle Between the Two Souls of the Neurosurgeon: To Wait or To Intervene

Abstract

eurosurgeon, as a modern Ulysses, is in a daily struggle between the desire to completely resect tumors, that is N the attraction for the mermaid’s chanting, and the self limitation of tying his hands whenever the prediction of the result of the surgical treatment, although promising in perspective, is not sufficiently reliable (6). The management of incidental brain lesion highlights once more this conflict. Although the incidence of asymptomatic brain lesion is low, a precise estimation is impossible and is going to constantly increase due to the increasingly larger access to radiologic studies, their progressive major effectiveness, and the impact of defensive medicine. However, in spite of a low general prevalence, incidental brain lesion may represent up to 8.6% of all brain lesions in children in referral centers, which is a phenomenon that should be taken into account (1). In this context, the management of asymptomatic presumed low-grade glioma (LGG) is controversial. Recent literature data try to shed light onto the natural history of incidental LGG, thus concluding that observation is a viable and safe option. On the contrary, surgical resection at diagnosis is still advocated on the basis of the lower morbidity of surgery compared to the past. Furthermore, surgery allows the confirmation of the diagnosis and avoids unexpected evolution of the lesion. The decision-making process becomes even more complex in children, due to the anxiety of parents and the concern about the impact of surgery or alternatively of the tumor itself on the patient’s neurological condition.