The Gross Total Resection and Molecular Markers in Grade II Glioma

  • Ijaz Hussain Wadd Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore – Pakistan
  • Shahid Mukhtar Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore – Pakistan
  • Syed Arslan Haider Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan
  • Sidra Ijaz Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan


Objective:  The study determined the importance of gross total resection in grade II Glioma and evaluated the importance of tumor markers as prognostic factors.

Material and Methods:  We included the 240 patients aged 13 – 65 years with supratentorialsuspected low-grade Glioma. Craniotomy was done in all my patients under general anesthesia and excised the tumor safely with the help of a microscope and CUSA without causing any focal deficit or hemodynamic instability. The 3D conformal radiotherapy and or Temozolomide chemotherapy was started as advised by the oncologist, postoperatively. The 5 and 10 years’ overall survival and progression-free survival were evaluated in my study.

Results:  Median age of the patients was 45 years. The 46.66% patients were IDH mutant Astrocytoma, 39.1 6% patients were IDH mutant Oligodendroglioma with loss of heterozygosity at I p/l9q levels, and 14.16% patients had IDH wild type Astrocytoma. The gross total resection was done in 113 patients, subtotal in 53 patients, partial resection in 45 patients, and biopsy in 29 patients. Postoperative radiotherapy was done in 170 patients and Temozolomide chemotherapy in 67 patients. The 5 and 10 years’ progression-free survival was 80% and 49% and overall survival was 86.3% and 67%. The 10 – year overall survival for Oligodendroglioma, the IDH mutant Astrocytoma, and IDH wild Astrocytoma were 93%, 61.6%, and 34.7% (respectively), and progression-free survival were 89.2%, 48%, and 34% (respectively). 

Conclusion:  The gross total resection of IDH mutant Astrocytoma had a good outcome.


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