Lowgrade Gliomas In Adults

Fig. 9.6. Case LC before surgery.
Fig. 9.7. Case LC 1 year after surgery.
Fig. 9.8. Case LC three years after surgery.

recurrence. New contrast enhancement after surgery may reflect malignant change or simply post-operative effects. If there is any doubt, as there often is, about the interpretation, it is best to repeat the scan after a few months. Changes due to recurrent tumor will obviously tend to become more pronounced with time, and postoperative effects less pronounced. As with routine follow-up scanning of large, inoperable tumors, routine follow-up scanning of patients who have undergone what appeared to be "complete" resection will often cause great difficulties for the neurosurgeon and his or her patient when such scans show what is probably residual or recurrent tumor, which is not causing any symptoms.

In some patients it will be clear that the tumor has undergone malignant transformation and treatment is now as for a malignant glioma. Depending on the time interval since initial treatment and the extent of recurrence, further surgery may be indicated as well as adjuvant treatment. If the scans suggest malignant change, biopsy can be required to confirm this if adjuvant treatment is to be considered. If the follow-up scans show only slight progressive change over a number of years, it is

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