reasonable to do nothing, although if the area of recurrence is well circumscribed and not very deep or eloquent, "second-look" surgery can be considered.

The question of how to treat possible or definite recurrence of low-grade gliomas is usually very difficult for both surgeon and patient. As mentioned above, it is most important that decisions about how to manage these cases are made jointly by neurosurgeons and neuro-oncologists working together.

5. Tumors that Cause Intractable Epilepsy

Provided that EEG studies have confirmed the tumor seen on the scan to be the epileptic focus, and provided that complete or near-complete resection of the tumor looks feasible, many patients can expect a significant improvement, with actual cure in some cases, of their epilepsy with surgery. The question of what constitutes "intractable" epilepsy can be difficult, as can the question of whether there are epileptic foci distant from the tumor. Simple, superficial tumors causing epilepsy can be dealt with on their merits, but other cases are probably best managed by surgeons with a particular interest in epilepsy, and are beyond the scope of this chapter.

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