Safety and efficacy of circumferential sulcus guided resection of low-grade gliomas

Abstract

Background
Diffuse low grade gliomas (LGGs) are a heterogeneous population of intrinsic brain tumors accounting for about 15% of all glial brain neoplasms in which the natural history is characterized by initially indolent growth with significant tendency for recurrence and malignant transformation. However, early and maximal safe resection is currently the first-line treatment for LGGs, the ideal resection technique has not been clearly defined.


Objective
The study aimed to evaluate safety and efficacy of circumferential sulcus guided resection (SGR) of LGGs.


Patients and methods
This study was prospectively conducted on 20 patients subjected to microsurgical circumferential sulcus guided resection of LGGs between May 2023 and May 2025 in the department of Neurosurgery, Tanta university hospitals.


Results

Twenty patients (12 males and 8 females) with a mean age of 31.65 years, ranging from 14 to 53 years. All (100%) patients suffered from generalized seizures as the main complain. The mean preoperative tumor size was 31.43 cm
3
ranging from 15.21 to 55.84 cm
3
with mean extent of tumor resection was 96.83% ranging from 45.05 to 100%. Only 3 (15%) patients have short-term postoperative neurological complications and no patients at all (0%) developed permanent postoperative neurological complications. 15 (75%) patients had diffuse astrocytoma IDH-mutant, grade 2 and 5 (25%) had oligodendroglioma IDH1-mutant & 1p/19q codeleted, grade 2. All (100%) patients were Engel 1 seizure-free with no recurrence all through the research time.



Conclusion
LGGs typically exhibit limited infiltration across sulcal boundaries, allowing sulci to serve as natural anatomical landmarks for tumor delineation. The SGR approach exploits this characteristic growth pattern to facilitate surgical precision. According to our findings, SGR is both safe and practical technique for LGG removal, including in eloquent brain areas, and is independently correlated with an increased likelihood of achieving complete tumor resection without worsening neurological morbidity.