Advances in the understanding of Low-Grade Glioma (LGG) biology have driven new paradigms in management. However, debate continues pushing the envelope toward improved quality of life and survival with safe gross total resection. In this article, we are trying to focus on the impact of the preoperative radiological data on the plan of management and intraoperative resection scenario. We applied a management protocol in our institute, in which we used functional magnetic resonance image (fMRI) and magnetic resonance tractography (MRt) data, in a prospective cohort of 56 patients with radiological diagnosis of LGG in the period from 2009 to 2016. Patients were divided depending on the management strategy into 3 groups: (1) gross total resection (GTR), (2) biopsy, (3) Don’t touch. Our primary outcome was quality of life using Karnofsky scale (KPS). Secondary outcomes included: Focal neurological function and extent of resection. Distribution of the cases between the groups was 34, 18 and 4 cases in the GTR, Biopsy and don’t touch groups respectively. We adopted radiological and clinical follow up every 6 months for a mean follow up period of 41.5 months. KPS < 70 (dependable) was found in 17/56 patients at presentation however at 18 months follow up 9/56 cases had KPS < 70 (dependable). Permanent morbidity (more than 6 months) was reported in 6/56 cases. Functional radiological preoperative data would be implemented in surgical decision making for patients with radiological LGG.
 

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