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What to do With the Patient Who Has Had a Fit and the Scan Shows a ‘Glioma’?

^* Consultant Neurologist and
Specialist Registrar Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London; E-mail: j.rees{at}ion.ucl.ac.uk

EXTRACT

A TYPICAL PATIENT

A 28-year-old lady was brought into the emergency department having had two generalized tonic–clonic seizures. These terminated spontaneously and by the next day she was feeling back to normal apart from a mild headache. She recalled involuntary head turning to the left just before blacking out. Postictally there was no neurological deficit, and there was no earlier history of headaches. She was otherwise fit and well. Her brain CT scan showed a large low-density space-occupying lesion in the right frontal lobe, which did not enhance with contrast, suggestive of a glioma, probably low-grade (Fig. 1).

At this point the key issues are:

• How reliable is CT/MR scanning in detecting and grading gliomas?
  
• What are the risks, benefits and limitations of stereotactic biopsy?
  
• When is it appropriate to recommend gross total resection?
  
• If a biopsy or resection is done and shows a low
  

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