Bringing Polemic Issues with Inchoate Guidelines into Sharper Focus
 

Andrew Kaye, MD; Melbourne, Australia
The expert says:
While a reasonable argument can be made for any of the options listed, I favor continued observation with a six-month, follow-up gadolinium-enhanced MRI with spectroscopy and blood flow studies. Awake-craniotomy with cortical mapping and attempted gross total resection would be indicated at the time of clinical and/or radiological progression. While it would be not unreasonable to undertake an attempted resection (awake with cortical mapping) at this stage, there is a small, but definite risk of debilitating neurological deficit, and the survival benefits are unclear if gross total resection is not obtained. Even if a “complete” resection is obtained as confirmed with MRI, there is no Class 1 evidence of survival benefit.