Current Approach to Incidental and Multifocal Gliomas

Erkin ÖZGİRAYa , Nevhis AKINTÜRKa

aEge University Faculty of Medicine, Department of Neurosurgery, İzmir, Türkiye

Özgiray E, Akıntürk N. Current approach to incidental and multifocal gliomas. In: Uğur HÇ, Bayatlı E, eds. Glial Tumours: Expectations from Today-Promises of the Future. 1st ed. Ankara: Türkiye Klinikleri; 2024. p.42-8.

ABSTRACT

Incidental and multifocal gliomas present unique challenges in both diagnosis and treat- ment due to their often asymptomatic nature and complex anatomical spread. Incidental gliomas are typ- ically discovered during imaging studies for unrelated reasons, while multifocal gliomas are characterized by their presence in multiple locations within the brain. Both types require careful management strate- gies tailored to the individual patient. Surgical intervention remains the primary approach for glioma treatment, with maximal safe resection improving overall survival. In incidental gliomas, especially those of low grade, active surveillance may initially be considered; however, studies suggest that early surgi- cal resection can improve long-term outcomes. Multifocal gliomas, however, are often not amenable to complete resection due to their spread, making subtotal resection or biopsy more common. Adjuvant therapies such as radiotherapy and chemotherapy play a critical role, particularly in high-grade gliomas. Temozolomide, often combined with radiotherapy, is the standard chemotherapeutic agent, while beva- cizumab is used in cases with high angiogenic activity or resistance to standard treatment. Radiotherapy, despite challenges posed by tumor spread in multifocal gliomas, remains essential in controlling symp- toms and reducing tumor burden. Recent advances in molecular profiling and targeted therapies offer per- sonalized treatment options. Genomic data can guide the use of EGFR inhibitors and BRAF inhibitors, while immunotherapies like checkpoint inhibitors are being explored in clinical trials. Additionally, ar- tificial intelligence and machine learning are enhancing glioma diagnosis and treatment planning by im- proving imaging analysis and prognostic modeling. Multidisciplinary approaches, involving neurology, oncology, radiology, and surgery, are crucial for optimizing patient outcomes. Ongoing research into surgical techniques, adjuvant therapies, and novel treatments such as gene therapy and immunotherapy promises to further refine glioma management and improve survival rates.

Keywords: Glioma; incidental; multifocal; microsurgery; biopsy; radiotherapy; chemotherapy

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