INTRODUCTION: Brain tumours are the leading cause of cancer death in the under 40 year olds in the United Kingdom. Over the last 15–20 years there has been a significant shift in the management of Low Grade Glioma (LGG), with increasing evidence that upfront resection can improve outcome. Despite this, there remains a variation between clinical teams in their understanding and attitude regarding treatment options. Through this survey we sought to obtain information about how LGG Neurosurgery & Oncology practice is shaped throughout the UK, about the involvement of Allied Health Professionals (AHPs) and how care is structured and delivered. METHODS: Neurosurgical units in the UK were distributed a Society of British Neurological Surgeons approved questionnaire asking about LGG practices in their area. Paediatric hospitals were excluded. RESULTS: Completed forms were returned by 17 out of 32 units (53.1% response rate). In 41%, the patients are seen in a specialised LGG clinic, 35% use neuro-oncology clinics, while 24% review their patients in general neurosurgery clinics. On average, specialised LGG clinics will have 4 specialties present, as opposed to 2 in neuro-oncology clinics and only a neurosurgeon in general clinics. An average of 11 different specialties will be involved during some stage of care. In 76% of the units, the strategy is to aim for primary resection where possible. Only 12% (two units) will start by observing the tumour even if it is focal and deemed resectable. Units seeing patients in general neurosurgery clinics have more tendency to biopsy routinely at presentation compared to those with neuro-oncology or specialist clinics (p=0.027). Most centres (88%) offer surgery via awake craniotomy – with a variety of testing methods used. There was a positive correlation between operative numbers and the ability to offer awake surgery (rs(13)=0.623, p=0.013). Following surgery for Grade 2 glioma, the majority of centres (65%) initially follow their patients with serial scans. The remainder (35%) may refer patients for consideration of adjuvant therapy (chemo- and/or radiotherapy) immediately following surgery. CONCLUSIONS: Five years after guidelines were published by the European Association for Neuro-Oncology, a large proportion of respondents confirmed that they provide specialist LGG services in established multidisciplinary environments. Whilst there is heterogeneity in the approaches to the management of these tumours, the majority of centres (but not all) recognise the value of upfront surgery with the aim of achieving significant bulk resection. The methodology surrounding awake craniotomy varies markedly across the UK centres that offer this service. A unit-to-unit variation in the post-operative care of grade 2 glioma patients was also noted, with disparity in which patients are referred for adjuvant therapy. This survey supports the establishment of a UK National LGG Working Group who can setup a regular National outcome audit & establish a National LGG Database.

INTRODUCTION: Low grade gliomas have historically been overlooked, perhaps because of the challenges their often eloquent locations pose, and their perceived “good” prognosis relative to GBM. Although there are no randomised trials to date, the work of Duffau and Berger has shown that radical surgery can alter prognosis. We present our experience of managing presumed low grade gliomas through a multidisciplinary team. METHODS: Retrospective database review of patients undergoing surgery for presumed low grade glioma between January 2010-December 2013. Demographics, procedure type, histological diagnosis, morbidity, tumour location, progression-free (PFS) and overall survival (OS) were analysed. Results were statistically analysed by Kaplan-Meier and Log Rank (Cox Proportional Regression Hazard) Testing (p < 0.05). RESULTS: Patients (n = 100, 70% male, 30% female) underwent 115 procedures - 26 biopsies, 40 asleep and 49 awake craniotomies. Mean age 41 years (range 16-70 years). Tumour locations were predominantly frontal, peri-Rolandic and insular. The majority of patients had WHO Grade II astrocytomas. Morbidity, PFS and OS will be discussed. CONCLUSION: Sub-specialising in low grade glioma management is important. We have demonstrated, through ever-increasing experience and familiarity, that awake surgery is well tolerated, minimises morbidity and imbues confidence for better resection. Most importantly, our patients have benefited and appreciated the multidisciplinary approach, throughout their journey.