The biological and clinical basis for early referral of low grade glioma patients to a surgical neuro-oncologist

•Low grade gliomas (LGG) traditionally categorised as indolent or ‘benign’ lesions.•Surveillance imaging has been the mainstay for incidental or asymptomatic LGG.•Such patients are monitored often without being referred to a Neuro-oncology unit.•New biological knowledge and validated treatment options have advanced LGG care.•Thus, proactive LGG management, with early neurosurgical referral, is essential.