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Background: Although previous research has suggested that patients with incidentally discovered low-grade gliomas (iLGG) who undergo surgery prior to the appearance of symptoms have improved outcomes compared to those who are symptomatic, an ideal approach to managing iLGG is not well-established. The purpose of this systematic review is to identify all cases of iLGG in the literature and characterize the effect of the timing of surgery on survival. Methods: We searched EMBASE, MEDLINE, and PubMed for articles related to iLGG. After duplicates were removed, the articles were then screened based on strict inclusion and exclusion criteria. Results: We retrieved 24/1377 unique articles with a total of 175 patients who underwent surgery for iLGG prior to symptoms appearing. The average age was 29.1yrs (range 1-62) and the mean follow-up period was 56 months (range 1-234months). Unfortunately, only 6/24 articles reported progression-free survival (average 32.4months) and only 1/24 reported 10-year survival. Conclusions: The articles we identified favored an early intervention for iLGG, however, there was a considerable lack of long-term follow-up and survival data to justify such a claim. Further studies need to be performed with adequate follow-up data in order to determine the optimal timing of surgical intervention for these patients.
Background: The diagnosis of cerebral vasospasm, either by digital subtraction angiography (DSA), or now more commonly by computerized tomographic angiography (CTA) occurs in up to 70% of patients with aneurysmal subarachnoid hemorrhage (aSAH). The lack of standardization among vasospasm grading has made its clinical correlation with delayed cerebral ischemia challenging Methods: 36 of the 764 aSAH patients found on the St. Michael’s Hospital RIS database had both DSA and CTA performed, at time of admission and again between day 2 and 14 following SAH. Two blinded neuroradiologists graded all vessels for vasospasm on two separate scales, by consensus for DSA and independently for CTA Results: Comparing CTA and DSA, Grading Scale (GS)1 had the highest Spearman Correlation Coefficient (SCC): 0.691 (P<0.001) for Rater (R)1, and 0.687 (P<0.001) for R2. SCC was higher when only considering proximal vessels. Cohen’s Kappa (CK) measuring inter-rater reliability was 0.695 (P<0.001) for GS2 and 0.681 (P<0.001) for GS1. CK was higher in anterior circulation vessels, and tended to decrease with increasing vasospasm grade. Conclusions: Although either scale will provide the benefits of standardization to clinical practice and research, GS1 is recommended as it is more intuitive and provides higher SCCs, with only slightly lower CKs.