MDT Perspectives in pLGG: Surgical Resection and Biopsy Considerations

In managing pLGGs, decisions around biopsy and resection are deeply influenced by the tumor’s location and potential impact on long-term neurologic function. Even when a tumor appears surgically accessible, clinicians must weigh the risks of intervention against the likely benefits, particularly given the typically indolent nature of these tumors. Tumors located in critical areas like the motor cortex or the optic pathway are approached with extra caution. In such cases, even when a complete resection might technically be possible, the possibility of subtle cognitive or physical deficits leads many care teams to opt for observation or limited intervention if the tumor is not causing symptoms.

The decision to biopsy is similarly complex. If a biopsy can be performed with minimal risk and provides valuable molecular information that could guide targeted therapy, it may be recommended even in asymptomatic patients. This information can expand treatment options and offer reassurance to families. However, in scenarios where the tumor’s behavior and imaging are consistent with known patterns—such as with optic pathway gliomas—biopsy might be avoided to prevent unnecessary risk. The emphasis is on personalized decision-making, driven by both anatomical feasibility and the child’s current and future quality of life.

Ultimately, the goal is not only tumor control but also the preservation of a child’s full developmental potential. Even subtle neurologic or cognitive deficits can impact long-term outcomes, such as academic achievement or athletic performance. Therefore, in pediatric patients expected to live long, healthy lives, the care team must consider the smallest potential trade-offs. This careful, patient-centered approach ensures that treatment not only controls disease but also protects what matters most to the child and their family over the long term.