Background: Diffuse infiltrative low-grade gliomas (LGGs) of the cerebral hemispheres in the adult are a group of tumours with distinct clinical, histological and molecular characteristics, and there are still controversies in management.

Methods: The scientific evidence collected from the literature was evaluated and graded according to EFNS guidelines, and recommendations were made.

Results and conclusions: The WHO classification recognizes grade II astrocytomas, oligodendrogliomas and oligoastrocytomas. Conventional MRI is used for differential diagnosis, guiding surgery, planning radiotherapy and monitoring treatment response. Advanced imaging techniques can increase diagnostic accuracy. Younger age, normal neurological examination, oligodendroglial histology and 1p loss are favourable prognostic factors. Prophylactic antiepileptic drugs are not useful, and there is no evidence that one drug is better than any other7. Total or near-total resection can improve seizure control and progression-free and overall survival, while reducing the risk of malignant transformation. Early postoperative radiotherapy improves progression-free but not overall survival. Low doses of radiation are as effective as high doses and are better tolerated. Modern radiotherapy techniques reduce the risk of late cognitive deficits. Chemotherapy can be useful both at recurrence after radiotherapy and as initial treatment after surgery to delay the risk of late neurotoxicity from large-field radiotherapy. Neurocognitive deficits are frequent and can be caused by the tumour itself, tumour-related epilepsy, treatments and psychological distress.