Several prognostic factors appear to be more important than treatment factors in determining the outcome of patients with low grade glioma. The role of surgery in establishing a histological diagnosis or in relieving neurological deficit is well established. The role of surgery in prolonging survival of patients with low grade glioma however, remains controversial, largely because studies in the literature on the management of this disease have been predominantly descriptive and observational, which precludes the setting of standards for the management of these patients. Several viable management options are discussed.