Advances in Brain Tumor Surgery for Glioblastoma in Adults

Abstract

Glioblastoma (GBM) is the most common primary intracranial neoplasia, and is characterized by its extremely poor prognosis. Despite maximum surgery, chemotherapy, and radiation, the histological heterogeneity of GBM makes total eradication impossible, due to residual cancer cells invading the parenchyma, which is not otherwise seen in radiographic images. Even with gross total resection, the heterogeneity and the dormant nature of brain tumor initiating cells allow for therapeutic evasion, contributing to its recurrence and malignant progression, and severely impacting survival. Visual delimitation of the tumor’s margins with common surgical techniques is a challenge faced by many surgeons. In an attempt to achieve optimal safe resection, advances in approaches allowing intraoperative analysis of cancer and non-cancer tissue have been developed and applied in humans resulting in improved outcomes. In addition, functional paradigms based on stimulation techniques to map the brain’s electrical activity have optimized glioma resection in eloquent areas such as the Broca’s, Wernike’s and perirolandic areas. In this review, we will elaborate on the current standard therapy for newly diagnosed and recurrent glioblastoma with a focus on surgical approaches. We will describe current technologies used for glioma resection, such as awake craniotomy, fluorescence guided surgery, laser interstitial thermal therapy and intraoperative mass spectrometry. Additionally, we will describe a newly developed tool that has shown promising results in preclinical experiments for brain cancer: optical coherence tomography.

Using Light for Therapy of Glioblastoma Multiforme (GBM)

“…Whilst the bulk of the tumour can often be resected, GBM almost always re-occur due to the rapid proliferation of infiltrative residual tumour cells. New growth typically originates from the walls of the surgical cavity or parenchyma within <2 cm of the tumour margin [10]. This is due to small patches of GBM, the "scout" cells, which infiltrate the area adjacent to the tumour.…”

Expression and function of chondroitin 4‐sulfate and chondroitin 6‐sulfate in human glioma

“…Glioblastoma multiforme remains the most aggressive and lethal form of astrocytoma, with a median patient survival time of only 12 months, and accounts for the majority of primary malignant brain tumors among adults. 1,2 With the advancement of medical technology, the treatment of glioma has progressed, with surgery, radiotherapy, and chemotherapy being the conventional means of treatment, but still results in a high recurrence rate. 3,4 Evidence has shown that the most prevalent reason for cancer recurrence is the uncontrollable growth and high invasiveness of cancer cells, with epithelial-to-mesenchymal transition (EMT) being one of the causes of this recurrence.…”

Tau regulates the microtubule-dependent migration of glioblastoma cells via the Rho-ROCK signaling pathway

“…In the present study, we showed that glioblastoma multiform cell lines (GBM) expressed Tau protein. GBM grade IV tumors account for 52 to 75% of diagnosed gliomas with a patients' median survival of only 15 months (Figarella-branger et al, 2013;Lara-Velazquez et al, 2017;Weller, 2018). The highly invasive phenotype of GBM tumors renders their complete surgical resection difficult and limits the efficacy of radiotherapy and chemotherapy.…”