Neurosurgical Options for Glioma

Abstract

Glioma surgery has been the main component of glioma treatment for decades. The surgical approach changed over time, making it more complex and more challenging. With molecular knowledge and diagnostic improvement, this challenge became maximally safe resection of tumor, which resulted in prolonged overall survival, progression-free period, and a better quality of life. Today, the standard glioma treatment includes maximally safe resection, if feasible, administration of temozolomide, radiotherapy, and chemotherapy. Surgical resection is performed as subtotal resection, gross total resection, and supratotal resection. Subtotal resection is the resection where a part of tumor is left. Gross total resection is a complete removal of the magnetic resonance imaging (MRI) visible tumor tissue. Supratotal resection is performed as gross total resection with excising the MRI visible tumor tissue borders into the unaffected brain tissue. Before we make final decision on which type of resection should be performed, many factors have to be considered. The main question has to be answered: what the actual impact of resection on the progression of glioma is and what the functional risk of resection is.

Role of intraoperative computed tomography scanner in modern neurosurgery – An early experience

“…Achieving a gross total resection is particularly important in low-grade gliomas as it can prolong progression-free survival by years. [ 14 ] The other high-grade gliomas where further action was not taken were adequately resected according to the first iCT scan.…”

“…One prospective randomized controlled trial utilized iMRI to increase the extent of resection,[ 20 ] an established parameter in both low- and high-grade glioma surgery to improve outcomes. [ 14 ] The trial did increase progression-free survival in the iMRI group, however, which could not demonstrate an increase in overall survival. Postoperative rates of neurological deficits did not differ between the control group and those operated on with the help of iMRI.…”

“…[ 8 ] in 1986, this limits the correlation surgeons can achieve between preoperative image and intraoperative anatomy. [ 14 ] This occurs due to a distortion of brain tissue with several studies documenting surgical manipulation of brain tissue, tissue swelling, and loss of cerebrospinal fluid and use of brain retractors[ 4 , 13 , 17 ] as a cause of this dynamic spatiotemporal event which is time dependent. [ 25 ] This renders the images in the navigation system incorrect and can make surgery inaccurate.…”