Extent of Resection and Survival in Glioblastoma Multiforme

Abstract

Despite concerted, intensive research efforts worldwide, the neuro-oncological fraternity still has a long road ahead in the search for a cure for glioblastoma. Current treatment protocols focus on extension of sur¬vival time through improvement of quality of life in a race against time. The gold standard therapy for glioblastoma consists of primary tumor surgery with the aim of achieving maximum possible resection, fol¬lowed by radiochemotherapy then chemotherapy alone for 6 months. Although the surgical aspect of glioblastoma management has a pivotal role in improving survival, with numerous studies showing that a resection of >98% of tumor volume is associated with maximum possi¬ble life expectancy, extreme caution must be exercised to prevent postoperative neurological deterioration. In this context, advances in surgical techniques, includ¬ing improved integrated visualization of brain function, are continuously expanding the definition of ‘safe’ gross total resection. History has taught us that the surgeon’s own intraoperative impression can no longer suffice as an acceptable determinant of the extent of resection: state-of-the-art visualization technology must be used to quantify tumor removal and improve surgical accuracy to enable resection to the maximal feasible extent.