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Journal of Neurosurgical Sciences 2019 December;63(6):625-32

DOI: 10.23736/S0390-5616.19.04787-8


language: English

Supramarginal resection of glioblastoma: 5-ALA fluorescence, combined intraoperative strategies and correlation with survival

Francesco CERTO 1, 2 , Walter STUMMER 3, Jibril O. FARAH 4, Christian FREYSCHLAG 5, Massimiliano VISOCCHI 6, Antonio MORRONE 1, Roberto ALTIERI 1, Giada TOCCACELI 1, Simone PESCHILLO 1, 2, Claudius THOMÈ 5, Michael JENKINSON 4, Giuseppe BARBAGALLO 1, 2

1 Department of Neurological Surgery, G. Rodolico Polyclinic University Hospital, Catania, Italy; 2 Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy; 3 Department of Neurosurgery, University Hospital of Münster, Münster, Germany; 4 The Walton Centre for Neurology and Neurosurgery, Liverpool, UK; 5 Department of Neurosurgery, Medizinische Universität Innsbruck, Innsbruck, Austria; 6 Institute of Neurosurgery, Sacred Heart Catholic University, Rome, Italy

INTRODUCTION: Glioblastoma treatment requires a multidisciplinary approach involving oncologists, radiotherapists and surgeons. Surgery constitutes the initial step of the therapeutic strategy and its efficacy is dependent on the extent of resection (EOR). Over the last decade, the goal of surgical treatment was the resection of the contrast enhancement on T1 MRI, defined as gross-total resection (GTR). More recently, an increasing number of studies reports a positive impact on survival parameters of a more aggressive surgical strategy aiming to resect all peri-tumoral infiltrated areas. These areas are histologically characterized by the presence of pathological cells infiltrating normal white matter and surround the neoplastic core of glioblastoma identified by gadolinium enhancement in T1-weighted MR. Intuitively, the major risk of the so called supramarginal resection is related to the possibility of resecting functionally eloquent brain tissue. Several strategies have been proposed to maximize the safety of resection and minimize the occurrence of postoperative functional deficits. The aim of this review was to focus on the clinical impact of supramarginal resection of glioblastomas, highlighting the role of image-guided surgery combined with neuromonitoring to increase surgical safety and efficacy.
EVIDENCE ACQUISITION: The MEDLINE database has been queried for the literature research.
EVIDENCE SYNTHESIS: Ten studies matched the inclusion criteria, reporting a global number of 3221 patients.
CONCLUSIONS: The current evidence suggests a positive correlation between a more extensive resection based on FLAIR abnormal areas and overall survival.

KEY WORDS: Glioblastoma; Survival; Surgery, computer-assisted

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