Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Jun;3(9):121.
doi: 10.3978/j.issn.2305-5839.2015.05.10.

Current trends in the surgical management and treatment of adult glioblastoma

Richard M Young  1 , Aria Jamshidi  1 , Gregory Davis  1 , Jonathan H Sherman  1
Affiliations
Review

Current trends in the surgical management and treatment of adult glioblastoma

Richard M Young et al. Ann Transl Med. 2015 Jun.

Abstract

This manuscript discusses the current surgical management of glioblastoma. This paper highlights the common pathophysiology attributes of glioblastoma, surgical options for diagnosis/treatment, current thoughts of extent of resection (EOR) of tumor, and post-operative (neo)adjuvant treatment. Glioblastoma is not a disease that can be cured with surgery alone, however safely performed maximal surgical resection is shown to significantly increase progression free and overall survival while maximizing quality of life. Upon invariable tumor recurrence, re-resection also is shown to impact survival in a select group of patients. As adjuvant therapy continues to improve survival, the role of surgical resection in the treatment of glioblastoma looks to be further defined.

Keywords: Glioblastoma; neoplasm; neurosurgery; surgical resection; therapeutics.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Head CT without contrast showing a right sided hypodensity with mass effect. The lesion is compressing the right lateral ventricle and third ventricle while causing a midline shift.
Figure 2
Figure 2
MRI brain. (A) Axial image without contrast; (B) axial image with contrast showing a right basal ganglia heterogeneously enhancing lesion with a hypointense core, consistent with a tumor and necrotic core; (C) T2W image showing the fluid in the surrounding brain parenchymal around the lesion with a (D) FLAIR sequence that shows the actual parenchymal edema.
Figure 3
Figure 3
MRI brain. (A) Axial image with contrast showing a heterogeneously enhancing lesion in the splenium of the corpus callosum crossing midline along the white mater tracts; (B) FLAIR sequence showing the surrounding edema; and (C) coronal image, again, showing the tumor invading both sides of the hemispheres with a hypointense core, consistent with necrosis; (D) T2 sequence again showing the surrounding edema.
Figure 4
Figure 4
Example of MR spectroscopy with (A) region-of-interest (ROI) of non-tumor that was selected above the enhancing lesion followed by (C) ROI of the enhancing lesion; (B) showing the spectroscopy of non-tumor having the Cho/Cr <2.0 (1.04); (D) spectroscopy of tumor having the Cho/Cr >2.0 (2.04), decrease in NAA peak, and having a lactate peak. Cho, choline; Cr, creatinine; NAA, N-acetylaspartate.
Figure 5
Figure 5
FDG PET example demonstrating (A) MRI brain with contrast showing an enhancing lesion midline deep to the left motor strip with the corresponding (B) FDG PET scan showing increased metabolism (black arrow). FDG, 2-fluoro-2-deoxy-D-glucose; PET, positron emission tomography.
Figure 6
Figure 6
The pathology slide. a, atypical cells; b, mitosis; c, vascular proliferation; d, necrosis with “ghost cells”.
Figure 7
Figure 7
Intraoperative software (upper right) showing a 3D rendering of the patient with three of the four posts mounted into the patient’s skull with the frame. There is also a (green) line indicating the entry point selected by the surgeon. The other windows show the respective sagittal, axial, and coronal sections demonstrating the target and biopsy needle trajectory to the tumor.
Figure 8
Figure 8
Intraoperative 3D-tractography with integrated fMRI objects: orange—corticospinal tracts; red—tumor; blue—lips; yellow—left hand; green—right hand; pink—optical radiation. fMRI, functional MRI.
See this image and copyright information in PMC

References

    1. Louis DN, International Agency for Research on Cancer, World Health Organization. WHO classification of tumours of the central nervous system. 4th ed. Lyon: International Agency for Research on Cancer, 2007.
    1. Ostrom QT, Gittleman H, Liao P, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. Neuro Oncol 2014;16 Suppl 4:iv1-63. - PMC - PubMed
    1. Ellor SV, Pagano-Young TA, Avgeropoulos NG. Glioblastoma: background, standard treatment paradigms, and supportive care considerations. J Law Med Ethics 2014;42:171-82. - PubMed
    1. Snyder H, Robinson K, Shah D, et al. Signs and symptoms of patients with brain tumors presenting to the emergency department. J Emerg Med 1993;11:253-8. - PubMed
    1. Witwer BP, Moftakhar R, Hasan KM, et al. Diffusion-tensor imaging of white matter tracts in patients with cerebral neoplasm. J Neurosurg 2002;97:568-75. - PubMed