Maximizing safe resection of low- and high-grade glioma

Abstract

Surgical resection plays a central role in the management of gliomas. In this study, we review the evidence in support of extent of resection to improve survival, symptom management, and time to malignant transformation in low- and high-grade gliomas, and summarize the findings from our literature search regarding the role of extent of resection and intraoperative practices to maximize safety. There is a growing body of evidence supporting improved overall survival, improved progression-free survival, and superior quality of life with greater extent of resection. Additionally, a better understanding of central nervous system plasticity allows for a staged approach to the surgical management of low- and intermediate-grade gliomas. A number of intraoperative techniques have been utilized to offer safer glioma surgery with greater extent of resection. Approaches such as awake brain tumor surgery can be safely performed with low failure rates and excellent long-term functional outcomes.

Keywords: 5-ALA; Awake craniotomy; Brain mapping; CNS plasticity; Cortical stimulation mapping; Extent of resection; Glioblastoma; Glioma; High-grade glioma; Intraoperative MRI; Low-grade glioma.