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Review
. 2022 May 16;12(5):652.
doi: 10.3390/brainsci12050652.

Supramarginal Resection for Glioblastoma: It Is Time to Set Boundaries! A Critical Review on a Hot Topic

Francesco Guerrini  1 , Elena Roca  2   3 , Giannantonio Spena  4
Affiliations
Review

Supramarginal Resection for Glioblastoma: It Is Time to Set Boundaries! A Critical Review on a Hot Topic

Francesco Guerrini et al. Brain Sci. .

Abstract

Glioblastoma are the most common primary malignant brain tumors with a highly infiltrative behavior. The extent of resection of the enhancing component has been shown to be correlated to survival. Recently, it has been proposed to move the resection beyond the contrast-enhanced portion into the MR hyper intense tissue which typically surrounds the tumor, the so-called supra marginal resection (SMR). Though it should be associated with better overall survival (OS), a potential harmful resection must be avoided in order not to create new neurological deficits. Through this work, we aimed to perform a critical review of SMR in patients with Glioblastoma. A Medline database search and a pooled meta-analysis of HRs were conducted; 19 articles were included. Meta-analysis revealed a pooled OS HR of 0.64 (p = 0.052). SMR is generally considered as the resection of any T1w gadolinium-enhanced tumor exceeding FLAIR volume, but no consensus exists about the amount of volume that must be resected to have an OS gain. Equally, the role and the weight of several pre-operative features (tumor volume, location, eloquence, etc.), the intraoperative methods to extend resection, and the post-operative deficits, need to be considered more deeply in future studies.

Keywords: Flairectomy; Glioblastoma; high-grade glioma; supramarginal resection.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
OS HRs Pooled Meta-Analysis.
Figure 2
Figure 2
A 56-year-old female suffered a single seizure (speech articulation impairment lasting 10 min). The upper figures (A,B) show pre-operative T1 gadolinium-enhanced MRIs of a Glioblastoma infiltrating the left supramarginal gyrus. The patient was operated on through an awake craniotomy and direct language mapping (C,D). Since the mapping did not show activation areas on the supramarginal gyrus, a complete gyrus resection was performed. (E) The post-operative MRI confirmed the complete resection not only of the tumor but also of the gyrus. Post-operatively, the patient did not experience any speech disturbances.
See this image and copyright information in PMC

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