EANS-EANO guidelines on the extent of resection in gliomas

Roland Goldbrunner^{1

2}, Nicolas Foroglou³, Francesco Signorelli⁴, Philippe Schucht⁵, Asgeir S Jakola^{6

7}, Giuseppe Minniti^{8

9}, Radoslaw Rola¹⁰, Mirjam Renovanz^{11

12

13}, Matthias Preusser¹⁴, Julia Furtner¹⁵, Rachel Grossman¹⁶, Christian Mawrin¹⁷, Andreas Demetriades¹⁸, Michael Weller¹⁹, Matthias Simon²⁰

Affiliations

¹ Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
² Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.
³ Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁴ Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences, University "Aldo Moro" of Bari, Bari, Italy.
⁵ Department of Neurosurgery, Bern University Hospital, Bern, Switzerland.
⁶ Section of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.
⁷ Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Department of Radiological Sciences, Oncology, and Anatomical Pathology, Sapienza University of Rome, Rome, Italy.
⁹ IRCCS Neuromed, Pozzilli, IS, Italy, (G.M.).
¹⁰ Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin, Poland.
¹¹ Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany.
¹² Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.
¹³ Department of Neurosurgery, University Hospital, Tübingen, Germany.
¹⁴ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
¹⁵ Research Center MIAAI (Medical Image Analysis and Artificial Intelligence), Danube Private University, Krems-Stein, Austria.
¹⁶ Brain Tumor Center, Department of Neurosurgery, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
¹⁷ Department of Neuropathology, Otto-Von-Guericke University, Magdeburg, Germany.
¹⁸ Department of Neurosurgery, Royal Infirmary, Edinburgh, UK.
¹⁹ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
²⁰ Department of Neurosurgery, Bethel Clinic, University of Bielefeld, Medical Center Ostwestfalen-Lippe, Bielefeld, Germany.

PMID: 40973061
PMCID: PMC12962633 (available on 2026-09-17)
DOI: 10.1093/neuonc/noaf217

Practice Guideline

EANS-EANO guidelines on the extent of resection in gliomas

Roland Goldbrunner et al. Neuro Oncol. 2026.

. 2026 Jan 1;28(1):38-54.

doi: 10.1093/neuonc/noaf217.

Authors

Affiliations

¹ Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
² Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany.
³ Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁴ Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences, University "Aldo Moro" of Bari, Bari, Italy.
⁵ Department of Neurosurgery, Bern University Hospital, Bern, Switzerland.
⁶ Section of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.
⁷ Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Department of Radiological Sciences, Oncology, and Anatomical Pathology, Sapienza University of Rome, Rome, Italy.
⁹ IRCCS Neuromed, Pozzilli, IS, Italy, (G.M.).
¹⁰ Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin, Poland.
¹¹ Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany.
¹² Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.
¹³ Department of Neurosurgery, University Hospital, Tübingen, Germany.
¹⁴ Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
¹⁵ Research Center MIAAI (Medical Image Analysis and Artificial Intelligence), Danube Private University, Krems-Stein, Austria.
¹⁶ Brain Tumor Center, Department of Neurosurgery, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
¹⁷ Department of Neuropathology, Otto-Von-Guericke University, Magdeburg, Germany.
¹⁸ Department of Neurosurgery, Royal Infirmary, Edinburgh, UK.
¹⁹ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
²⁰ Department of Neurosurgery, Bethel Clinic, University of Bielefeld, Medical Center Ostwestfalen-Lippe, Bielefeld, Germany.

PMID: 40973061
PMCID: PMC12962633 (available on 2026-09-17)
DOI: 10.1093/neuonc/noaf217

Abstract

Intense efforts are employed to optimize neurosurgical resection of gliomas in different clinical scenarios. However, the level of evidence employed toward personalized treatment decisions is still moderate. Therefore, a joint task force was created by the European Association for Neurosurgical Societies (EANS) and the European Association of Neuro-Oncology (EANO) in order to provide interdisciplinary guidance on the extent of resection (EOR) in glioma surgery. This task force assessed the data on the EOR in gliomas, evaluated the level of evidence, and composed recommendations. The EOR is determined routinely by postoperative magnetic resonance imaging. Since EOR may be associated with survival and may have an impact on epilepsy, neurocognition, quality of life, neurological status, and also on planning of radiation and pharmacotherapy (evidence classes I-IV), recommendations of different levels can be made for the resection of newly diagnosed glioblastomas (level A), recurrent glioblastomas (level C), newly diagnosed (level B) and recurrent (good practice point) IDH mutant gliomas, ependymomas in children (level B) and adults (good practice point) as well as World Health Organization CNS grade 1 tumors (good practice point). We hereby report the outcome of this collaborative effort by the joint task force between EANS and EANO.

Keywords: glioblastoma; glioma; prognosis; resection; surgery; survival.

© The Author(s) 2025. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Conflict of interest statement

R.G.: none, N.F.: none, F.S.: none, P.S.: none, A.S.J.: none, G.M.: honoraria for lectures, consultation, or advisory board participation from Brainlab, Accuray, Servier, Astra-Zeneca, Pfizer, and Novocure. R.R.: none, M.R.: funding for IIT (Novocure), M.P.: honoraria for lectures, consultation or advisory board participation from the following for-profit companies: Bayer, Bristol-Myers Squibb, Novartis, Gerson Lehrman Group (GLG), CMC Contrast, GlaxoSmithKline, Mundipharma, Roche, BMJ Journals, MedMedia, Astra Zeneca, AbbVie, Lilly, Medahead, Daiichi Sankyo, Sanofi, Merck Sharp & Dome, Tocagen, Adastra, Gan & Lee Pharmaceuticals, Janssen, Servier, Miltenyi, Böhringer-Ingelheim, Telix, Medscape, OncLive, Medac, Nerviano Medical Sciences, and ITM Oncologics GmbH. J.F.: honoraria for lectures, consultation, or advisory board participation from Novarits, Seagen, Sanova, and Servier. R.G.: none, C.M.: funding for IIT (Novocure), A.D.: none, M.W.: research grants from Novartis, Quercis, and Versameb, and honoraria for lectures or advisory board participation or consulting from Anheart, Bayer, Curevac, Medac, Neurosense, Novartis, Novocure, Orbus, Pfizer, Philogen, Roche, and Servier, and M.S.: none.

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EANS-EANO guidelines on the extent of resection in gliomas

Affiliations

EANS-EANO guidelines on the extent of resection in gliomas

Authors

Affiliations

Abstract

Conflict of interest statement

References

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Medical