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Novel Surgical Approaches to High-Grade Gliomas

  • Neuro-oncology (R Soffietti, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Treatment of patients with high-grade glioma (HGG) should begin with thorough evaluation by a specialized multidisciplinary team to determine whether or not the patient is appropriate for surgery, chemotherapy and radiotherapy. Particular attention should be paid to the performance status and neurological function. Surgery is the first step in therapeutic intervention. Patients undergo either biopsy, debulking surgery or maximal resection depending on the anatomical location of the tumour and the patient’s clinical condition. Extent of resection has a prognostic value. In patients who are ‘fit for surgery’, the aim is to remove all contrast-enhancing tumour without causing neurological deficit. If microsurgical resection is not feasible, then a biopsy, either open or stereotactic, should be performed to confirm high-grade glioma diagnosis and to perform molecular genetic analyses (MGMT methylation status, loss of heterozygosity in 1p/19q, IDH1 status) as this has treatment implications. Over the past decade, much glioma research has focussed on novel surgical approaches to improve long-term outcomes. The evidence to support the benefit of maximizing extent of resection is growing. Advances in neurosurgical techniques allow safer, more aggressive surgery to maximize tumour resection whilst minimizing neurological deficit. Surgical adjuncts including advanced neuronavigation, intraoperative magnetic resonance imaging, high-frequency ultrasonography, fluorescence-guided microsurgery using intraoperative fluorescence, functional mapping of motor and language pathways, and locally delivered therapies are extending the armamentarium of the neurosurgeon to provide patients with the best outcome. Operating on elderly patients and those with recurrent disease, although controversial, is becoming more common due to emerging neurosurgical approaches. Here, we discuss the emerging surgical techniques and comment on the future of HGG surgery.

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Acknowledgments

Cancer Research UK, The Brain Tumour Charity and The University of Cambridge Biomedical Research Centre support CW. FTR is supported by the Medical Research Council.

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Fahid Tariq Rasul and Colin Watts declare no conflicts of interest

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Clinical Neurosciences, Brain Repair Centre, University of Cambridge, ED Adrian Building, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK

    Fahid Tariq Rasul BSc, MBBS, MRCS, MSc

  2. Department of Clinical Neurosciences Division of Neurosurgery, Cambridge Biomedical Campus, University of Cambridge, ED Adrian Building, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK

    Colin Watts MBBS, PhD, FRCS

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  1. Fahid Tariq Rasul BSc, MBBS, MRCS, MSc
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  2. Colin Watts MBBS, PhD, FRCS
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Correspondence to Colin Watts MBBS, PhD, FRCS.

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This article is part of the Topical Collection on Neuro-oncology

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Rasul, F.T., Watts, C. Novel Surgical Approaches to High-Grade Gliomas. Curr Treat Options Neurol 17, 38 (2015). https://doi.org/10.1007/s11940-015-0369-y

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