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Congress of neurological surgeons systematic review and evidence-based guidelines update on the role of cytoreductive surgery in the management of progressive glioblastoma in adults



In patients with previously diagnosed glioblastoma who are suspected of experiencing progression, does repeat cytoreductive surgery improve progression free survival or overall survival compared to alternative interventions?

Target population

These recommendations apply to adults with previously diagnosed glioblastoma who are suspected of experiencing progression of the neoplastic process and are amenable to surgical resection.


Level II: Repeat cytoreductive surgery is recommended in progressive glioblastoma patients to improve overall survival.

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Fig. 1

Data availability

The studies used to compile the dataset for the current manuscript are available through PubMed. All authors have ensured all data and materials as well as software applications or custom code supports their published claims and comply with field standards.



Complete resection of enhancing tumor


Extent of resection


Glioblastoma multiforme


Karnofsky Performance Status


Magnetic resonance imaging


Progression free survival


Stereotactic biopsy




Overall survival


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The guidelines task force would like to acknowledge the Congress of Neurological Surgeons Guidelines Committee for their contributions throughout the development of the guideline, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Review Committee for their review, comments, and suggestions throughout peer review, as well as the contributions of Trish Rehring, MPH, CHES, Senior Manager of Clinical Practice Guidelines for the CNS, and Mary Bodach, MLIS, from the Congress of Neurological Surgeons Guidelines Office for organizational assistance and reference librarian services, respectively as well as Jeremy Kupsco, PhD, Informationist, Emory University, for their valuable input as Medical Research Librarians. Throughout the review process, the reviewers and authors were blinded from one another. At this time the guidelines task force would like to acknowledge the following individual peer reviewers for their contributions: John O’Toole, MD, Brian Howard, MD, Jamie Van Gompel, MD, Howard Silberstein, MD, Navid Redjal, MD and Shawn Hervey-Jumper, MD.

Disclaimer of liability

This clinical systematic review and evidence-based guideline was developed by a physician volunteer task force as an educational tool that reflects the current state of knowledge at the time of completion. The presentations are designed to provide an accurate review of the subject matter covered. This guideline is disseminated with the understanding that the recommendations by the authors and consultants who have collaborated in its development are not meant to replace the individualized care and treatment advice from a patient's physician(s). If medical advice or assistance is required, the services of a physician should be sought. The proposals contained in this guideline may not be suitable for use in all circumstances. The choice to implement any particular recommendation contained in this guideline must be made by a managing physician in light of the situation in each particular patient and on the basis of existing resources.

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All authors listed on this publication agree with the content included and give explicit consent to the submission of this publication. The authors obtained consent from the responsible authorities at the institute/organization where the work has been carried out, before the work was submitted. All authors whose names appear on the submission: (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Hayes H. Patrick.

Ethics declarations

Conflict of interest

All Guideline Task Force members were required to disclose all potential COIs prior to beginning work on the guideline, using the COI disclosure form of the AANS/CNS Joint Guidelines Review Committee. The CNS Guidelines Committee and Guideline Task Force Chair reviewed the disclosures and either approved or disapproved the nomination and participation on the task force. The CNS Guidelines Committee and Guideline Task Force Chair may approve nominations of task force members with possible conflicts and restrict the writing, reviewing, and/or voting privileges of that person to topics that are unrelated to the possible COIs. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this series of articles.


These guidelines were funded exclusively by the Congress of Neurological Surgeons (CNS) and the Joint Section on Tumors, which received no funding from outside commercial sources to support the development of this document.

Ethical approval

All authors involved in this review have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this series of articles. The authors declare that they have no conflict of interest.

Informed consent

Informed consent was not necessary for obtaining data for this review.

Research involving human and animal rights

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

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Sponsors: Congress of Neurological Surgeons (CNS) and the Section on Tumors.

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Patrick, H.H., Sherman, J.H., Elder, J.B. et al. Congress of neurological surgeons systematic review and evidence-based guidelines update on the role of cytoreductive surgery in the management of progressive glioblastoma in adults. J Neurooncol 158, 167–177 (2022).

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  • Glioblastoma
  • Recurrent
  • Cytoreductive surgery