Glioblastoma multiforme surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[2]

Overview

Surgery is the mainstay of treatment for glioblastoma multiforme. The aim of surgery is to Make a definitive diagnosis. Debulk the tumor to relieve elevated intracranial pressure, reduce the tumor mass as a precursor to adjuvant treatment. Removal of 98% or more of the tumor has been associated with a better prognosis. using an intraoperative imaging control could increase the aggressiveness of the surgical procedure

Surgery

1. Surgery is the mainstay of treatment for glioblastoma multiforme.

• The aim of surgery is to:
  • Make a definitive diagnosis
  • Debulk the tumor to relieve elevated intracranial pressure
  • Reduce the tumor mass as a precursor to adjuvant treatment
• Removal of 98% or more of the tumor has been associated with a better prognosis.
• The chances of near-complete initial removal of the tumor can be greatly increased if the surgery is guided by a fluorescent dye known as 5-aminolevulinic acid.
• Glioblastoma multiforme tumor cells are widely infiltrative through the brain at diagnosis. Despite a near-total resection, majority of people with glioblastoma multiforme develop recurrence, either at the original site or at distant satellite lesions within the brain.

2. CSF shunting is performed to relieve the pressure in the brain due to blockade in the flow of cerebrospinal fluid by the tumor.

• External ventricular drain
  • Temporary shunt
• Internal drain
  • Permanent shunt
  • Drains CSF into the patient’s abdomen, where it is absorbed into the body

Indication for using intra-operative MRI

• the best indication for using an ioMRI appears to be when a GTR/NTR resection seems preoperatively possible associated with a low permanent morbidity.
• Three factors should play a major role:

1. the tumor location at distance from an eloquent area
2. the surgeon's experience
3. the patient desire

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