• Vol. 36 No. 5, 358–363
  • 15 May 2007

The Role of Surgery in High-grade Glioma – Is Surgical Resection Justified? A Review of the Current Knowledge



Introduction: The aims of this article were to review the role of surgical resection in the management of high-grade gliomas and to determine whether there is any survival benefit from surgical resection. Methods: A literature review of the influence of surgical resection on outcome was carried out. Relevant original and review papers were obtained through a PubMed search using the following keywords: glioma, resection, prognosis and outcome. Results: Presently, there is a lack of evidence to support a survival benefit with aggressive glioma resection, but this should not detract patients from undergoing surgery as there are many other clinical benefits of glioma excision. In addition, limiting surgical morbidity through the use of adjuvant techniques such as intraoperative magnetic resonance imaging (MRI), functional MRI and awake craniotomy is becoming increasingly important. Conclusions: Ideally, a randomised controlled trial would be the best way to resolve the issue of whether (and to what extent) surgical resection leads to improvements in patient outcome and survival, but this would not be ethical. The second best option would be well-controlled retrospective studies with a multivariate analysis of all potential confounding factors.

High-grade glioma (malignant glioma) is the most common primary intra-axial tumour of the central nervous system (CNS). Despite recent therapeutic advances in glioma treatment, the outcome for high-grade glioma has been disappointing. The first reported case of glioma resection was performed by Rickman Godlee in 1884.1 More than a century later, patient outcome remains poor with marginal improvement since the 1970s.2,3 The higher end of current reported mean survival is about 16 to 18 months, which is fairly similar to figures reported more than 20 years ago.4-6 The term glioblastoma, which refers to high-grade glioma, was introduced by Mallory7 in 1914 and is still in common use today. The oncologic principle of total tumour resection achieved by complete excision with a clear margin has improved survival drastically in many other solid organ malignant tumours. However, this is harder to achieve in glioma surgery due to potential neurological deficits that may be incurred with wide margin resection, especially when the tumour is situated near the eloquent cortex.8,9

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