Surgery

Chapter 4 - Treatment Strategies for Anaplastic Astrocytoma and Glioblastoma

Neurosurgical interventions are commonly performed initially to obtain tissue for histological and molecular diagnosis.

Surgery Figure 1

Courtesy A. Valavanis, Zurich

If lesions are not resectable, then a serial biopsy to obtain representative tissue samples should be considered.

Management decisions should almost never be made without histological confirmation of the suspected diagnosis.

Childhood diffuse intrinsic pontine gliomas (DIPG) are still commonly treated without histological confirmation.

Gross total resection is associated with improved outcome.

The superiority of partial tumour resection over biopsy alone has not been demonstrated.

Surgery Figure 3

 Courtesy J-C. Tonn, Munich

If the goal is gross total resection, various techniques for maximising the safety of resective surgery are available, including ultrasound, intraoperative magnetic resonance imaging (MRI) and the use of fluorescent dyes to label tumour tissue.

The role of surgery in recurrent gliomas remains controversial, but selected patients with resectable tumours recurring more than a few months after the first surgery may benefit.

Recurrent gliomas are likely to exhibit significant differences in their molecular profile compared with the primary tumours, probably justifying more surgical reinterventions in the future.

Revision Questions

  1. In which clinical situations is clinical decision-making feasible without verification of the histological diagnosis?
  2. Which technical means can be used to achieve a gross total resection?
  3. Which patients are candidates for re-resection of anaplastic astrocytoma or glioblastoma?

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Last update: 18 September 2017