Summary and Further Reading

Chapter 7 - Surgery, Indications and Limitations


  • Information about brain anatomy, tumour biology and cerebral function is essential
  • Histopathology and Biomarker profile should be determined for every glioma
  • FET-PET allows detection of “hot-spot“ areas in low-grade gliomas
  • Stereotactic biopsy is a safe and minimally invasive procedure
  • Only complete tumour resection has a positive prognostic impact in gliomas
  • Different imaging modalities can be integrated in modern neuronavigation systems
  • Intraoperative imaging update helps to achieve maximal safe resection
  • Use of 5-ALA increases the rate of complete resection in malignant gliomas
  • Intraoperative electrophysiological testing reduces long-term neurological deterioration
  • Awake craniotomy allows tumour resection in eloquent areas for speech

Further Reading

Capelle L, Fontaine D, Mandonnet E, et al; French Réseau d’Étude des Gliomes. Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases: clinical article. J Neurosurg 2013; 118:1157–1168.

Chang EF, Clark A, Smith JS, et al. Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival. Clinical article. J Neurosurg 2011; 114:566–573.

Duffau H. A two-level model of interindividual anatomo-functional variability of the brain and its implications for neurosurgery. Cortex 2017; 86:303–313.

Kreth FW, Thon N, Simon M, et al; German Glioma Network. Gross total but not incomplete resection of glioblastoma prolongs survival in the era of radiochemotherapy. Ann Oncol 2013; 24:3117–3123.

Kunz M, Thon N, Eigenbrod S, et al. Hot spots in dynamic 18FET-PET delineate malignant tumor parts within suspected WHO grade II gliomas. Neuro Oncol 2011; 13:307–316.

Sanai N, Mirzadeh Z, Berger MS. Functional outcome after language mapping for glioma resection. N Engl J Med 2008; 358:18–27.

Schnell O, Tonn J-C. Surgical resection: techniques, intraoperative update and outcome. In: Germano IM (Ed). Glioblastoma Multiforme: Symptoms, Diagnosis, Therapeutic Management and Outcome. New York: Nova Science Publishers Inc, 2015.

Senft C, Bink A, Franz K, et al. Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 2011; 12:997–1003.

Stummer W, Pichlmeier U, Meinel T, et al. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 2006; 7:392–401.

Suchorska B, Weller M, Tabatabai G, et al. Complete resection of contrast-enhancing tumor volume is associated with improved survival in recurrent glioblastoma – results from the DIRECTOR trial. Neuro Oncol 2016; 18:549–556.

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Last update: 18 September 2017