Complications and expected outcome of glioma surgery

The management of patients with intracerebral glioma is focused upon the selection of treatment modalities that prolong survival while minimizing the risk of complications and maintaining an adequate quality of life. In the author's experience, patients with low-grade gliomas are best treated with gross total resection in order to decrease the risk of recurrence with higher grade lesions. In patients with high-grade glioma, age, Karnofsky Performance Status, histology and the use of radiotherapy are major predictors of survival. The extent of surgical resection is less important than these factors, but recent series support a survival advantage in patients that undergo more extensive surgery. The major complication from surgical resection is neurologic impairment. Careful preoperative planning with the assistance of functional MRI and intraoperative mapping is useful for accomplishing the maximum safe resection.