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Updated: Aug 10, 2026
Image-Guided Resection of Glioblastoma and Intracranial Implantation of Therapeutic Stem Cell-seeded Scaffolds
Published on: July 16, 2018
Surgery for gliomas
1Department of Clinical Neurosciences, Edinburgh University, Western General Hospital, UK. irw@skull.dcn.ed.ac.uk
Purpose Of Review:
To assess selected papers on surgery for glioma for their impact on clinical practice.
Recent Findings:
Recent developments in surgical neuro-oncology for gliomas have centred around technological advances that enable the fusion of preoperative structural and functional imaging datasets, the use of intraoperative magnetic resonance imaging scanning, and awake craniotomy and cortical stimulation as means to maximize glioma resection, minimize postoperative morbidity, and improve survival times. Correlations of preoperative functional imaging information with operative awake neurophysiological findings are good, but the problem of brain shift during resective surgery remains problematical and is a cogent reason for using intraoperative magnetic resonance imaging. Two reviews showed little evidence to support the concept that 'aggressive' resection of both high and low-grade gliomas significantly prolongs the life of patients. Attempting radical excision of these tumours can have unfortunate consequences in eloquent brain regions, particularly as functional studies confirm brain activity within the limits of many gliomas.
Summary:
Despite amazing technical advances in the investigation, assessment and surgical management of patients with glioma, the lack of an evidence basis for 'aggressive' resective management continues to pose dilemmas for surgeons.
Insights
Despite surgical advances for gliomas, evidence for aggressive resection is lacking. Maximizing tumor removal while preserving function remains a challenge for neurosurgeons.
Area of Science:
- Neurosurgery
- Neuro-oncology
- Surgical Technology
Background:
- Glioma surgery has seen advancements in imaging and intraoperative techniques.
- Technological progress aims to improve glioma resection extent and patient outcomes.
Purpose of the Study:
- To evaluate the clinical impact of recent surgical papers on glioma treatment.
- To assess the evidence supporting aggressive resection strategies for gliomas.
Main Methods:
- Review of selected scientific literature on glioma surgery.
- Analysis of technological advancements like image fusion and intraoperative MRI.
- Evaluation of neurophysiological monitoring during awake craniotomy.
Main Results:
- Advanced techniques (image fusion, intraoperative MRI, awake craniotomy) aim to maximize resection and minimize morbidity.
- Correlation between preoperative imaging and intraoperative findings is good, but brain shift remains a challenge.
- Limited evidence suggests aggressive resection of gliomas significantly prolongs survival.
- Radical excision in eloquent brain areas carries risks due to functional activity within tumor margins.
Conclusions:
- Despite technological progress in glioma surgery, a lack of evidence for aggressive resection poses clinical dilemmas.
- Balancing maximal tumor removal with functional preservation remains a critical challenge for neurosurgeons.
