Surgery of malignant gliomas: advances and perspectives

One of the most controversial issues in the combined treatment of malignant gliomas is the role of surgical resection, even though the relevance of surgery in obtaining tissue diagnosis and alleviating clinical symptoms is well defined; more debated is the importance of radical surgery in improving the patient final outcome. This review aims to present an overview of the recommendations for surgical treatment of malignant gliomas, and to describe the potential role of locoregional treatments.

An increasing series of data are being collected in favour of radical surgical removal, with the support of intraoperative imaging and fluorescence guide. More controversial, but theoretically relevant, are the experiences of locoregional treatments, mainly in the contest of present combined modality treatments; different interesting approaches are being studied, without any significant therapeutical advantage in phase III studies, and only biodegradable carmustine wafers entered in the clinical practice.

The gold standard of surgical treatment of malignant gliomas has to include well tolerated and radical tumour removal, taking advantage of the introduction of new technological tools. The future role of neurosurgical treatment of malignant glioma is linked to intratumoural administration of antiblastic agents and the development of more efficient delivery systems; localized therapies have to be considered in a well defined multistep therapeutic strategy.