Challenges Associated with Reoperation in Patients with Glioma

Reoperation for glioma is increasingly common but there is neither firm agreement on the indications nor unequivocally proven benefit from clinical trials. Patient and tumor factors should be considered when offering reoperation and a clear surgical goal set. Reoperation is challenging because of placement of previous incisions, wound devascularization by preceding radiotherapy and/or chemotherapy, chronic steroid use, the need for further adjuvant therapy, and adherent and defective dura. This article reviews indications, challenges, and recommendations for repeat surgery in the patient with glioma.