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Updated: Oct 20, 2025
Image-Guided Resection of Glioblastoma and Intracranial Implantation of Therapeutic Stem Cell-seeded Scaffolds
Published on: July 16, 2018
Extending the multistage surgical strategy for recurrent initially low-grade gliomas: functional and oncological
Noor Hamdan1,2, Hugues Duffau3,4,5
11Department of Neurosurgery, Jean Minjoz Hospital, Besançon University Medical Center, Besançon.
Objective:
Maximal safe resection is the first treatment in diffuse low-grade glioma (DLGG). Due to frequent tumor recurrence, a second surgery has already been reported, with favorable results. This study assesses the feasibility and functional and oncological outcomes of a third surgery in recurrent DLGG.
Methods:
Patients with DLGG who underwent a third functional-based resection using awake mapping were consecutively selected. They were classified into group 1 in cases of slow tumor regrowth or group 2 if a radiological enhancement occurred during follow-up. All data regarding clinicoradiological features, histomolecular results, oncological treatment, and survival were collected.
Results:
Thirty-one patients were included, with a median age of 32 years. There were 20 astrocytomas and 11 oligodendrogliomas in these patients. Twenty-one patients had medical oncological treatment before the third surgery, consisting of chemotherapy in 19 cases and radiotherapy in 8 cases. No neurological deficit persisted after the third resection except mild missing words in 1 patient, with 84.6% of the patients returning to work. The median follow-up duration was 13.1 ± 3.4 years since diagnosis, and 3.1 ± 2.9 years since the third surgery. The survival rates at 7 and 10 years were 100% and 89.7%, respectively, with an estimated median overall survival of 17.8 years since diagnosis. A comparison between the groups showed that the Karnofsky Performance Scale score dropped below 80 earlier in group 2 (14.3 vs 17.1 years, p = 0.01). Median residual tumor volume at the third surgery was smaller (2.8 vs 14.4 cm3, p = 0.003) with a greater extent of resection (89% vs 70%, p = 0.003) in group 1.
Conclusions:
This is the first consecutive series showing evidence that, in select patients with progressive DLGG, a third functional-based surgery can be achieved using awake mapping with low neurological risk and a high rate of total resection, especially when reoperation is performed before malignant transformation.
Insights
A third surgery for diffuse low-grade glioma (DLGG) is feasible and safe, offering high resection rates with minimal neurological impact. This approach is particularly beneficial before tumor progression or malignant transformation.
Area of Science:
- Neurosurgery
- Oncology
- Neuro-oncology
Background:
- Maximal safe resection is the primary treatment for diffuse low-grade glioma (DLGG).
- Recurrent DLGG may necessitate repeat surgeries, with second resections showing favorable outcomes.
- The feasibility and outcomes of a third surgical intervention for DLGG remain less explored.
Purpose of the Study:
- To assess the feasibility of a third surgery in recurrent diffuse low-grade glioma.
- To evaluate the functional and oncological outcomes of a third surgical resection in DLGG patients.
- To determine the safety and efficacy of repeat surgery in managing progressive DLGG.
Main Methods:
- A consecutive series of DLGG patients undergoing a third functional-based resection using awake mapping were selected.
- Patients were categorized based on tumor regrowth patterns (slow vs. radiological enhancement).
- Clinicoradiological, histomolecular, oncological treatment, and survival data were collected and analyzed.
Main Results:
- Thirty-one patients (median age 32) with astrocytomas and oligodendrogliomas underwent third surgery.
- No significant neurological deficits persisted post-surgery, with 84.6% returning to work.
- Median overall survival was 17.8 years, with 7- and 10-year survival rates of 100% and 89.7%, respectively.
Conclusions:
- A third functional-based surgery for progressive DLGG is achievable with low neurological risk.
- High rates of total resection were observed, particularly when performed before malignant transformation.
- This study provides evidence for the safety and efficacy of repeat surgical interventions in select DLGG patients.
