Supramaximal resection in primary brain tumors

In recent years, supramaximal resection has emerged as a critical surgical principle in the management of primary brain tumors, particularly gliomas. This approach goes beyond traditional gross total resection, typically limited to contrast-enhancing tumor margins on T1-weighted MRI in IDH-wildtype glioblastoma and the T2/FLAIR region in IDH-mutant glioma, while aiming to preserve neurological function. Growing evidence suggests that this more extensive resection, if performed safely, may confer survival benefits without compromising quality of life. In this chapter, we review the historical development, conceptual underpinnings, and clinical data supporting supramaximal resection. We also describe modern techniques-including intraoperative mapping and functional preservation strategies-that enable safe and effective implementation of this approach.