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Two-Stage Surgery in Patients with Diffuse Glioma-Indications, Implications and Outcome
Sebastian Jeising1,2, Johannes Reinken3, Marion Rapp3,4
1Institute of Neuropathology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany.
Cancers
|March 14, 2026
Summary
Planned two-stage glioma surgery effectively increases maximal tumor resection in eloquent brain areas. This approach achieves significant tumor reduction without compromising patient neurological or functional status, offering a favorable risk-benefit profile despite potential complications.
Area of Science:
- Neurosurgery
- Oncology
- Brain Tumor Research
Background:
- Complete resection of intrinsic brain tumors is crucial but challenging in eloquent areas.
- Planned two-stage glioma surgery is an alternative strategy when single-stage resection is not feasible.
Purpose of the Study:
- To evaluate surgical outcomes of planned two-stage glioma surgery.
- To assess the efficacy and safety of this approach in achieving maximal tumor resection.
Main Methods:
- Retrospective analysis of 36 patients undergoing planned two-stage glioma surgery between 2013-2023.
- Two-stage surgery defined as re-intervention within 6 weeks of the initial surgery.
- Evaluation of resection extent, functional status (KPS, NIHSS), and complications.
Main Results:
- Planned two-stage surgery was primarily used for gliomas in eloquent locations (61.11%), often requiring multifocal approaches (47.2%).
- Maximal and supramaximal resection rates increased from 0% to 58.88% after the second surgery, significantly reducing residual tumor volume (p < 0.001).
- No significant changes in functional (KPS) or neurological (NIHSS) status were observed; however, 16.67% experienced severe perioperative complications (Clavien-Dindo grade IIIb/IV).
Conclusions:
- Planned two-stage surgery is a viable strategy for maximizing glioma resection in eloquent brain regions.
- This approach achieves significant tumor reduction without functional decline, presenting a favorable risk-benefit ratio.
- Staged multifocal approaches and primary debulking followed by staged resection warrant consideration in complex glioma cases.
