Value of surgical intervention in the treatment of glioma

The benefit of cytoreductive surgery in the management of glioma remains speculative. We therefore reviewed all confirmed deaths in our Neuro-Oncology Program and examined various clinical factors related to survival. There were 63 patients (34 males/29 females), with an average age of 57.6 years. The pathology was glioblastoma in 44 and anaplastic astrocytoma in 19; median survival was 12 months. Forty patients underwent at least one craniotomy, following which 22.5% achieved a gross total resection, 23 had biopsy only. Only age and gross total resection of tumor as judged by postoperative MR (CT in 2 cases) correlated significantly with outcome. The subtotal craniotomy group and biopsy only cohort were indistinguishable (median survival 11 vs. 10 months, respectively). Although craniotomy associated with gross total resection results in enhanced survival (median 27 months), subtotal tumor excision offers little beyond a diagnosis. Therefore, careful and realistic preoperative assessment of glioma patients ought to be performed to determine optimal surgical management.