Certo Francesco, Stummer Walter, Farah Jibril O, Freyschlag Christian, Visocchi Massimiliano, Morrone Antonio, Altieri Roberto, Toccaceli Giada, Peschillo Simone, Thomè Claudius, Jenkinson Michael, Barbagallo Giuseppe
Department of Neurological Surgery, G. Rodolico Polyclinic University Hospital, Catania, Italy -
Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy -
J Neurosurg Sci. 2019 Dec;63(6):625-632. doi: 10.23736/S0390-5616.19.04787-8. Epub 2019 Jul 29.
Glioblastoma treatment requires a multidisciplinary approach involving oncologists, radiotherapists and surgeons. Surgery constitutes the initial step of the therapeutic strategy and its efficacy is dependent on the extent of resection (EOR). Over the last decade, the goal of surgical treatment was the resection of the contrast enhancement on T1 MRI, defined as gross-total resection (GTR). More recently, an increasing number of studies reports a positive impact on survival parameters of a more aggressive surgical strategy aiming to resect all peri-tumoral infiltrated areas. These areas are histologically characterized by the presence of pathological cells infiltrating normal white matter and surround the neoplastic core of glioblastoma identified by gadolinium enhancement in T1-weighted MR. Intuitively, the major risk of the so called supramarginal resection is related to the possibility of resecting functionally eloquent brain tissue. Several strategies have been proposed to maximize the safety of resection and minimize the occurrence of postoperative functional deficits. The aim of this review was to focus on the clinical impact of supramarginal resection of glioblastomas, highlighting the role of image-guided surgery combined with neuromonitoring to increase surgical safety and efficacy.
The MEDLINE database has been queried for the literature research.
Ten studies matched the inclusion criteria, reporting a global number of 3221 patients.
The current evidence suggests a positive correlation between a more extensive resection based on FLAIR abnormal areas and overall survival.
胶质母细胞瘤的治疗需要肿瘤学家、放疗科医生和外科医生多学科协作。手术是治疗策略的第一步，其疗效取决于切除范围（EOR）。在过去十年中，手术治疗的目标是切除T1加权磁共振成像（MRI）上的强化灶，即全切除（GTR）。最近，越来越多的研究报告称，一种更积极的手术策略对生存参数有积极影响，该策略旨在切除所有肿瘤周围浸润区域。这些区域在组织学上的特征是存在浸润正常白质的病理细胞，并围绕T1加权磁共振成像中钆增强所确定的胶质母细胞瘤肿瘤核心。直观地说，所谓的超边缘切除的主要风险与切除功能明确的脑组织的可能性有关。已经提出了几种策略来最大限度地提高切除的安全性，并尽量减少术后功能缺陷的发生。本综述的目的是关注胶质母细胞瘤超边缘切除的临床影响，强调影像引导手术结合神经监测在提高手术安全性和疗效方面的作用。
已查询MEDLINE数据库进行文献研究。
十项研究符合纳入标准，共报告了3221例患者。
目前的证据表明，基于液体衰减反转恢复序列（FLAIR）异常区域的更广泛切除与总生存期之间存在正相关。
