Craniotomy (brain tumor resection) for Glioblastoma

 

Aggressive surgical resection of malignant gliomas has been controversial, because of the concern that the benefit to the patient did not outweigh the risk of complications.

In general the NCCN guidelines recommend maximal surgical resection if it can be safely done (see NCCN). A recent study from MD Anderson (Cancer Control 2003;10:109.) noted that with modern surgery the risk of complications is only 8.5% and surgical mortality 1.7%. They noted that in those patients who had complete resections (98%or more based on postOp MRI) the survival was improved (13.4 months compared to only 8.8 months for those with lesser resections.)

In a study of 416 patients who underwent resection for Glioblastoma Multiforme, the devised an outcome scoring system and then noted the survival based on outcome score and degree of resection as noted below:

Outcome Scoring System
tumor necrosis on MRI Score
yes 2
no 0
Age in years  
< 45 0
45-64 1
65 or older 2
Karnofsky score  
< 80 1
80 -100 0

Outcome Based on Score and Degree of Surgical Resection
Score Group # of patients Median Survival Resection 98% Less Resection
0 A 15 35.3 months 35.3 months 32.8 months
1-2 B 89 14.9 months 19.0 months 10.9 months
3 C 184 10.7 months 13.1 months 8.3 months
4-5 D 128 8.2 months 8.6 months 7.8 months