Abstract
The role of surgery in malignant gliomas under the assistance of modern multi-modal navigation systems was retrospectively analyzed. The patients in this study included 12 with anaplastic astrocytomas and 38 with glioblastomas, all of which presented as supratentorial hemispheric tumors in adults. The navigation systems used consisted of echo-linked real time navigation, fluorescence-guided tumor detection and functional mapping with subcortical stimulation. The mean rate of tumor resection was 92% in non-eloquent areas and 88% in eloquent areas. About half of the tumors in eloquent areas were resected by 95% and more. The extensive resection used in the glioblastomas did not deteriorate these patient's postoperative KPS scores, but rather improved them. Although three patients with 100% resection of their glioblastoma survived longer than three years, extensive resection of 95% and more did not significantly prolong either the overall survival or progression-free survival compared to a tumor resection of less than 95% in glioblastomas. Median survival time (MST) in resections of 95% and more in glioblastoma was 18.5 months and MST in resections of less than 95% of the tumor was 12.6 months. The modern multi-modal navigation systems enabled the extensive resection of malignant gliomas without compromising neuronal function, but any significance of the extent of tumor resection in prognosis remains unclear.
