Surgical Treatment of Glioblastoma : Current Limitations and Future Possibilities

Abstract

  Glioblastomas are highly proliferative and invasive tumors ; therefore complete removal is typically not feasible. Several retrospective analyses suggest that maximal safe resection of glioblastoma may help improve the prognosis. Nevertheless, the indication for surgery should be carefully evaluated as improper patient selection for surgery may worsen the prognosis, especially for recurrent cases. Recent years have witnessed the development of several advanced surgery-related technologies such as tractography, intraoperative functional mapping, photodynamic diagnosis using 5-aminolevulinic acid, gliadel carmustine wafer treatment, and photodynamic therapy. Despite the advances in knowledge and technologies for surgical resection of glioblastoma, there are several unresolved issues ; these include the determination of the appropriate tumor resection boundary, the surgical indications for elderly patients with glioblastoma, lack of in-depth characterization of brain plasticity, development of surgical strategies based on molecular and genetic profile of tumor, and the establishment of modalities for immunotherapy. Resolution of these issues and further technological advances is expected to further improve the outcomes of glioblastoma surgery in the future.