Skip to main content
SpringerLink
Log in

Basic Surgical Techniques in the Resection of Malignant Gliomas

  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Although progress is being made in the imaging and medical therapy of malignant gliomas, surgery continues to play a central role in the management of these tumors. Surgery remains necessary for histological diagnosis and relief of mass effect upon adjacent neurological structures. Surgery also achieves cytoreduction of tumor mass, allowing more effective treatment of residual tumor volume. Recent technical advances have made the goal of gross total tumor resection safer and more readily achieved. Surgical techniques and adjuncts that aid the aggressive surgical resection of malignant gliomas will be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Berger MS: Malignant astrocytomas: Surgical aspects. Sem Oncol 21: 172–185, 1994

    Google Scholar 

  2. Ciric I, Ammirati M, Vick N, Mikhael M: Supratentorial gliomas: Surgical considerations and immediate postoperative results: Gross total resection versus partial resection. Neurosurgery 21: 21–26, 1987

    PubMed  Google Scholar 

  3. Ciric I, Rovin R, Cozzens JW, Eller TW, Vick NA, Mikhael MA: Role of surgery in the treatment of malignant cerebral gliomas. In: Apuzzo MLJ (ed) Malignant Cerebral Glioma, American Association of Neurological Surgeons, Park Ridge, IL, 1990, pp 141–153

    Google Scholar 

  4. Curran WJ, Scott CB, Horton J, Nelson JS, Weinstein AS, Fishbach AJ, Chang CH, Rotman M, Asbell SO, Krisch RE, Nelson DF: Recursive partitioning analysis of prognostic factors in three radiation therapy oncology group malignant glioma trials. J Natl Cancer Inst 85: 704–710, 1993

    PubMed  Google Scholar 

  5. Fadul C, Wood J, Thaler H, Galicich J, Patterson RH Jr, Posner JB: Morbidity and mortality of craniotomy for excision of supratentorial gliomas. Neurol 38: 1374–1379, 1988

    Google Scholar 

  6. Hirakawa K, Suzuki K, Ueda S, Nakagawa Y, Yoshino E, Ibayashi N, Hayashi K: Multivariate analysis of factors affecting postoperative survival in malignant astrocytoma. J Neurooncol 2: 331–340, 1984

    PubMed  Google Scholar 

  7. Medical Research Council Brain Tumour Working Party: Prognostic factors for high-grade malignant glioma: Development of prognostic index. J Neurooncol 9: 47–55, 1990

    Google Scholar 

  8. Quigley MR, Flores N, Maroon JC, Sargent B, Lang S, Elrifai A: Value of surgical intervention in the treatment of glioma. Stereotact Funct Neurosurg 65: 171–1175, 1995

    PubMed  Google Scholar 

  9. Salcman M: Glioblastoma and malignant astrocytoma. In: Kaye AH, Laws ER (eds) Brain Tumors. Churchill Livingstone, London, pp 449–477, 1995

    Google Scholar 

  10. Salcman M: The role of surgery in brain tumor management: Malignant glioma management. Neurosurg Clin N Am 1: 49–63, 1990

    PubMed  Google Scholar 

  11. Salcman M, Scholtz H, Kaplan RS, Kulik S: Long-term survival in patients with malignant astrocytoma. Neurosurgery 34: 213–219, 1994

    PubMed  Google Scholar 

  12. Sawaya R: Neurosurgery issues in oncology. Curr Opin Oncol 3: 459–466, 1991

    PubMed  Google Scholar 

  13. Vecht CJ, Avezaat CJJ, van Putten WLJ, Eijkenboom WMH, Stefanko SZ: The influence of the extent of surgery on the neurologic function and survival in malignant glioma. A retrospective analysis in 243 patients. J Neurol Neurosurg Psychiatry 53: 466–471, 1990

    PubMed  Google Scholar 

  14. Wood JR, Green SB, Shapiro WR: The prognostic importance of tumor size in malignant gliomas:Acomputed tomographic scan study by the brain tumor cooperative group. Clin Oncol 2: 338–343, 1988

    Google Scholar 

  15. Ojemann JG, Miller JW, Silbergeld DL: Preserved function in brain invaded by tumor. Neurosurgery 39: 253–258, 1996

    PubMed  Google Scholar 

  16. Silbergeld DL, Chicoine MR: Isolation and characterization of human malignant glioma cells from histologically normal brain. J Neurosurg 86: 525–531, 1997

    PubMed  Google Scholar 

  17. Ammirati M, Galicich JH, Arbit E, Liao Y: Reoperation in the treatment of recurrent intracranial malignant gliomas. Neurosurgery 21: 607–614, 1987

    PubMed  Google Scholar 

  18. Harsh GR 4th, Levin VA, Gutin PH, Seager M, Silver P, Wilson CB: Reoperation for recurrent glioblastoma and anaplastic astrocytoma. Neurosurgery 21: 615–621, 1987

    PubMed  Google Scholar 

  19. Graf CJ, Rossi NP: Catecholamine response to intracranial hypertension. J Neurosurg 49: 862–868, 1978

    PubMed  Google Scholar 

  20. Edmunds-Seal J, Prys-Roberts C, Adams AP: Air embolism. A comparison of various methods of detection. Anaesthesia 26: 202–298, 1971

    PubMed  Google Scholar 

  21. Van Hemelrijck J, Van Aken H, Plets C, Goffin J, Vermaut G: The effects of propofol on intracranial pressure and cerebral perfusion pressure in patients with brain tumors. Acta Anaesthesiol Belg 40: 95–100, 1989

    PubMed  Google Scholar 

  22. Newberg LA, Milde JH, Michenfelder JD: Cerebral protection by isoflurane during hypoxemia or ischemia. Anesthesiology 59: 23–28, 1983

    PubMed  Google Scholar 

  23. Kitaguchi K, Ohsumi H, Kuro M, Nakajima T, Hayashi Y: Effects of sevoflurane on cerebral circulation and metabolism in patients with ischemic cerebrovascular disease. Anesthesiology 79: 704–709, 1993

    PubMed  Google Scholar 

  24. Holaday DA, Smith FR: Clinical characteristics and biotransformation of sevoflurane in healthy human volunteers. Anesthesiology 54: 100–106, 1981

    PubMed  Google Scholar 

  25. Warner DS, Boehland LA: Effects of iso-osmolar intravenous fluid therapy on post-ischemic brain water content in the rat. Anesthesiology 68: 86–91, 1988

    PubMed  Google Scholar 

  26. Lanier WL, Stangland KJ, Scheithauer BW, Milde JH, Michenfelder JD: The effects of dextrose infusion and head position on neurologic outcome after complete cerebral ischemia in primates: examination of a model. Anesthesiology 66: 39–48, 1987

    PubMed  Google Scholar 

  27. Pulsinelli WA, Levy DE, Sigsbee B, Scherer P, Plum F: Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. Am J Med 74: 540–544, 1983

    PubMed  Google Scholar 

  28. Sawaya R, Donlon JA: Chronic disseminated intravascular coagulation and metastatic brain tumor: A case report and review of the literature. Neurosurgery 12: 580–584, 1983

    PubMed  Google Scholar 

  29. Brain AIJ: The laryngeal mask airway-a new concept in airway management. Br J Anaesth 55: 801–805, 1983

    PubMed  Google Scholar 

  30. Costa e Silva L, Brimacombe JR: Tracheal tube/laryngeal mask exchange for emergence. Anesthesiology 85: 218, 1996

    PubMed  Google Scholar 

  31. Hammoud MA, Ligon BL, El Souki R, Shi WM, Schomer DF, Sawaya R: Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging. J Neurosurg 84: 737–741, 1996

    PubMed  Google Scholar 

  32. Barnett GH, McKenzie RL, Ramos L, Palmer J: Nonvolumetric stereotaxy-assisted craniotomy. Results in 50 consecutive cases. Stereotact Funct Neurosurg 61: 80–95, 1993

    PubMed  Google Scholar 

  33. Barnett GH, Kormos D, Steiner C, Weisenberger: Use of a sonic digitizing arm for frameless stereotaxy. Neurosurgery 33: 674–678, 1993

    PubMed  Google Scholar 

  34. Kelly PJ, Kall BA, Goerss S, Earnest F IV: Computerassisted stereotaxic laser resection of intra-axial brain neoplasms. J Neurosurg 64: 427–439, 1986

    PubMed  Google Scholar 

  35. Masciopinto J, Preston JK, Salamat MS, Badhie B: Microscopic evidence of intraoperative tumor dissemination with the use of ultrasonic aspirators. (Abstract) Proceedings of the 47th Annual Meeting of the Congress of Neurological Surgeons: 503–504, 1997

  36. Kreth FW, Warnke PC, Scheremet R, Ostertag CB: Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78: 762–766, 1993

    PubMed  Google Scholar 

  37. Devaux BC, O'Fallon JR, Kelly PJ: Resection, biopsy, and survival in malignant glial neoplasms. J Neurosurg 78: 767–775, 1993

    PubMed  Google Scholar 

  38. Iacoangeli M, Roselli R, Prezioso A, Scerrati M, Rossi GF: Staging of supratentorial hemispheric glioma using tumour extension, histopathologic grade and extent of surgical resection. Br J Surg 80: 1130–1133, 1993

    PubMed  Google Scholar 

  39. Winger MJ, Macdonald DR, Cairncross JG: Supratentorial anaplastic gliomas in adults. The prognostic importance of extent of resection and prior low-grade glioma. J Neurosurg 71: 487–493, 1989

    PubMed  Google Scholar 

  40. Curran WJ, Scott CB, Horton J, Nelson JS, Weinstein AS, Nelson DF, Fischbach AJ, Chang CH, Rotman M, Asbell SO, Powlis WD: Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci (AAF)? A report from three Radiation Oncology Group (RTOG) trials. J Neurooncol 12: 219–227

Download references

Author information

Authors and Affiliations

  1. The Departments of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Steven A. Toms & Raymond Sawaya

  2. Anesthesiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    David Z. Ferson

Authors
  1. Steven A. Toms
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Z. Ferson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raymond Sawaya
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Toms, S.A., Ferson, D.Z. & Sawaya, R. Basic Surgical Techniques in the Resection of Malignant Gliomas. J Neurooncol 42, 215–226 (1999). https://doi.org/10.1023/A:1006121817861

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1006121817861

Search

Navigation