Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review - Report - MDSpire

Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review

  • By

  • Tamara Ius

  • Giovanni Sabatino

  • Pier Paolo Panciani

  • Marco Maria Fontanella

  • Roberta Rudà

  • Antonella Castellano

  • Giuseppe Maria Vincenzo Barbagallo

  • Francesco Belotti

  • Riccardo Boccaletti

  • Giuseppe Catapano

  • Gabriele Costantino

  • Alessandro Della Puppa

  • Francesco Di Meco

  • Filippo Gagliardi

  • Diego Garbossa

  • Antonino Francesco Germanò

  • Maurizio Iacoangeli

  • Pietro Mortini

  • Alessandro Olivi

  • Federico Pessina

  • Fabrizio Pignotti

  • Giampietro Pinna

  • Antonino Raco

  • Francesco Sala

  • Francesco Signorelli

  • Silvio Sarubbo

  • Miran Skrap

  • Giannantonio Spena

  • Teresa Somma

  • Carmelo Sturiale

  • Filippo Flavio Angileri

  • Vincenzo Esposito

  • March 24, 2023

  • 0 min

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Clinical Report: Advances in Surgical Management of Grade 4 Glioma

Overview

This systematic review from the Italian Society of Neurosurgery highlights recent technological and conceptual advances in surgical approaches for Grade 4 glioma (GG4). It emphasizes the critical role of extent of resection (EOR) in improving survival, supported by intraoperative tools such as ultrasound, cortical mapping, and fluorescence-guided surgery.

Background

Grade 4 gliomas, including IDH-mutant astrocytomas and IDH wild-type glioblastomas, represent aggressive brain tumors with poor prognosis. Incidence is approximately six per 100,000 people annually, with a slight male predominance. Molecular profiling and surgical resection extent are key prognostic factors. Despite advances in adjuvant therapies, maximal safe surgical resection remains the cornerstone of treatment.

Data Highlights

The review included studies published from 2018 onwards focusing on adult patients with GG4. Key prognostic factors identified include age, EOR, necrosis size, and molecular markers such as MGMT methylation and IDH mutations. Technological adjuncts like intraoperative ultrasound, cortical mapping, sodium fluorescein, and 5-ALA fluorescence have been shown to increase rates of total resection and potentially improve survival outcomes.

Key Findings

  • Extent of resection (EOR) is one of the most significant predictive factors for survival in GG4 patients.
  • Infiltrative tumor growth and ill-defined margins limit the possibility of radical resection.
  • Intraoperative technologies such as ultrasound, cortical mapping, and fluorescence-guided surgery enhance surgical precision and safety.
  • Despite maximal resection, tumor relapse commonly occurs within 2 cm of resection margins due to infiltrative and resistant tumor cells.
  • Preoperative management with antiepileptics and steroids is important and discussed in current literature.
  • Multimodal treatment including surgery, radiotherapy, and chemotherapy remains the standard of care.

Clinical Implications

Maximizing the extent of safe resection using advanced intraoperative tools should be prioritized to improve survival in GG4 patients. Surgeons must balance aggressive resection with preservation of neurological function. Integration of molecular profiling with surgical planning can further refine prognosis and therapeutic strategies.

Conclusion

Technological innovations have expanded the surgical armamentarium for GG4, enabling safer and more extensive resections. Continued multidisciplinary approaches combining surgery with adjuvant therapies remain essential to optimize patient outcomes.

References

  1. Italian Society of Neurosurgery (SINch®) -- Advancements in Surgical Approaches for Grade 4 Glioma: A Systematic Review

Original Source(s)

Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review

  • by Tamara Ius, Giovanni Sabatino, Pier Paolo Panciani, Marco Maria Fontanella, Roberta Rudà, Antonella Castellano, Giuseppe Maria Vincenzo Barbagallo, Francesco Belotti, Riccardo Boccaletti, Giuseppe Catapano, Gabriele Costantino, Alessandro Della Puppa, Francesco Di Meco, Filippo Gagliardi, Diego Garbossa, Antonino Francesco Germanò, Maurizio Iacoangeli, Pietro Mortini, Alessandro Olivi, Federico Pessina, Fabrizio Pignotti, Giampietro Pinna, Antonino Raco, Francesco Sala, Francesco Signorelli, Silvio Sarubbo, Miran Skrap, Giannantonio Spena, Teresa Somma, Carmelo Sturiale, Filippo Flavio Angileri, Vincenzo Esposito

  • March 24, 2023

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