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

Abstract

'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'] Purpose The extent of resection (EOR) is an independent prognostic factor for overall survival (OS) in adult patients with Glioma Grade 4 (GG4). The aim of the neuro-oncology section of the Italian Society of Neurosurgery (SINch®) was to provide a general overview of the current trends and technical tools to reach this goal. Methods A systematic review was performed. The results were divided and ordered, by an expert team of surgeons, to assess the Class of Evidence (CE) and Strength of Recommendation (SR) of perioperative drugs management, imaging, surgery, intraoperative imaging, estimation of EOR, surgery at tumor progression and surgery in elderly patients. Results A total of 352 studies were identified, including 299 retrospective studies and 53 reviews/meta-analysis. The use of Dexamethasone and the avoidance of prophylaxis with anti-seizure medications reached a CE I and SR A. A preoperative imaging standard protocol was defined with CE II and SR B and usefulness of an early postoperative MRI, with CE II and SR B. The EOR was defined the strongest independent risk factor for both OS and tumor recurrence with CE II and SR B. For intraoperative imaging only the use of 5-ALA reached a CE II and SR B. The estimation of EOR was established to be fundamental in planning postoperative adjuvant treatments with CE II and SR B and the stereotactic image-guided brain biopsy to be the procedure of choice when an extensive surgical resection is not feasible (CE II and SR B).