4.5 Review

Updates on Surgical Management and Advances for Brain Tumors

Journal

CURRENT ONCOLOGY REPORTS
Volume 23, Issue 3, Pages -

Publisher

SPRINGER
DOI: 10.1007/s11912-020-01005-7

Keywords

Glioma; Glioblastoma; Brain tumors; Extent of resection; Brain metastases; 5-ALA; Intraoperative MRI; Laser interstitial thermal therapy; SRS; Whole-brain radiation therapy; Endoscopic resection

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This review highlights the importance of surgical resection in the treatment of malignant brain tumors, with tools such as intraoperative MRI, 5-ALA, and neuronavigation aiding in maximal safe resection. Technological advancements have allowed for minimally invasive surgical approaches, while a multimodal, multidisciplinary treatment approach is crucial for managing primary and metastatic brain tumors effectively.
Purpose of Review This review summarizes the modern approach to surgical management of malignant brain tumors, highlighting new technology and multimodal treatment paradigms. Recent Findings Outcomes in patients with glioblastoma are strongly correlated with extent of initial surgical resection. Intraoperative MRI, 5-ALA, and neuronavigation are surgical tools that can help achieve a maximal safe resection. Stereotactic radiosurgery and brachytherapy can be used to enhance local control for brain metastases in conjunction with surgery, while combinatorial approaches are increasingly employed in patients with multiple metastases. Advances in surgical techniques allow for minimally invasive approaches, including the use of tubular retractors, endoscopes, and laser interstitial thermal therapy. Primary and metastatic brain tumors require a multimodal, multidisciplinary approach to treatment. Surgical resection can be paired with radiation for metastases to maximize tumor control, expanding systemic options. Technological innovations have improved the safety of surgical resection, while expanding the surgical options and indications for treatment.

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