The surgical management of diffuse gliomas: Current state of neurosurgical management and future directions

After recent updates to the World Health Organization pathological criteria for diagnosing and grading diffuse gliomas, all major North American and European neuro-oncology societies recommend a maximal safe resection as the initial management of a diffuse glioma. For neurosurgeons to achieve this goal, the surgical plan for both low- and high-grade gliomas should be to perform a supramaximal resection when feasible based on preoperative imaging and the patient's performance status, utilizing every intraoperative adjunct to minimize postoperative neurological deficits. While the surgical approach and technique can vary, every effort must be taken to identify and preserve functional cortical and subcortical regions. In this summary statement on the current state of the field, we describe the tools and technologies that facilitate the safe removal of diffuse gliomas and highlight intraoperative and postoperative management strategies to minimize complications for these patients. Moreover, we discuss how surgical resections can go beyond cytoreduction by facilitating biological discoveries and improving the local delivery of adjuvant chemo- and radiotherapies.

Automated summary

Following updates to the WHO pathological criteria, all major neuro-oncology societies in North America and Europe now advocate for maximal safe resection as the initial management for diffuse gliomas. Surgical plans for both low- and high-grade gliomas should aim to achieve supramaximal resection based on preoperative imaging and the patient's performance status, with preservation of functional cortical and subcortical regions. This summary statement highlights the tools and technologies that facilitate safe removal of diffuse gliomas, along with management strategies to minimize complications and the potential for further biological discoveries and improved delivery of adjuvant therapies.