Current surgical management of glioblastoma.

Surgical resection is a critical aspect of the management of a patient with a glioblastoma (GBM). An intimate knowledge of the anatomy of a GBM, as well as familiarity with particular surgical techniques and adjunctive technologies is required for safe surgical resection. The goals of resection include diagnosis, relief of mass effect, and cytoreduction. A recent study showed that resection of 98% or more of the tumor mass can result in a statistically significant survival advantage. Even in functionally critical areas, "gross total" resections are possible if proper techniques are employed. It is recommended that a "gross total" resection of the enhancing portion of a GBM be performed whenever possible. With this philosophy, the mortality rate is 3% and the rate of major neurologic morbidity is less than 10%.