A consensus definition of supratotal resection for anatomically distinct primary glioblastoma: an AANS/CNS Section on Tumors survey of neurosurgical oncologists

Abstract

Supratotal resection (SpTR) of glioblastoma may be associated with improved survival, but published results have varied in part from lack of consensus on the de nition and appropriate use of SpTR. A previous small survey of neurosurgical oncologists with expertise performing SpTR found resection 1-2 cm beyond contrast enhancement was an acceptable de nition and glioblastoma involving the right frontal and bilateral anterior temporal lobes were considered most amenable to SpTR. The general neurosurgical oncology community has not yet con rmed the practicality of this de nition. MethodsSeventy-six general neurosurgical oncology members of the AANS/CNS Tumor Section were surveyed using a crowdsourcing approach. Participants were presented with 11 de nitions of SpTR and rated each de nition's appropriateness. Participants additionally reviewed magnetic resonance imaging for 10 anatomically distinct glioblastomas and assessed the tumor location's eloquence, perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans. ResultsFifty-two neurosurgeons (73.2%) agreed that resection 1-2 cm beyond contrast enhancement was an acceptable de nition for SpTR. Cases were divided into three anatomically distinct groups by perceived equipoise between gross total and SpTR. The best clinical trial candidates were right anterior temporal (n=58, 76.3%) and right frontal (n=55, 73.3%) glioblastomas. ConclusionSupport exists within the neurosurgical oncology community to adopt the proposed consensus de nition of SpTR of glioblastoma and to treat right anterior temporal and right frontal glioblastomas using SpTR.A smaller proportion of general neurosurgical oncologists than SpTR experts consider SpTR feasible in the left anterior temporal lobe.

SUPRAMAX-study: supramaximal resection versus maximal resection for glioblastoma patients: study protocol for an international multicentre prospective cohort study (ENCRAM 2201)

“…To mitigate this risk, volumetric analyses should be coordinated between participating centres, performed by semi-automatic or fully automatic segmentation software, double-checked by independent neuro-radiologists and accompanied by inter-rater variability measurements for full disclosure. Second, the AANS/CNS Section on Tumors published in 2022 the results of their survey investigating a consensus definition of supratotal resection 21. Approximately three-quarters of the respondents agreed that the right anterior temporal and right frontal would be the most suitable candidate locations for SMR.…”

Correlating MRI features with additional genetic markers and patient survival in histological grade 2-3 IDH-mutant astrocytomas

“…In contrast, well-defined tumour margins seem to have little value for genotype prediction once a correlation with T2-FLAIR mismatch has been accounted for [ 24 ], but provided additional prognostic information within this tumour type. This may be particularly important when supratotal resection [ 29 ] is being considered. A trend towards earlier and more extensive surgical resection [ 30 - 32 ] and improving access to genetic sequencing methods arguably decreases the value of radiogenomics per se.…”

The clinical and neurocognitive functional changes with awake brain mapping for gliomas invading eloquent areas: Institutional experience and the utility of The Montreal Cognitive Assessment

“…Supratotal resection was still defined differently by neurosurgical oncologists. Generally, resection beyond 1-2 cm for contrast-enhanced tumors or 1-2 cm beyond the boundary in Flair images for non-enhanced tumors could be considered acceptable supratotal resection (33). Evidence indicated that supratotal resection might improve EOR and prolong the progression-free as well as OS in glioma patients (34).…”