Mapping the Brain During Awake Surgery for Patients with Neurological Disorders Including Brain Tumors

Ruiz‐Garcia, Henry; Middlebrooks, Erik H.; Sabsevitz, David S.; Bechtle, Perry S.; Quiñones‐Hinojosa, Alfredo

doi:10.1007/978-3-030-54879-7_21

Cited by 1 publication

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“…For example, fluorescence-guided resection with 5-aminolevulinic acid has led to improved progression-free survival and gross total resection rates, and the use of intraoperative MRI has demonstrated improved outcomes too [ 69 , 70 ]. Other surgical techniques, such as awake craniotomy with cortico-subcortical mapping and neuronavigational systems also play a critical role in appropriately selected cases thereby preserving neurologic function and bettering patient outcomes [ 62 , 71 , 72 ]. Some have also advocated for a supratotal resection for GBM [ 73 ].…”

Section: Treatment Overviewmentioning

confidence: 99%

Preoperative Stereotactic Radiosurgery for Glioblastoma

Lehrer

Ruiz‐Garcia

Nehlsen

et al. 2022

Biology

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Glioblastoma is a devastating primary brain tumor with a median overall survival of approximately 15 months despite the use of optimal modern therapy. While GBM has been studied for decades, modern therapies have allowed for a reduction in treatment-related toxicities, while the prognosis has largely been unchanged. Adjuvant stereotactic radiosurgery (SRS) was previously studied in GBM; however, the results were disappointing. SRS is a highly conformal radiation technique that permits the delivery of high doses of ionizing radiation in 1–5 sessions while largely sparing surrounding healthy tissues. Furthermore, studies have shown that the delivery of ablative doses of ionizing radiation within the central nervous system is associated with enhanced anti-tumor immunity. While SRS is commonly used in the definitive and adjuvant settings for other CNS malignancies, its role in the preoperative setting has become a topic of great interest due to the potential for reduced treatment volumes due to the treatment of an intact tumor, and a lower risk of nodular leptomeningeal disease and radiation necrosis. While early reports of SRS in the adjuvant setting for glioblastoma were disappointing, its role in the preoperative setting and its impact on the anti-tumor adaptive immune response is largely unknown. In this review, we provide an overview of GBM, discuss the potential role of preoperative SRS, and discuss the possible immunogenic effects of this therapy.

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