Neurosurgical Approach to the Patient with Glioblastoma

Abstract

Extent of resection is one of the major contributing factors for survival of glioblastoma patients. However, before this surgical goal may be contemplated, the patient with suspected glioblastoma must undergo a series of preoperative steps: to confirm this pathology as the most probable clinical hypothesis, to assess the extension of the lesion and the potential involvement of eloquent areas of the brain, as well as to determine the clinical performance status of the patient and have the patient’s and family member’s goals and expectations aligned with surgical options that minimizes risks of poor outcome or functional deficits and increases survival odds. Several surgical adjuncts may contribute in increasing these odds, such as intraoperative imaging (i.e., intraoperative MRI and ultrasound), intraoperative navigation, fluorescent dyes, such as 5-ALA, and finally intraoperative mapping with or without awake craniotomy.