Initial Biopsy and Early Re‐resection Practices in the Treatment of Glioblastoma among AANS/CNS Tumor Section Surgeons

A recent ten-question survey distributed to AANS/CNS Tumor Section members sought to characterize the surgical management of glioblastoma (GBM) among neurosurgeons. While surgical resection remains the best initial treatment for GBM, practice patterns differ prior to and following resection. Some surgeons elect to perform either stereotactic or open biopsies for suspected GBM tumors to confirm diagnosis prior to definitive resection. Surgeons also will perform early re-resections of GBM tumors (within 30 days) if a maximal resection was not achieved initially due to early recurrence of tumors.

The results of a ten-question survey distributed to AANS/CNS Tumor Section members characterized the frequency of and causes for these procedures. A majority of respondents performed 11–25 GBM resections annually. Of those cases, most neurosurgeons claimed that biopsies were rarely performed prior to tumor resection. In <10% of cases for which biopsies are done, common reasons are to confirm radiological findings or improve the treatment plan. Re-resections are similarly rare, but in less than five cases most neurosurgeons performed annually, common reasons included incomplete initial resections, referrals for greater resection or unspecified reasons. Considering the limitations associated with most survey studies, including low response rates, memory bias and hesitancy in reporting morbidity rates, further research is needed. Overall, the results show low rates of performed biopsy and early re-resection procedures among AANS/CNS Tumor Section neurosurgeons at tertiary care centers, which can be used to form guidelines in the treatment of GBM.

Baron R., Kessler R., and Hadjipanayis C. G. (2019). Initial biopsy and early re-resection practices in the treatment of glioblastoma among AANS/CNS tumor section surgeons. J Neuro-Oncology (epub ahead of print).