Abstract
Introduction: Diffuse gliomas are highly infiltrative brain tumors associated with poor prognosis and limited therapeutic response. Surgical resection remains a cornerstone of treatment, yet the balance between maximizing extent of resection (EOR) and preserving neurological function remains challenging. Advances in intraoperative technologies and molecular profiling have opened new possibilities for individualized treatment.
Materials and methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies evaluating surgical strategies—subtotal resection (STR), gross total resection (GTR), and supramaximal resection (SMR)—were included. Additionally, we assessed the prognostic and therapeutic implications of molecular biomarkers such as IDH mutations, MGMT promoter methylation, and 1p/19q codeletions.
Results: IDH-mutant gliomas were consistently associated with longer overall survival and better responses to adjuvant therapies. MGMT promoter methylation correlated with improved overall survival in patients receiving temozolomide. Supramaximal resection outperformed gross total resection and subtotal resection in terms of progression-free and overall survival. Fluorescence-guided surgery and intraoperative imaging modalities reduced residual tumor volume, enhanced resection accuracy, and lowered complication rates. However, aggressive resections were linked to increased risk of postoperative neurological deficits.
Discussion: Integrating surgical innovation with molecular characterization enables more precise and effective glioma management. While maximizing the extent of resection is beneficial oncologically, it must be weighed against potential functional impairment. Technological adjuncts can help mitigate this trade-off, especially in eloquent regions.
Conclusions: Advanced surgical techniques combined with biomarker-driven strategies improve survival outcomes in diffuse gliomas. Personalized approaches are essential to tailor both surgical and adjuvant treatments, ultimately enhancing quality of life and extending survival.
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