Bringing Evidence Based Neurosurgery to North Atlanta

Dr Mairaj Sami MD, a neurosurgeon at Apex Spine and Neurosurgery is a contributing author to the latest guidelines for the surgical treatment of glioblastoma, the most common primary brain tumor affecting adults.  Dr. Sami is bringing evidence-based neurosurgery to the citizens of Atlanta, GA.  If you, or anyone that you know, has been diagnosed with a brain tumor let Dr. Sami and the other providers at Apex Spine and Neurosurgery help guide you through your care.  See the abstract below:

Epub 2020 Nov 19.

Cytoreductive surgery in the management of newly diagnosed glioblastoma in adults: a systematic review and evidence-based clinical practice guideline update

Joseph S Domino, D Ryan Ormond, Isabelle M Germano, Mairaj Sami, Timothy C Ryken, Jeffrey J Olson

Abstract

Target population: These recommendations apply to adults with newly diagnosed or suspected glioblastoma.

Question: What is the effect of extent of surgical resection on patient outcome in the initial management of adult patients with suspected newly diagnosed glioblastoma?

Recommendation: Level II: Maximal cytoreductive surgery is recommended in adult patients with suspected newly diagnosed supratentorial glioblastoma with gross total resection defined as removal of contrast enhancing tumor. Level III: Biopsy, subtotal resection, or gross total resection is suggested depending on medical comorbidities, functional status, and location of tumor if maximal resection may cause significant neurologic deficit.

Question: What is the role of cytoreductive surgery in adults with newly diagnosed bi-frontal "butterfly" glioblastoma?

Recommendation: Level III: Resection of newly diagnosed bi-frontal "butterfly" glioblastoma is suggested to improve overall survival over biopsy alone.

Question: What is the goal of cytoreductive surgery in elderly adult patients with newly diagnosed glioblastoma?

Recommendation: Level III: Elderly patients (> 65 years) show survival benefit with gross total resection and it is suggested they undergo cytoreductive surgery.

Question: What is the role of advanced intraoperative guidance techniques in cytoreductive surgery in adults with newly diagnosed glioblastoma?

Recommendation: Level III: The use of intraoperative guidance adjuncts such as intraoperative MRI (iMRI) or 5-aminolevulinic acid (5-ALA) are suggested to maximize extent of resection in newly diagnosed glioblastoma. There is insufficient evidence to make a suggestion on the use of fluorescein, indocyanine green, or intraoperative ultrasound.

Keywords: Cytoreduction; Glioblastoma; Guideline; Surgery.