Surgical treatment of glioblastomas with various MR characteristics

Objective: To justify the need for intraoperative monitoring (IOM) for surgical treatment of glioblastoma (GB) with various magnetic resonance characteristics. Material and Methods. 59 patients aged 24-76 years operated on for GB were studied. There were 3 observation groups according to the GB type: 1st - without non-contrasting zone (nCEZ) (n=18); 2nd - with non-contrasting part, hyperintensive in T2 FLAIR mode, corresponding to Sawaya I (n=26); 3rd - with hyperintensive in T2 FLAIR mode zone, corresponding to Sawaya II (n=15). Results. In the 1st and 3rd observation groups, all patients managed to achieve radical removal of the tumor, regardless of the use of IOM. In group 2, total removal was achieved in 69.2% of cases. Analysis of the progression-free period in the three groups showed no significant differences (p=0.05). There was a tendency to increase the progression-free period when using IOM (p=0.07). Using IOM significantly increased overall survival (p=0.04). Conclusion. The use of IOM for the surgical treatment of GB with nCEZ infiltrating functionally significant areas of brain contributes to the radical removal of such tumors. Given that the tissue corresponding to the hyperintensive area in the T2 FLAIR mode contains cancer stem cells, has a high potential compared to other components of the tumor and is most often a source for continued growth, the totality of its resection provides the highest duration of the progression-free period.