Optimizing outcomes with maximal surgical resection of malignant gliomas.

BACKGROUND Aggressive surgical resection of malignant gliomas is a controversial issue in neurosurgery. Studies with rigorous methodology that fully address this issue have only recently become available. METHODS The controversy regarding the role of maximal surgical resection of malignant gliomas is reviewed. The authors discuss surgical techniques and adjunctive technologies that can be utilized to assist in resection of these lesions. RESULTS Using current microneurosurgical techniques, it is possible to resect malignant gliomas in gross total fashion. An aggressive approach in which 98% or more of the tumor mass is resected results in a statistically significant survival advantage. CONCLUSIONS An aggressive surgical procedure for malignant gliomas can result in increased survival duration for selected groups of patients.