The Role of Lobectomy in Glioblastoma Management.

Introduction: Glioblastoma (GB) remains the most prevalent and aggressive primary tumor of the central nervous system, with median overall survival between 14 and 20 months. Maximal extent of resection is associated with extended overall survival. Lobectomy may lend itself in the management of patients with glioblastomas in certain anatomical areas for accomplishing maximal or even supramaximal resection.

Patient selection: Patients with good preoperative KPS, with a tumor confined to one lobe, and no infiltration of the subependymal zone are good candidates for lobectomy.Preoperative considerations: A thorough medical history, a detailed neurological examination, along with diagnostic work-up is essential in decision-making and proper surgical planning. Neurocognitive evaluation is also of paramount importance.Frontal lobectomy: High-speed drill is used for performing a frontotemporal craniotomy in non-dominant cases, while a more extensive fronto-parieto-temporal osseous flap is required in dominant cases for detailed cortical and subcortical mapping via an awake procedure. A corticectomy is then performed along with subpial resection of the white matter of the involved lobe.Temporal lobectomy: The same craniotomy strategy is used in temporal lobectomies. A corticectomy is performed through the inferior temporal gyrus, removal of the underlying white matter, and entrance to the ipsilateral temporal horn. After the neocortical resection, the mesial temporal structures have to be removed under the microscope. The importance of subpial resection technique cannot be overemphasized.

Complications: Complications such as neurocognitive deficits, paresis, dysphasia, infections, hydrocephalus, and hemorrhage are mainly reported in lobectomies performed for epilepsy. In GB lobectomy studies, no statistically significant differences were observed regarding complications.

Results: In the pertinent literature, lobectomy demonstrates a mean overall survival of 25 months, compared to 13.72 months for gross total resection (GTR), and a progression-free survival of 16.13 months, compared to 8.77 months for GTR.