What is new in the surgical approach for malignant brain tumours

Maligant gliomas occur at an incidence from 2 to 10/100,000 (Japan vs. Sweden) constituting up 50% of all patients suff ering from brain tumours. Despite all therapeutic approaches the median survival for glioblastomas is 15 months and for anaplastic gliomas Grade III are 30 months. Surgery is the fi rst step in the therapeutic cascade of the patients. Th ere is still debate about the surgical extent of resection and whether a most radical resection is more benefi cial than an extended resection. Image-guided neurosurgery has become the gold standard for interventions in the brain and helps to defi ne the radiographic limits of the tumour to maximize safety and the extent of resection whilst minimizing damage to eloquent brain tissue. Tumour removal in eloquent areas such as speech area will be performed in local anaesthesia as an awake operation. A precise presurgical examination is therefore mandatory. Th is includes all information gathered from functional diagnostics (fMRI, fi bretracking and 3D reconstruction) and metabolic information from FET/FDG PET. Age, Karnofsky performance and histology as well as radical removal have signifi cant infl uence on overall survival. Adjuvant radiotherapy and chemotherapy with Temozolemide have further improved the outcome signifi cantly. Th e 2-year survival has reached 28% in most recent studies. Experimental surgical therapies are in clinical trials and will be introduced to general clinical practice in the near future. Th ese include intratumoural convection-enhanced instillation of immuntoxins and radiopeptids, photodynamic therapy and direct instillation of new formulations of chemotherapeutic drugs. Th ese new developments in the treatment of malignant brain tumours allow designing an individual neuro-oncological treatment concept to enhance overall survival and quality of life.