• Ming Lu, Zheng-Hao Fu, Xiao-Jun He, Jian-Kan Lu, Xin-Qing Deng, De-Liu Lin, You-Ming Gu, Yan-Feng Fan, Ming-Yao Lai, Juan Li, Ming-Ming Yang, and Zhong-Ping Chen.
• Department of Neurosurgery, Guangdong 999 Brain Hospital, Guangzhou, China.
• World Neurosurg. 2020 Mar 1; 135: e738-e747.

BackgroundDespite evidence that a greater extent of resection (EOR) improves survival, the role of extended resection based on magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) in the prognosis of glioblastoma (GBM) remains controversial. This study aims to investigate the role of additional resection of FLAIR-detected abnormalities and its influence on clinical outcomes of patients with GBM.MethodsForty-six patients with newly diagnosed GBM involving eloquent brain areas were included. Surgeries were performed using awake craniotomy (AC) or AC combined with sodium fluorescein (SF) guidance. Following total removal of the contrast-enhancing tumor area, the EOR of FLAIR abnormalities was dichotomized to identify the best separation threshold for progression-free survival (PFS), overall survival (OS), and 30-day postoperative neurologic function of patients with GBM.ResultsThe threshold for removal of FLAIR abnormalities affecting survival was determined to be 25%. The median OS and PFS were shorter in the group with FLAIR resection <25% compared with the group with FLAIR resection ≥25% (12 months vs. 26 months; P = 0.001 and 6 months vs. 15 months; P = 0.016, respectively). Univariate and multivariate analyses identified tumor location within or near the eloquent brain areas and the 25% threshold for FLAIR EOR as independent factors affecting OS and PFS.ConclusionsIdentifying a feasible threshold for the resection of FLAIR abnormalities is valuable in improving the survival of patients with GBM. Extended resection of GBM involving eloquent brain areas was safe when using a combination of AC and SF-guided surgery.Copyright © 2020 Elsevier Inc. All rights reserved.

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