The surgical perspective in precision treatment of diffuse gliomas

Niklas Thon, Joerg-Christian Tonn, Friedrich-Wilhelm Kreth Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany Abstract: Over the last decade, advances in molecular and imaging-based biomarkers have induced a more versatile diagnostic classification and prognostic evaluation of glioma patients. This, in combination with a growing therapeutic armamentarium, enables increasingly individualized, risk-benefit-optimized treatment strategies. This path to precision medicine in glioma patients requires surgical procedures to be reassessed within multidimensional management considerations. This article attempts to integrate the surgical intervention into a dynamic ­network of versatile diagnostic characterization, prognostic assessment, and multimodal treatment options in the light of the latest 2016 World Health Organization (WHO) classification of diffuse brain tumors, WHO grade II, III, and IV. Special focus is set on surgical aspects such as resectability, extent of resection, and targeted surgical strategies including minimal invasive stereotactic biopsy procedures, convection enhanced delivery, and photodynamic therapy. Moreover, the influence of recent advances in radiomics/radiogenimics on the process of surgical decision-making will be touched. Keywords: extent of resection, biomarker, metabolic imaging, molecular markers, personalized medicine, precision medicine, prognosis, stereotactic biopsy, cytoreductive surger