Reoperation for Recurrent High-Grade Glioma: A Current Perspective of the Literature

Hervey-Jumper, Shawn L. MD; Berger, Mitchel S. MD

doi: 10.1227/NEU.0000000000000486

Optimal treatment for recurrent high-grade glioma continues to evolve. Currently, however, there is no consensus in the literature on the role of reoperation in the management of these patients. In this analysis, we reviewed the literature to examine the role of reoperation in patients with World Health Organization grade III or IV recurrent gliomas, focusing on how reoperation affects outcome, perioperative complications, and quality of life. An extensive literature review was performed through the use of the PubMed and Ovid Medline databases for January 1980 through August 2013. A total 31 studies were included in the final analysis. Of the 31 studies with significant data from single or multiple institutions, 29 demonstrated a survival benefit or improved functional status after reoperation for recurrent high-grade glioma. Indications for reoperation included new focal neurological deficits, tumor mass effect, signs of elevated intracranial pressure, headaches, increased seizure frequency, and radiographic evidence of tumor progression. Age was not a contraindication to reoperation. Time interval of at least 6 months between operations and favorable performance status (Karnofsky Performance Status score ≥70) were important predictors of benefit from reoperation. Extent of resection at reoperation improved survival, even in patients with subtotal resection at initial operation. Careful patient selection such as avoiding those individuals with poor performance status and bevacizumab within 4 weeks of surgery is important. Although limited to retrospective analysis and patient selection bias, mounting evidence suggests a survival benefit in patients receiving a reoperation at the time of high-grade glioma recurrence.

ABBREVIATIONS: EOR, extent of resection

GTR, gross total resection

KPS, Karnofsky Performance Status

STR, subtotal resection

WHO, World Health Organization

Department of Neurological Surgery, University of California San Francisco, San Francisco, California

Correspondence: Shawn Hervey-Jumper, MD, Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, M779, Box 0112, San Francisco, CA 94143-0112. E-mail:

Received April 03, 2014

Accepted June 18, 2014

Copyright © by the Congress of Neurological Surgeons