• Domenique M J Müller, Pierre A Robe, Hilko Ardon, Frederik Barkhof, Lorenzo Bello, Mitchel S Berger, Wim Bouwknegt, Wimar A Van den Brink, Conti NibaliMarcoM6Neurosurgical Oncology Unit, Department of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy., Roelant S Eijgelaar, Julia Furtner, Seunggu J Han, Shawn L Hervey-Jumper, IdemaAlbert J SAJS13Department of Neurosurgery, Northwest Clinics, Alkmaar, The Netherlands., Barbara Kiesel, Alfred Kloet, Emmanuel Mandonnet, Jan C De Munck, Marco Rossi, Tommaso Sciortino, W Peter Vandertop, Martin Visser, Michiel Wagemakers, Georg Widhalm, Marnix G Witte, Aeilko H Zwinderman, and Philip C De Witt Hamer.
• 1Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam.
• J. Neurosurg. 2022 Jan 1; 136 (1): 455545-55.

ObjectiveThe aim of glioblastoma surgery is to maximize the extent of resection while preserving functional integrity. Standards are lacking for surgical decision-making, and previous studies indicate treatment variations. These shortcomings reflect the need to evaluate larger populations from different care teams. In this study, the authors used probability maps to quantify and compare surgical decision-making throughout the brain by 12 neurosurgical teams for patients with glioblastoma.MethodsThe study included all adult patients who underwent first-time glioblastoma surgery in 2012-2013 and were treated by 1 of the 12 participating neurosurgical teams. Voxel-wise probability maps of tumor location, biopsy, and resection were constructed for each team to identify and compare patient treatment variations. Brain regions with different biopsy and resection results between teams were identified and analyzed for patient functional outcome and survival.ResultsThe study cohort consisted of 1087 patients, of whom 363 underwent a biopsy and 724 a resection. Biopsy and resection decisions were generally comparable between teams, providing benchmarks for probability maps of resections and biopsies for glioblastoma. Differences in biopsy rates were identified for the right superior frontal gyrus and indicated variation in biopsy decisions. Differences in resection rates were identified for the left superior parietal lobule, indicating variations in resection decisions.ConclusionsProbability maps of glioblastoma surgery enabled capture of clinical practice decisions and indicated that teams generally agreed on which region to biopsy or to resect. However, treatment variations reflecting clinical dilemmas were observed and pinpointed by using the probability maps, which could therefore be useful for quality-of-care discussions between surgical teams for patients with glioblastoma.

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