• Adham M Khalafallah, Maureen Rakovec, Chetan Bettegowda, Christopher M Jackson, Gary L Gallia, Jon D Weingart, Michael Lim, Yoshua Esquenazi, Brad E Zacharia, Ezequiel Goldschmidt, Mateo Ziu, Michael E Ivan, Andrew S Venteicher, Edjah K Nduom, Adam N Mamelak, Ray M Chu, John S Yu, Jason P Sheehan, Brian V Nahed, Bob S Carter, Mitchel S Berger, Raymond Sawaya, and Debraj Mukherjee.
• Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• Neurosurgery. 2021 Sep 15; 89 (4): 712-719.

BackgroundGross total resection (GTR) of contrast-enhancing tumor is associated with increased survival in primary glioblastoma. Recently, there has been increasing interest in performing supratotal resections (SpTRs) for glioblastoma.ObjectiveTo address the published results, which have varied in part due to lack of consensus on the definition and appropriate use of SpTR.MethodsA crowdsourcing approach was used to survey 21 neurosurgical oncologists representing 14 health systems nationwide. Participants were presented with 11 definitions of SpTR and asked to rate the appropriateness of each definition. Participants reviewed T1-weighed postcontrast and fluid-attenuated inversion-recovery magnetic resonance imaging for 22 anatomically distinct glioblastomas. Participants were asked to assess the tumor location's eloquence, the perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans.ResultsMost neurosurgeons surveyed (n = 18, 85.7%) agree that GTR plus resection of some noncontrast enhancement is an appropriate definition for SpTR. Overall, moderate inter-rater agreement existed regarding eloquence, equipoise, and personal treatment plans. The 4 neurosurgeons who had performed >10 SpTRs for glioblastomas in the past year were more likely to recommend it as their treatment plan (P < .005). Cases were divided into 3 anatomically distinct groups based upon perceived eloquence. Anterior temporal and right frontal glioblastomas were considered the best randomization candidates.ConclusionWe established a consensus definition for SpTR of glioblastoma and identified anatomically distinct locations deemed most amenable to SpTR. These results may be used to plan prospective trials investigating the potential clinical utility of SpTR for glioblastoma.© Congress of Neurological Surgeons 2021.

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