• Mario Matute-González, Alejandra Mosteiro-Cadaval, Nuria Vidal-Robau, Alfredo Páez-Carpio, Izaskun Valduvieco, Estela Pineda, José Juan González, Iban Aldecoa, and Laura Oleaga.
• Department of Neuroradiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. Electronic address: mmatute@clinic.cat.
• World Neurosurg. 2023 Oct 1; 178: e480e488e480-e488.

BackgroundGliosarcoma (GS) is a rare primary high-grade brain neoplasm with a poor prognosis and challenging surgical resection. Although it is now considered a morphologic variant of IDH-wildtype glioblastoma (World Health Organization Classification of Tumours 2021), GS may display peculiarities that hamper both surgical and oncological management.MethodsIn this retrospective study, we searched our registry for histologically confirmed GS patients between 2006 and 2020. Cases were reviewed for clinical information, pathologic characteristics, imaging findings, management, and outcome.Results21 patients with histologically confirmed GS were identified with a median age of 62 years. Twelve were men and 9 women. The temporal lobe was the most common location (9 patients, 42.9%). Nineteen patients underwent surgical resection, and only 4 (19%) demonstrated gross total resection on postsurgical MRI, with an overall median survival of 7 months (range, 0.5-37). Diagnostic MRI demonstrated heterogenous lesions with necrotic-cystic areas and a ring-enhancement pattern. Only 1 case of extracranial extension was seen in our sample, and no patient showed distant metastases.ConclusionsThe rarity of primary GS and the absence of specific therapeutic guidelines represent a significant clinical challenge. Our study provides a comprehensive analysis of clinical and neuroimaging characteristics in a real-world patient cohort and compares our findings with the available literature.Copyright © 2023 Elsevier Inc. All rights reserved.

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