Surgical Management and Clinical Outcomes in Recurrent Glioma

Open Access

Abstract

Background: Recurrent gliomas, particularly glioblastomas, present significant treatment challenges due to high recurrence rates, aggressive behavior, and limited standardized management options. Repeat surgical resection is a potential therapeutic approach but carries risks of neurological complications. To evaluate the clinical characteristics, surgical management, postoperative outcomes, and complications in patients undergoing reoperation for recurrent brain gliomas. Methods & Materials: This prospective observational study included 30 patients who underwent reoperation for recurrent gliomas at Dhaka Medical College and Green Life Hospital from January 2021 to December 2023. Data on demographics, comorbidities, tumor histology, extent of resection, tumor location, time to recurrence, pre- and postoperative Karnofsky Performance Scale (KPS), and postoperative complications were collected and analyzed using SPSS-26. Results: The mean age was 48.7 years, with 63.3% males. Glioblastoma multiforme was the most frequent initial histology (53.3%), followed by diffuse astrocytoma (20%) and anaplastic astrocytoma (13.3%). Gross total resection was achieved in 53.3% of primary surgeries. At recurrence, hemiparesis (43.3%) and convulsions (36.7%) were most common; 66.7% had KPS ≥70. Early recurrence (<6 months) occurred exclusively in GBM patients, while low-grade gliomas recurred later. Postoperative KPS improvement was observed in 75% of patients with preoperative KPS ≥70, compared to only 20% of those with KPS <70.Conclusion: Reoperation for recurrent gliomas is feasible and can improve functional outcomes, particularly in patients with higher preoperative KPS. Glioblastoma recurs earlier than low-grade gliomas. While complications are common, careful patient selection based on functional status, tumor characteristics, and comorbidities can optimize surgical outcomes.