Definition: Complete removal of the visible and identifiable tumor.
Usage: General term, sometimes used interchangeably with Gross Total Resection, though may imply a broader removal (including microscopic disease).
Limitation: May overstate if no imaging or histological confirmation is done.
Definition: Only a portion of the tumor is removed.
Indications: Tumor is infiltrative, near eloquent brain areas, or patient cannot tolerate longer surgery.
Outcome: Generally associated with lower survival/progression-free survival rates compared to more extensive resections.
Definition: 100% removal of contrast-enhancing tumor on postoperative imaging (usually MRI with gadolinium).
Goal: Remove all visible tumor on imaging, not necessarily microscopic infiltration.
Limitation: Microscopic disease may remain, especially in gliomas.
Definition: Remove as much tumor as possible without causing significant neurological deficit.
Principle: Balance between oncological benefit and functional preservation.
Common Practice: Used especially in gliomas or tumors near eloquent areas (motor cortex, speech centers, etc.).
Definition: >90–95% of tumor removed, but small residual remains (often due to risk of damage to critical areas).
Imaging: Tiny enhancing remnant visible on postop scan.
Use: Common compromise when Gross Total Resection risks too much morbidity.
Definition: Less than Gross Total Resection, often <90% tumor removal.
Cause: Tumor location, size, vascularity, or infiltration into eloquent brain.
Prognosis: Intermediate between biopsy/partial and GTR.
Definition: Resection goes beyond the enhancing tumor margins, including removal of surrounding non-enhancing T2/FLAIR abnormality.
Goal: Target potential microscopic infiltration—especially in high-grade gliomas.
Benefit: Shown in some studies to improve survival, but with increased risk if not carefully planned.
Definition: Surgical removal of areas of FLAIR hyperintensity on MRI (often non-enhancing, infiltrative parts of gliomas).
Specific to: Diffuse gliomas, particularly IDH-mutant gliomas where FLAIR abnormalities correlate with tumor infiltration.
Relation to Supramaximal: FLAIRectomy is a type of supramaximal resection.
Challenge: Differentiating between tumor infiltration and peritumoral edema or gliosis.
Gross total resection (GTR)
Near total resection (NTR)