The Treatment of Glioblastoma Multiforme: Have We Come Far?

Keywords: glioblastoma multiforme, outcome, Harvey Cushing, resection, History

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     Histological descriptions of GBM pre-date Virchow, but the first confirmed intracranial brain tumor resection was reported in 1884. Bennett and Godlee’s report incited debate amongst premier surgeons of the time, with Horsley and Jackson being proponents of early identification and surgery.
     Despite much interest in surgery, the high mortality (over 60% in initial cases) and lack of expertise limited its use as a primary modality. Patients relied heavily on potassium iodine injections and other medical management.
     Cushing’s subtemporal craniotomy (1905) allowed for relief of mass effect for inoperable tumors and safe debulking in resectable cases. Our study examined seminal information from 1884 through 2011 to formulate notions about glioblastoma survival during the professional evolution of neurosurgery. Surprisingly, the surgical resection strategy has not changed, while the addition of radiotherapy was cited in 1960 as adding shortterm survival benefit. That GBMs had become a central problem for neurosurgeons is illustrated by Elsberg’s invitation to the 20th Society of Neurological Surgeons meeting (1929) specifying their first special symposium on a series of problems in infiltrating brain tumors, especially those of spongioblastoma varia.
     Meeting minutes note: Dr. Elberg’s opinion is that simple decompression without removal of the tumor is the worst possible thing to do for spongioblastoma. The history of glioblastoma is marked by failures, as much as successes.
     This is a retrospective review.
     Early efforts to understand GBM focused on appropriate categorization and cell-of-origin studies.
     Ironically, these are the same areas of investigation that may hold the most promise for patients today.


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