Controversias en el tratamiento quirúrgico de los gliomas lobares de alto grado
Resumen
OBJETIVO: Valorar las controversias sobre el tratamiento quirúrgico de los gliomas lobares de alto grado de malignidad en el adulto.
ADQUISICIÓN DE LA EVIDENCIA: Se utilizaron las investigaciones publicadas en los buscadores PubMed y Scielo en los últimos 5 años (2013-2018). Se tuvieron en cuenta aquellos documentos que contenían información contradictoria.
RESULTADOS: El tratamiento multimodal es la alternativa que ha mostrado los mejores resultados en la supervivencia de los pacientes con gliomas de alto grado de malignidad. En la mayoría de los pacientes la cirugía es el procedimiento más importante en el tratamiento. Existen tres controversias en relación con la conducta quirúrgica de los gliomas de alto grado de malignidad: craneotomía versus un solo trépano; valoración del grado de resección tumoral, y la cirugía versus tratamiento médico observacional. Se debe indicar una resección tumoral máxima, sin añadir defectos neurológicos. Se recomienda el uso de las nuevas tecnologías para lograr resecciones amplias y seguras. La biopsia se indica en pacientes y tumores bien seleccionados.
CONCLUSIONES: El tratamiento multimodal es la pauta general para los pacientes con gliomas de alto grado de malignidad. Sin embargo, en la era molecular, el tratamiento personalizado es necesario.
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Referencias
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