Surgical Treatment of Astrocytoma: Insights from Contemporary Evidence
DOI:
https://doi.org/10.63666/ejsmr.1694-9013.3.I.2025.72Keywords:
Astrocytoma, surgical resection, extent of resection, glioma, fluorescence-guided surgery, awake craniotomyAbstract
Astrocytomas represent a heterogeneous group of glial tumors ranging from indolent low-grade lesions to aggressive high-grade malignancies. Surgical resection remains the cornerstone of treatment, with the extent of resection (EOR) consistently identified as a key prognostic factor across grades. This systematic literature review synthesizes contemporary evidence on surgical strategies for astrocytomas, emphasizing the impact of gross total resection (GTR), subtotal resection (STR), and adjuvant technologies such as fluorescence-guided surgery, awake craniotomy, and intraoperative neuromonitoring. A comprehensive analysis of studies from 2021–2025, including meta-analyses and retrospective series, demonstrates that maximal safe resection significantly improves overall survival (OS) and progression-free survival (PFS) in both low- and high-grade astrocytomas, particularly pilocytic, diffuse low-grade, and anaplastic variants. Advanced surgical adjuncts enhance EOR while minimizing neurological deficits. This review integrates findings from recent guidelines and highlights ongoing challenges in balancing oncological efficacy with quality of life. Evidence supports early aggressive surgery for resectable tumors, with multimodal integration of radiotherapy and chemotherapy for higher grades.
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