الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
No standard of care for recurrent glioblastoma is universally accepted: all the treatment options have limited activity. The most common strategy proposed in case of recurrence is systemic therapy; however, in case of a limited and well-defined recurrent disease, systemic and regional are both local treatments to consider. Unfortunately, the level of evidence supporting the use of these local strategies is low because the majority of the studies are retrospective with strong selection bias
The reoperation of recurrent glioma is a contradictory topic. Some authors suggest that a second even third operation can be beneficial for the extent of survival, several treatment options are considered: supportive care alone, systemic therapies, re-resection, or re-irradiation
Since there is no evidence of superiority in terms of the efficacy of one or the other strategy, the choice between these two treatments needs to be based on other factors. Some authors stated that recurrent glioma can take advantage of repeated surgery. Younger patients with good clinical conditions can be suitable candidate to re-surgical resection.
Here, in the current study we concluded that the effect of surgery shows improvement of outcome in the low grade gliomas which favour the choice of surgery over other modalities of treatment.
High grade gliomas shows minimal improvement in outcome when redoing surgery as there is prolonged survival but with increasing complication.
Thus re-operation is considered a tool to improve survival in glioma when patients are well selected
In cases presented with histopathology of radionecrosis patients showed improvement following surgery as there alleviation of mass effect caused by it.
Histopathology at recurrence revealed the same histopathology as that of the primary lesion. But some cases showed radiological evedince of radionecrosis and a number of them showed upgrading in histopathological type to a higher grade malignancy.
Clinical performance of the patients is an important factor to determine who is candidate for re-surgery. Presenting KPS at recurrence forms a significant value in predicting the outcome of the surgery as patients with pre-operative high KPS showed improvement in clinical outcome and in there follow up showed signs of stable disease , whereas patients with low pre-operative KPS almost didn’t show post-operative improvement and follow up of these patients more likely to be a progressive disease thus patients with lower KPS didn’t show good response to surgery and almost with no benefit.
Time interval between the primary surgery and recurrence short time interval especially when near total excision was achieved may indicate aggressive lesion and even with re-surgery survival would be dismal .Survival was also evident to be as short as 6 months or less in high grade gliomas and as long as 2years or more in recurrent low grade types.
Overall survival among the studied group was 14 months. it was found different variables showed no significant effect on the overall survival included number of previous surgeries, preoperative KPS score, localization zone of recurrence , initial histopathology , histopathology at recurrence and adjuvant therapy.
Despite newly developed hemiparesis as a complication overall survival is not affected .
In conclusion; surgical management of recurrent gliomas is generally associated with prolonged survival but surgical complications occur more frequently with each procedure.. However, overall rates of functional decline with repeated surgeries remain low. These findings may assist the clinician in counseling patients considering repeat surgery for glioma. Future multiple centers studies on large number of patients are warranted to draw firm conclusion.