title: Re-do Craniotomy for Recurrent Grade IV Glioblastomas: Impact and Outcomes from the National Neuroscience Institute Singapore.
abstract: OBJECTIVE
  We hypothesize that re-do craniotomy for recurrent grade IV glioblastomas improves survival while preserving outcome in selected patients.
  
  
  METHODS
  A retrospective analysis was conducted of 141 patients, from a prospectively collected database from 2004-2014, with grade IV glioblastomas who underwent craniotomy and excision. Sixty-five patients were included in our analysis. Twenty patients underwent re-do craniotomy at recurrence and were compared with 45 patients who received nonsurgical therapy for recurrences. Primary end point was overall survival from time of diagnosis. Demographic and disease factors were analyzed using Cox regression analysis for significance.
  
  
  RESULTS
  The median survival for those with re-do craniotomy was 25.4 months compared with 11.6 months (P < 0.001) in the group that underwent nonsurgical therapy. The mean age for this group was 53.5 years. This group had a higher postsurgical/treatment median Karnofsky performance scale (KPS) of 80 compared with 60 (P < 0.001) showing better functional outcome. A Cox regression analysis of factors determined that age, KPS at recurrence, extent of resection at initial surgery and re-do craniotomy were significant for positive outcomes.
  
  
  CONCLUSIONS
  Our results show that in a select group of patients with recurrent grade IV glioblastomas, repeated excision, aiming for gross total resection where safely possible, has significant survival benefit without severely compromising functionality and should be considered.
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Min Wei
authors.initials: MW
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Morsy
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Sai
authors.initials: S
authors.lastname: Liang
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore. Electronic address: Wai_Hoe_Ng@nni.com.sg.
authors.forename: Wai Hoe
authors.initials: WH
authors.lastname: Ng
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D003399:Craniotomy / Q000379:methods; D016208:Databases, Factual; D023381:Endpoint Determination; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012846:Singapore; D016019:Survival Analysis
keywords: High-grade glioma; Overall Survival; Re-do Craniotomy; Recurrent