The Extent of Resection in Gliomas—Evidence-Based Recommendations on Methodological Aspects of Research Design

Henry Ruiz-Garcia, Erik H. Middlebrooks, Daniel M. Trifiletti, Kaisorn L. Chaichana, Alfredo Quinones-Hinojosa, Jason P. Sheehan

Research output: Contribution to journalArticlepeer-review


Objective: Modern neurosurgery has established maximal safe resection as a cornerstone in the management of diffuse gliomas. Evaluation of the extent of resection (EOR), and its association with certain outcomes or interventions, heavily depends on an adequate methodology to draw strong conclusions. We aim to identify weaknesses and limitations that may threaten the internal validity and generalizability of studies involving the EOR in patients with glioma and to suggest methodological recommendations that may help mitigate these threats. Methods: A systematic search was performed by querying PubMed, Web of Science, and Scopus since inception to April 30, 2021 using PICOS/PRISMA guidelines. Articles were then screened to identify high-impact studies evaluating the EOR in patients diagnosed with diffuse gliomas in accordance with predefined criteria. We identify common weakness and limitations during the evaluation of the EOR in the selected studies and then delineate potential methodological recommendations for future endeavors dealing with the EOR. Results: We identified 31 high-impact studies and found several research design issues including inconsistencies regarding EOR terminology, measurement, data collection, analysis, and reporting. Although some of these issues were related to now outdated reporting standards, many were still present in recent publications and deserve attention in contemporary and future research. Conclusions: There is a current need to focus more attention to the methodological aspects of glioma research. Methodological inconsistencies may introduce weaknesses into the internal validity of the studies and hamper comparative analysis of cohorts from different institutions. We hope our recommendations will eventually help develop stronger methodological designs in future research endeavors.

Original languageEnglish (US)
Pages (from-to)382-395.e3
JournalWorld neurosurgery
StatePublished - May 2022


  • Bias
  • Confunders
  • Extent of resection
  • Glioma
  • Methodology
  • Study design
  • Tumor segmentation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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