Minimally Invasive Treatments for Glioblastoma: A Review of Current and Emerging Surgical Technologies

Glioblastoma (GBM) is malignant, primary intracranial neoplasm associated with poor outcomes. Maximal, safe cytoreduction remains an important component of effective treatment for patients with this disease; however, some patients are not candidates for resection due to comorbid status, tumor location, or other factors. In this review, we aimed to describe minimally invasive surgical techniques that are emerging as important tools for improving safety and efficiency in GBM cytoreduction, including for patients with previously unresectable lesions. Specifically, we aimed to describe the commercially available tubular retractor systems and describe the available data regarding the benefits, risks, and utility of these retractors for patients with GBM. Additionally, we aimed to describe laser interstitial thermal therapy (LITT) and its use in GBM, including a description of the mechanism of action, commercially available systems, the steps in surgical implantation, available outcomes data, and future directions for the technology in this context. Finally, we aimed to review the use of MRI-guided high-intensity focused ultrasound (MRgHIFU) in GBM, including a description of its mechanism and data regarding efficacy in GBM. The availability and use of tubular retractors, LITT, and MRgHIFU provide clinically effective alternative methods for cytoreduction in GBM and are also emerging as important tools for the expansion of treatment to GBM that previously may have been classified as nonresectable. This review will assist in the development of an intimate knowledge of the use and utility of these techniques and is important for clinicians caring for patients with GBM.