Surgical Strategies in Basal Ganglia Gliomas: A Systematic Review of Resection Extent, Mortality, and Neurological Recovery.

Abstract

Basal ganglia gliomas are challenging for the neurosurgeon owing to their depth and the risk of permanent neurologic impairment. Several treatment modalities are reported, including resection, biopsy, and adjunct treatment. This review evaluates the surgical outcomes in basal ganglia gliomas through a comprehensive analysis of neurological improvement, recurrence, mortality, and complication rates, stratified by tumor characteristics and resection extent. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed for the systematic analysis of resection, biopsy, and conservative management cases. The outcome by treatment type, extent of the resection, and prognosis were assessed. One-arm proportional meta-analyses using fixed-effect models assessed pooled estimates of improvement, recurrence, and mortality. Subgroup analyses were conducted based on tumor grade, anatomical site, and surgery type. Subtotal resection demonstrated the highest neurological improvement (40.6%) and lowest mortality (13.3%) compared to gross total resection and radiosurgery. Low-grade tumors showed significantly better outcomes, with a 45% improvement rate and 7.7% mortality. Caudate nucleus tumors exhibited the most favorable prognosis, while putaminal tumors carried the highest risk of worsening and mortality. Radiosurgery yielded the poorest outcomes across all domains. This is the first meta-analysis to quantitatively stratify surgical outcomes in basal ganglia gliomas by tumor grade, location, and resection extent. Subtotal resection may offer a safer alternative to gross total resection in functionally critical areas. These findings support a paradigm shift toward individualized surgical planning that balances resection with functional preservation, especially in deep-seated gliomas.