Surgery vs. Biopsy in the Treatment of Butterfly Glioblastoma: A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: There is uncertainty regarding the role of surgical resection in the management of butterfly glioblastoma (bGBM). We therefore investigated this question by pooling available data from the literature and performing a systematic review and meta-analysis. Our results show that operative management of bGBM was associated with longer overall survival compared with biopsy alone. This effect persisted in both >80% and <80% extent of resection subgroups. At the same time, complications were not statistically significantly higher; however, these were numerically larger for surgery. Our study corroborates findings from smaller studies and supports the consideration of surgery in the treatment of bGBM patients. ABSTRACT: Butterfly glioblastomas (bGBM) are grade IV gliomas that spread to bilateral hemispheres by infiltrating the corpus callosum. Data on the effect of surgery are limited to small case series. The aim of this meta-analysis was to compare resection vs. biopsy in terms of survival outcomes and postoperative complications. A systematic review of the literature was conducted using PubMed, EMBASE, and Cochrane databases through March 2021 in accordance with the PRISMA checklist. Pooled hazard ratios were calculated and meta-analyzed in a random-effects model including assessment of heterogeneity. Out of 3367 articles, seven studies were included with 293 patients. Surgical resection was significantly associated with longer overall survival (HR 0.39, 95%CI 0.2–0.55) than biopsy. Low heterogeneity was observed (I(2): 0%). In further analysis, the effect persisted in extent of resection subgroups of both ≥80% and <80%. No statistically significant difference between surgery and biopsy was detected in terms of postoperative complications, although these were numerically larger for surgery. In patients with bGBM, surgical resection was associated with longer survival prospects compared with biopsy.