Neurosurgeons’ perspective on surgical treatment of glioblastoma: Practices, beliefs and willingness to randomize in surgical trials

Duerinck J, Lescrauwaet L, Karschnia P, Alfayate RP, Jenkinson MD, Molina ES, Simon M, Gerritsen J, Van Der Veken J, Picart T, Le Rhun E, Minniti G, Preusser M, Weller M, Wittens MMJ, Jakola AS, Mansouri A (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Neuro-Oncology Advances Oxford University Press

Book Volume: 8

Article Number: vdag166

Journal Issue: 1

DOI: 10.1093/noajnl/vdag166

Abstract

Background: The optimal extent of resection for glioblastoma remains debated, with high-level evidence from randomized controlled trials (RCTs) notably scarce. We aimed to evaluate international surgical practices, perceived quality of evidence, and feasibility of future RCTs through an international survey of neurosurgeons. Methods: An international survey was distributed via European Organization for Research and Treatment of Cancer (EORTC), European Association of Neurosurgical Societies (EANS), Congress of Neurological Surgeons (CNS), and national societies. We used descriptive statistics to summarize surgical practices and univariate analysis and multivariate regression to identify demographic or institutional factors associated with clinical decision-making. Results: Responses were received from 328 neurosurgeons across 38 countries. Participation was predominantly from Europe (81.1%), with 12.2% from North America. Most participants (82.9%) practiced in academic centers. While 60.4% identified supramarginal resection (SMR) as the optimal surgical goal, 37.8% aim for complete resection of enhancing tumor (CRET). Overall, 90.2% viewed the evidence for CRET as strong, compared to 63.1% for SMR. Despite these views, 72.6% expressed willingness to randomize patients between CRET and SMR, while 49.4% would be willing to randomize between partial resection and biopsy, if CRET is not feasible. Despite differences in individual practice, willingness to participate in RCTs remained consistent across geographic regions. The incomplete overlap between case-based decisions and general willingness to randomize highlights the importance of case-specific nuances. A paradox was observed where perceived weak evidence correlated with lower willingness to randomize(P < .001). Conclusion: There is substantial global willingness among neurosurgeons to participate in surgical RCTs for glioblastoma. These findings provide a foundation for designing future international trials to resolve long-standing controversies regarding optimal surgical strategy for glioblastoma.

Authors with CRIS profile

Philipp Karschnia Department of Neurosurgery

Involved external institutions

Universitätsspital Zürich (USZ) CH Switzerland (CH) Vrije Universiteit Brussel (VUB) BE Belgium (BE) Sahlgrenska University Hospital / Sahlgrenska Universitetssjukhuset SE Sweden (SE) Penn State Health Children's Hospital US United States (USA) (US) The University of Liverpool GB United Kingdom (GB) Universitätsklinikum Münster DE Germany (DE) Universität Bielefeld DE Germany (DE) Erasmus University Medical Center (MC) NL Netherlands (NL) Flinders Medical Centre AU Australia (AU) Hopital Neurologique Pierre Wertheimer FR France (FR) Università degli studi "La Sapienza" IT Italy (IT) Universitair Ziekenhuis Brussel BE Belgium (BE) Hospital Clínico San Carlos ES Spain (ES) Medizinische Universität Wien AT Austria (AT)

How to cite

APA:

Duerinck, J., Lescrauwaet, L., Karschnia, P., Alfayate, R.P., Jenkinson, M.D., Molina, E.S.,... Mansouri, A. (2026). Neurosurgeons’ perspective on surgical treatment of glioblastoma: Practices, beliefs and willingness to randomize in surgical trials. Neuro-Oncology Advances, 8(1). https://doi.org/10.1093/noajnl/vdag166

MLA:

Duerinck, Johnny, et al. "Neurosurgeons’ perspective on surgical treatment of glioblastoma: Practices, beliefs and willingness to randomize in surgical trials." Neuro-Oncology Advances 8.1 (2026).

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