The Growth of Glioblastoma Multiforme (Astrocytomas, Grades 3 and 4) in Neurosurgical Practice (1961)

I N BAILEY and Cushing's 2 original series the gl ioblastoma multiforme (astroeytomas, grades 3 and 4) made up about 40 per cent of their gliomas. In our series, this t y p e of mal ignant glioma constitutes a lmost 60 per cent of the total number and more t h a n 90 per cent of all gliomas in elderly pat ients . 6 M a n y pathologic investigations have been carr ied out regarding this type of tumor. The surgical t r e a t m e n t has not been solved. A t t e m p t s have been made by many neuropathologis ts to demonst ra te the distribution of this highly mal ignant tumor in the brain, bu t their main interest has been its preferent ial sites and its microscopic differentiation in each location. I-4 Os te r tag TM described the location of the var ious types of glioinas, and recently Ziilch ts publ ished his own series of brain tumors and demons t r a t ed preferential localization in each lobe. I k u t a ~ suggested an embryologic reason for the location of certain gliomas in specific regions. However, few studies have been made concerning the gross aspect of growth and extension of this tumor on the laws governing structural development. T h e earliest observations were made in this field by Stroebe 1~ in 1895. In 1934 Voris 'a r epor ted t h a t ~4 per cent of frontal-lobe gliolnas have bilateral infiltration across the corpus eallosum. In 1938 and 1940 Seherer ~2,~:~ worked on the forms of growth in gliolnas and their pract ical significance. I Ie obta ined 1~0 gliomas a t necropsy and studied the morpho logy of this type of tumor. At t ha t tiine he said tha t mos t investigators of the last twen ty years have been fascinated by eytologieal and histogenetic problems to such a degree tha t they pay little a t tent ion to most of the other aspects of the morphology of gliolna. This curious s tate of things still seems to be true. Astroeytoinas, grades 3 and 4, have infilt ra t ive characteristics of growth which make sueeessful radical extirpation difficult. In the l i terature m a n y workers f requent ly emphasized the fact tha t in a glioma no capsule is formed. In m a n y eases tha t we have noted, as t roeytomas, grades 3 and 4, have spread diffusely throughout nmeh of the brain. Seherer12,1a said tha t primari ly diffuse gliomas wi thout formation of a definite mass and without pronounced destruction of the preexisting tissue are encountered in about ~5 per eent of gliomas in general. Seherer also reported tha t in m a n y glioblastomas, in medulloblastomas, in most of the oligodendrogliomas and eerebellar astroeytomas, and in the so-called polar spongioblastomas, a narrow zone of infiltration is eneountered. He thought tha t several factors sueh as an arresting of its spread a t given pre-existing struetures, espeeially in white m a t t e r a t its junction with the eortex or deeper gray mat ter , would l imit the growth of gliomas. He and others 3,7'm13'ls mentioned various types of growth in the glioma group and emphasized tha t the form of the glioma depends on the pre-existing brain tissue in whieh it is growing or on p r imary arehiteetural propert ies of the brain. Recen t studies