In patients with glioblastoma younger than 65 years of age, even with IDH wild type, surgical resection of 100% enhancing portion + at least 90% non-enhancing portion, followed by temozolomide radiotherapy, resulted in a median survival of approximately 37.3 months. The median survival was 14-16 months with resection of only the enhancing portion. It is suggested to cut more to benefit more. If you have more time, you can learn more: Current guidelines recommend resection of the enhancing portion of high-grade gliomas. Therefore, enhancement MRI within 72 hours after surgery is used as the gold standard to assess the extent of resection. （The classic regimen used for postoperative adjuvant treatment of glioblastoma is the Stupp regimen (temozolomide with radiotherapy). This regimen sets total resection as a total resection of the enhancing portion on magnetic resonance. The median survival of patients was obtained as 14-16 months. The outcome of treatment for high-grade glioma has long been pessimistic. Previous basic studies have shown that tumor cells are present in all areas of abnormal MRI signal (in fact, tumor cells are still present in areas of normal signal around the lesion). Does resection of the non-enhanced portion on top of resection of the enhanced portion have a better prognosis? A recent JAMA article showed1 that in patients younger than 65 years with IDH wild-type glioblastoma, surgical resection of 100% of the enhancing portion + 90% of the non-enhancing portion, followed by postoperative temozolomide radiotherapy, resulted in a median survival of approximately 37.3 months. Survival gain was independent of MGMT methylation status. This survival was consistent with secondary glioblastoma of the IDH mutant type. It was significantly better than in patients who had only the enhancing portion removed. Previous data confirm that 90% of glioblastomas are IDH wild type (no IDH mutation) and 10% are IDH mutated. Meaning that for a patient with glioblastoma, one cannot bet on IDH and will basically lose. Reflecting the importance of expanded resection, it is possible to enhance the prognosis of a patient with IDH wild type to be comparable to IDH mutant type by expanded surgical resection. The hint is that for high-grade gliomas, the area of abnormal signal on MRI (enhancing portion + non-enhancing portion) should be considered as the area to be resected. That is, resect as many areas of abnormal signal as possible with safety in mind. In our clinical practice, it is often anatomical structures (landmarks) to resect tumors. It both improves the efficiency of surgery and increases the extent of resection.