Functional Recovery After Severe Postoperative Decline in Glioblastoma: The Importance of Reassessing Treatment Eligibility
6 affiliations
- 1Family and Community Medicine, Rio Hortega University Hospital, Valladolid, ESP
- 2General Medicine, Independent Research, Boston, USA
- 3Family Medicine, Rio Hortega University Hospital, Valladolid, ESP
- 4Neurological Surgery, Universidad de Ciencias Médicas de Granma, Manzanillo, CUB
- 5Community Medicine, Community Medical Group, Lakeland, USA
- 6Medicine, Georgetown American University, Georgetown, GUY
Abstract
Glioblastoma is the most common and aggressive primary malignant brain tumor in adults, and those arising in the frontal lobe can present with subtle cognitive and behavioral changes, often delaying diagnosis. We present a case of a 67-year-old male patient who presented with a two-week history of psychomotor slowing and progressive difficulty expressing himself, initially concerning for aphasia. Neurological examination suggested a frontal lobe syndrome rather than a true aphasic disorder. Magnetic resonance imaging (MRI) demonstrated a 4.4×3.2×3.8 cm left frontal mass with peripheral enhancement, central necrosis, and extensive vasogenic edema. He underwent left frontal craniotomy with radiologically complete resection; histopathology confirmed isocitrate dehydrogenase (IDH)-wildtype glioblastoma, central nervous system (CNS) World Health Organization (WHO) grade 4. The patient’s postoperative course was complicated by a new intraparenchymal hematoma and parafalcine subarachnoid hemorrhage. Three weeks after surgery, his Karnofsky performance status (KPS) was 40%, initially raising doubts about his candidacy for chemotherapy. He subsequently improved clinically, allowing initiation of hypofractionated radiotherapy (40 Gy in 15 fractions) with concurrent temozolomide, followed by all six planned cycles of adjuvant temozolomide, complicated by fluctuating thrombocytopenia with one asymptomatic nadir of 37,000/µL. Surveillance MRI approximately nine months after surgery showed no evidence of viable tumor recurrence. This case highlights that a severely reduced early postoperative performance status in glioblastoma does not necessarily preclude completion of standard multimodal therapy, and underscores the importance of reassessing functional status and excluding reversible complications, such as postoperative hemorrhage, before treatment is withheld.
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BibTeX
@article{barreiros2026functional,
title = {{Functional Recovery After Severe Postoperative Decline in Glioblastoma: The Importance of Reassessing Treatment Eligibility}},
author = {Alain Roberto Barreiros and Idalberto Luis Fernandez Eng and Jennifer Rodríguez Benítez and Luis A Guzman Blanco and Manuel A Guerra Guerrero and Elizabeth Valdes},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117211},
url = {https://europepmc.org/article/PMC/PMC13721622},
note = {CC BY},
}
RIS
TY - JOUR
TI - Functional Recovery After Severe Postoperative Decline in Glioblastoma: The Importance of Reassessing Treatment Eligibility
AU - Alain Roberto Barreiros
AU - Idalberto Luis Fernandez Eng
AU - Jennifer Rodríguez Benítez
AU - Luis A Guzman Blanco
AU - Manuel A Guerra Guerrero
AU - Elizabeth Valdes
PY - 2026
DA - 2026/09/30
JO - Cureus
DO - 10.7759/cureus.117211
UR - https://europepmc.org/article/PMC/PMC13721622
AB - Glioblastoma is the most common and aggressive primary malignant brain tumor in adults, and those arising in the frontal lobe can present with subtle cognitive and behavioral changes, often delaying diagnosis. We present a case of a 67-year-old male patient who presented with a two-week history of psychomotor slowing and progressive difficulty expressing himself, initially concerning for aphasia. Neurological examination suggested a frontal lobe syndrome rather than a true aphasic disorder. Magnetic resonance imaging (MRI) demonstrated a 4.4×3.2×3.8 cm left frontal mass with peripheral enhancement, central necrosis, and extensive vasogenic edema. He underwent left frontal craniotomy with radiologically complete resection; histopathology confirmed isocitrate dehydrogenase (IDH)-wildtype glioblastoma, central nervous system (CNS) World Health Organization (WHO) grade 4. The patient’s postoperative course was complicated by a new intraparenchymal hematoma and parafalcine subarachnoid hemorrhage. Three weeks after surgery, his Karnofsky performance status (KPS) was 40%, initially raising doubts about his candidacy for chemotherapy. He subsequently improved clinically, allowing initiation of hypofractionated radiotherapy (40 Gy in 15 fractions) with concurrent temozolomide, followed by all six planned cycles of adjuvant temozolomide, complicated by fluctuating thrombocytopenia with one asymptomatic nadir of 37,000/µL. Surveillance MRI approximately nine months after surgery showed no evidence of viable tumor recurrence. This case highlights that a severely reduced early postoperative performance status in glioblastoma does not necessarily preclude completion of standard multimodal therapy, and underscores the importance of reassessing functional status and excluding reversible complications, such as postoperative hemorrhage, before treatment is withheld.
SN - 2168-8184
ER -