The impact of extent of surgical resection on survival for HGGs continues to be debated. Clearly, given the biological constraints noted above, a "complete" resection of an HGG is not possible. Extent of surgical resection is best defined based on volumetric analysis  of residual contrast-enhancing volume on MR or CT imaging obtained within 24-48 hours of surgery, although non-specific contrast enhancement can be seen after operation for non-neoplastic lesions as soon as 17 hours postoperatively . While contrast enhancement is the most obvious and consistent radiographic indicator of HGG tissue, a small percentage of GBMs do not enhance, and 30-50% of non-GBM HGGs lack contrast enhancement on CT imaging. Conversely, up to 40% of non-enhancing gliomas are anaplastic.
The scientific analysis of cytoreductive surgery for HGG is further confounded by a lack of uniformity in defining and assessing extent of resection and use of subsequent treatment modalities that can prolong survival, and the variable and poorly understood interaction of the multiple patient, treatment and tumor factors that collectively determine patient survival. It is doubtful that a single study could be designed that would definitively address all of these confounding issues and clearly determine the impact of surgical resection on patient outcome. However, in the only study of its kind,
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.