A Bilateral, Mirror-Like Multifocal/Multicentric Glioblastoma: A Case Report and Literature Review

Abstract Background Multifocal or multicentric glioblastoma (mGBM) generally carries an unfavorable prognosis. Tumor burden, choice of surgical approach, and perioperative management of cerebral edema directly determine whether adjuvant chemoradiotherapy can commence on schedule. We report a patient with bilateral, symmetric supratentorial lesions without callosal continuity who developed diffuse postoperative cerebral edema with cardio-respiratory instability and died 4 months after surgery. Case presentation: A 60-year-old woman presented with a 2-week history of progressive limb weakness (GCS 15; KPS 60; limb power grade 3). MRI suggested bilateral frontal tumors. She underwent simultaneous bilateral frontal craniotomies for tumor resection under general anesthesia. Final pathology confirmed GBM, WHO grade 4, IDH-wildtype. Although initially arousable, her consciousness worsened on postoperative days 3–6, followed by cardio-respiratory instability and lower respiratory tract infection/ventilation-related complications. She alternated between the general ward and neurointensive care unit (NICU). Unable to tolerate adjuvant chemoradiotherapy because of poor performance status, she died approximately 4 months postoperatively after the family elected to cease treatment. Conclusions For mGBM, the primary surgical objective is to debulk within functional tolerability and secure the 2–6-week postoperative window for chemoradiotherapy to extend overall survival. Operative strategies should be individualized according to tumor burden, particularly in patients with large, bilaterally balanced hemispheric disease. Prognosis depends more on achieving an adequate extent of resection within functional limits, rigorous postoperative edema/ICP control, and on-schedule completion of the Stupp regimen than on the multifocal/multicentric phenotype per se. These observations are hypothesis-generating and should be interpreted in the context of a single case.