Perioperative Modulation of Microglia in Glioblastoma Resection

Glioblastoma recurrence remains nearly universal despite maximal safe surgical resection and multimodal adjuvant therapy. Beyond tumor debulking, resection induces profound local brain microenvironment alterations, including sterile neuroinflammation, blood–brain barrier disruption, extracellular matrix remodeling, and rapid activation of innate immune pathways. Among resident immune populations, microglia emerge as central regulators of the post-resection microenvironment, influencing inflammatory signaling, tissue repair, and tumor–host interactions. Activated microglia accumulate at the resection margin, where they adopt highly plastic functional states shaped by cytokine gradients, metabolic stress, hypoxia, and tumor-derived mediators. This dynamic activation landscape establishes bidirectional crosstalk with residual glioblastoma cells, promoting invasion, angiogenesis, maintenance of stem-like phenotypes, and suppression of anti-tumor immunity. As a result, microglial responses contribute to a permissive microenvironment that supports therapeutic resistance and tumor regrowth. Importantly, the perioperative period represents a short but important opportunity to modify microglial activity. Targeted therapeutic strategies, including pharmacologic modulation, local drug delivery systems, immunometabolic approaches, and gene- and cell-based therapies, may help alter the tumor microenvironment. This narrative review synthesizes current mechanistic insights into microglial dynamics following glioblastoma resection and evaluates emerging therapeutic strategies targeting microglial function. We further discuss integration with standard-of-care treatments and highlight evolving biomarker platforms for monitoring microglial states. Ultimately, targeting microglial plasticity represents a biologically grounded and clinically actionable strategy to improve outcomes after glioblastoma surgery.