[Surgical intervention in patients with malignant glioma]

Glial tumors occur at an incidence from 2 to 10/ 100.000 (Japan vs. Sweden) and building up to 50 % of all patients suffering from brain tumors. 50 % of those are again malignant gliomas Grade III and Grade IV. Despite all therapeutic approaches the median survival for glioblastomas is 15 months and for anaplastic gliomas Grade III 30 months. After diagnosis, preferably by MRI, a neurosurgical procedure is performed under microsurgical guidelines mostly by means of neuronavigation and intraoperative guidance. Depending on the preoperative diagnosis and localisation of the pathologic lesion an open craniotomy or a stereotactic biopsy is performed. This allows the histological verification and decompression and cytoreduction. A gros total safe removal preserving neurological function is the most important goal of surgery. Tumor removal in eloquent areas such as speech area is performed under local anesthesia as an awake operation. Age, Karnofsky performance status, histology as well as radical removal have a significant influence on overall survival. Adjuvant radiotherapy and chemotherapy with Temozolemide have further improved the outcome significantly. The 2-year survival has reached 28 % in most recent studies. Further experimental therapies in controlled trials, such as intratumoral convection-enhanced instillation of immunotoxins and radiopeptids, photodynamic therapy and direct instillation of new formulations of chemotherapeutic drugs (e. g. nanoparticles) are promising new approaches. New developments in the treatment of patients harboring malignant brain tumors allow an individual neurooncological treatment concept to be established to enhance overall survival and quality of life.