Surgical management of intracranial gliomas

Surgery is indicated in almost all glioma patients at some point during the course of their disease. The surgical intervention aims at obtaining a tissue diagnosis, providing symptom relief, improving patient survival by reducing the tumor burden, and in rare cases even effecting a cure.A resection will reduce symptoms related to the mass effect of the tumor, and offers a good chance for seizure control. An increasing body of data suggests that glioma patients will benefit from a maximal safe surgical cytoreduction. However, the size of the effect may vary for the different glioma entities. Modern adjuvant neuro-oncological treatment strategies rely heavily on the histological diagnosis. A (stereotactic) biopsy should therefore be offered to patients with nonresectable gliomas to allow for histology-guided adjuvant therapy. Some gliomas can be managed successfully with stereotactic interstitial radiosurgery (brachytherapy). Intra- and extraoperative electrophysiological mapping and/or monitoring, functional MRI, intraoperative imaging, and neuronavigation are increasingly used in many neurosurgical centers in order to reduce surgical morbidity. A definite effect on long-term outcome needs yet to be proven.Advances in computers, imaging, and other technologies will continue to play a large role in the evolution of neurosurgical treatment for gliomas. This may well lead to further centralization of care. There will be an increasing pressure on neurosurgeons to justify the costs involved by showing that patients will actually benefit from complex treatments in highly specialized centers.