Surgery of Intracranial Gliomas in Children

Gliomas are the most common type of brain cancer in the pediatric patients, constituting about 50% of all childhood intracranial tumors. This is a highly heterogeneous group, varying from the benign WHO histopathological grades I and II to malignant WHO grades III and IV. The histology and location are significant prognostic factors, which influence the decision for surgical intervention, as well as the extent of possible tumor removal. In low-grade gliomas, surgery remains the initial option and should be directed at gross total resection in favorable locations, such as the cerebral hemispheres and the cerebellum. Management of high-grade gliomas (HGG), which are less common in children compared to adults, continue to pose a significant challenge. In non-brainstem HGG, the goal is safe maximal tumor removal, while it generally does not play any role in diffuse intrinsic pontine gliomas. Treatment must, thus, be individualized in the majority of cases of HGG. Surgery for gliomas in children continues to be aided by technological advancements facilitating tumor resection and improving patient safety and outcomes.