Management of deep-seated gliomas

The management of thalamic and brain stem astrocytomas remains controversial. Treatment options are: (a) clinical observation, (b) radiotherapy without biopsy, (c) stereotactic biopsy followed by radio and/or chemotherapy, and (d) surgical removal with or without adjuvant therapy. Stereotactic surgical techniques have improved the morbidity and mortality rates of biopsies and surgical resection of deep-seated gliomas. The biologic behavior of these lesions is not well known and proliferation cell index tests may help in the choice of therapy. In this review, seven recent papers on the management of deep-seated gliomas are presented. Radical removal of thalamic pilocytic astrocytoma may cure the patient. In cases of low-grade astrocytomas, stereotactic guided surgical removal has low morbidity. Adjuvant radiotherapy should be used only in selected cases. Sterotactic biopsy followed by radio- and/or chemotherapy is the best option for thalamic or brain stem anaplastic astrocytomas and glioblastomas.