2: Management

Initial Management

For all adult gliomas, surgical resection is the first step. Surgery is important for:

  • Diagnosis
  • Reduction of tumour bulk to relieve symptoms
  • Reduction of tumour bulk to improve the impact of adjuvant treatments

In some cases, the decision to proceed with surgery can be complicated:

  • In elderly patients
  • In patients with significant comorbidities
  • When tumours are located near eloquent cortex
  • When tumours are located centrally (thalamus, brainstem)
  • Large tumours where resection would lead to significant functional deficits (eg. bilateral or multifocal glioblastoma)

Discussion with the patient and family should be undertaken in these circumstances. In some cases, a biopsy of the lesion can be performed that will have (hopefully) minimal impact on neurological function.

Once diagnosis has been achieved, further management is dependent on histopathology.