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.
