Malignant gliomas are generally referred to as high-grade gliomas. These gliomas are not curable simply by surgical excision, but can easily recur after surgical excision, resulting in disability or even death. Even after surgery, adjuvant radiotherapy to further control the growth of malignant glioma can delay the time of tumor recurrence, but for most cases of malignant glioma, recurrence is almost inevitable. In view of this type of malignant high-grade glioma, some patients or family members think that the treatment effect is not ideal anyway, so they do not want to do open-heart surgery and do not want to bear the risk and trauma of open-heart surgery, but want to do radiotherapy directly, hoping to control the growth of tumor and achieve the purpose of treatment through less invasive treatment. However, this option is not applicable to the vast majority of patients with malignant glioma. First, such a regimen is likely to be unworkable, and even if it could be carried out, the treatment would be very ineffective. Malignant gliomas are often already growing relatively large when they are discovered, compressing surrounding brain tissue and vital structures, and even causing significant increases in intracranial pressure. In this case, the edema and other reactions caused by direct radiotherapy without reducing the tumor load mixed with the increased intracranial pressure caused by the tumor itself will intensify the compression of the surrounding tissues by the malignant glioma, and the severe increased intracranial pressure may even cause life-threatening brain herniation, making it impossible to carry out radiotherapy. Moreover, because of the large size of malignant glioma, it is difficult for radiotherapy or chemotherapy to kill so many malignant tumor cells, so the effect of radiotherapy alone without surgical resection and tumor reduction is not ideal. In addition, malignant glioma without surgery to obtain tumor specimens for pathological confirmation may not be truly malignant glioma, and direct selection of radiotherapy at this time is likely to be wrong in terms of treatment direction and will cause unnecessary damage to the patient. This is because malignant gliomas diagnosed by MRI or CT alone may not sometimes be truly pathologically malignant gliomas. MRI and CT are the most commonly used tests in neurosurgery and provide a relatively accurate diagnosis for most high-grade gliomas, but both MRI and CT diagnoses are preliminary and have a degree of error from the final diagnosis. In some cases, the pre-surgical MRI diagnosis is malignant glioma, but the post-surgical pathological diagnosis is not malignant glioma, but may be a benign lesion that does not require radiotherapy after surgery. If radiotherapy is used for a patient who does not need radiotherapy, it will not only fail to achieve the therapeutic effect, but also damage the patient’s body. Assuming that such patients are treated with radiotherapy instead of surgery, the entire treatment plan is wrong and not only will it fail to control the progression of the lesion, but radiotherapy will also seriously damage the patient’s body. For most malignant gliomas, removal of the tumor through open surgery followed by adjuvant radiotherapy or electric field therapy is the standard of care and the best option for most patients with malignant gliomas. Direct radiotherapy without surgery is less damaging, but is not a good treatment option in most cases.