There are five types of treatment for glioma, generally surgery is the main treatment. However, due to the infiltrative growth of tumor, there is no obvious border between the tumor and brain tissue, except for the small tumor in the early stage and located in the appropriate area, it is difficult to remove all the tumor, and generally advocate comprehensive treatment, that is, postoperative radiotherapy, chemotherapy, etc., which can delay the recurrence and prolong the survival. We should strive for early diagnosis and timely treatment to improve the treatment effect. Late stage is not only difficult to operate, but also dangerous and often has neurological deficits. Especially for tumors with high malignancy, they often recur within a short period of time. Surgical treatment: The principle is to remove the tumor as much as possible while preserving the neurological function. In early stage, all tumors should be removed if they are small. For shallow tumors, cortical incision should be made around the tumor, and for white matter tumors, cortical incision should be made avoiding important functional areas. When separating the tumor, it should be done at a certain distance from the tumor and within the normal brain tissue, not close to the tumor. Especially for more benign tumors such as astrocytoma and oligodendroglioma in frontal or anterior temporal lobes or cerebellar hemispheres, better results can be obtained. For larger tumors located in the frontal or anterior temporal lobes, lobectomy can be performed to remove them together with the tumor. In the frontal lobe, the posterior margin of the incision should be at least 2 cm in front of the anterior central gyrus, in the dominant hemisphere and should avoid the motor speech center. In the temporal lobe, the posterior margin should be before the inferior anastomotic vein and avoid damage to the lateral fissure. If the frontal or temporal lobe tumors are too extensive to be removed, the frontal pole or frontal pole can be removed as much as possible for internal decompression, which can also prolong the recurrence time. If the tumor involves more than two lobes of the cerebral hemisphere, but does not invade the basal ganglia, thalamus or the contralateral side, hemispherectomy can be performed. If the tumor is located in motor and speech area without obvious hemiparesis and aphasia, attention should be paid to maintain the neurological function to remove the tumor appropriately to avoid serious sequelae. Sub-temporal muscle or debridement decompression can be performed at the same time. Or, decompression can be performed after biopsy only. If the thalamus tumor compresses and obstructs the third ventricle, shunt can be performed, otherwise decompression can also be performed. Ventricular tumor can be removed from the non-important functional area to enter the ventricle according to the location of the tumor, so as to remove the tumor and relieve the ventricular obstruction. Care should be taken to avoid damaging the hypothalamus or brainstem adjacent to the tumor to prevent danger. Except for small nodular or cystic tumors, brain stem tumors can be resected, and those with increased intracranial pressure can be shunted. If the tumor is difficult to be resected, shunt can also be performed. For those who are in critical condition, dehydration medication should be given to the supratentorial tumor first, and the diagnosis should be confirmed by examination as soon as possible, and then surgery should be performed immediately. For posterior cranial fossa tumor, ventricular drainage can be performed first, and then surgery can be performed 2-3 days later when the condition improves and stabilizes. Radiation therapy: The radiation sources used for external irradiation are high-voltage x-ray therapy machine, 60Co therapy machine, electronic gas pedal and so on. The latter two belong to high-energy rays, strong penetrating power, low skin dose, small bone absorption and little bypass scattering. Gas pedals, on the other hand, concentrate the dose at the expected depth, beyond which the dose drops sharply, and can protect the normal brain tissue behind the lesion. Radiation therapy is recommended as soon as possible after recovery from surgery. The irradiation dose is usually given to 5000-6000 cGy for glioma and is completed within 5-6 weeks. Those with high sensitivity to radiation therapy in large irradiation fields, such as medulloblastoma, can be given 4000-5000 cGy. The sensitivity of various types of gliomas to radiation therapy varies. It is generally considered that poorly differentiated tumors are more sensitive than well differentiated ones. Medulloblastoma is the most sensitive to radiotherapy, followed by ventriculoblastoma. Glioblastoma multiforme is only moderately sensitive, and astrocytoma, oligodendroglioma, and pineal cell tumor are even worse. For medulloblastoma and ventricular meningioma, whole spinal canal irradiation should be included because they are easily disseminated with cerebrospinal fluid. Chemotherapy: chemotherapeutic drugs with high lipolytic properties that cross the blood-brain barrier are suitable for cerebral gliomas. In astrocytoma grade III-IV, the blood-brain barrier is destroyed due to edema, so that water-soluble large molecules can pass through, so some people think that the selection of drugs can be expanded to many water-soluble molecules. However, in fact, the blood-brain barrier is not severely damaged in the peritumor area where proliferating cells are dense. Therefore, the choice of drugs should be mainly fat-soluble ones. The current preferred drugs are highlighted below. 1.Ghostoside: chemical name: 4′-deprenyl-epi-ghostoside-β-methanopyranoside, trade name Vumon (Teniposide, VM26), is a semi-synthetic derivative of ghostoside. VM26 has a wide antitumor spectrum, is highly lipid-soluble, crosses the blood-brain barrier, is a cell staging drug, destroys deoxyribonucleic acid, and blocks G2 (late DNA synthesis) and M (division phase). 120-200mg/m2 per day for 2-6 days. When combined with CCNU, the dosage can be reduced to 60mg/m2 per day and added to 10% glucose solution 250m1 intravenously for about one and a half hours for 2 days, followed by CCNU orally for 2 days on the 3rd and 4th days, for a total of 4 days as a course of treatment. Repeat a course of treatment every 6 weeks. Side effects: light suppression of bone marrow, low toxicity; cardiovascular reaction manifested as hypotension, so it is advisable to monitor blood pressure during the sedation. 2. Cyclohexylnitrosourea (CCNU): It has been in clinical use for many years and is a cell cycle drug, acting on all phases of proliferating cells and also on the stationary phase of cells. It has strong lipid solubility and can pass the blood-brain barrier. Therefore, it is chosen for the treatment of malignant glioma. Toxic reactions, mainly in the form of delayed myelosuppression and accumulation reactions, have significantly limited its application, forcing postponement or even interruption of treatment after 4 to 5 courses of treatment. In addition, gastrointestinal reactions are also very serious, with a high percentage of nausea, vomiting and abdominal pain occurring after taking the drug. The liver and lungs are also affected. The common dose is 100-130 mg/m2 per day orally in adults for 1 to 2 days, repeated every 4 to 6 days. The dose can be reduced to 60mg/m2 per day when combined with VM26. 3.Methylcyclonitrosourea (MeCCNU): The dosage is 170-225mg/m2. The dose is the same as CCNU, but less toxic. Chemotherapy for glioma tumors tends to be combined, with more than two drugs, or even multiple drugs, according to cell kinetics and the specificity of the drugs to the cell cycle, to improve the efficacy. Shanghai Tianxi Zhang applied teniposide-cyclohexylnitrosourea sequence chemotherapy with obvious efficacy, which is recommended. The methodological steps are: each course of treatment has a total of 4 days. The first and second days: VM26 100mg added to 10% glucose solution 250mI IV maintenance l, 5 to 2 hours for 2 days, VM26 rapid drip or direct IV will cause a sudden drop in blood pressure, should not be used, and in the course of IV need to observe blood pressure to prevent accidents, such as blood pressure dropped to below 10kpa should be immediately discontinued. Given that VM26 is prone to failure after dilution at room temperature for more than 4 hours, it is advisable to use it as it is prepared. Days 3 and 4: CC-NU 80mg orally daily. An antiemetic such as morpholine is given half an hour before dosing to reduce GI reactions. After a course of treatment, repeat the next course of treatment at 6-week intervals. Generally, the effect of CCNU reaches its peak in the fourth week after dosing, so it is advisable to routinely recheck blood leukocytes and platelet counts at the end of the fifth week. If the blood leukocytes are lower than 3×109/L and platelets are lower than 90×109/L, it is advisable to postpone the chemotherapy until the blood picture regains before starting the next course of treatment. Due to the accumulation toxicity of CCNU, the blood picture is usually not easily maintained after 4 to 5 courses, and the interval has to be postponed. Or VM26 alone can be used as a transition, and the combination of the two drugs can be resumed when the blood picture improves. During this period, supportive therapies such as DNA and squalacol can be routinely given. If the patient tolerates it well, 10 to 15 consecutive courses of treatment may be given. There is no sign of recurrence on review by CT scan. If the clinical performance is satisfactory, the drug can be finally discontinued for follow-up. Immunotherapy: Immunotherapy is still in the trial stage, and the efficacy is still uncertain and needs further study. Other drug therapy: Hormone therapy can be given first for malignant glioma, with dexamethasone having the best effect. In addition to reducing brain edema, it also has the effect of inhibiting the growth of tumor cells. It can reduce the symptoms, and then surgery can be performed.