1.Overview Glioma is a tumor originated from glial cells and is the most common primary intracranial tumor, which is classified as grade I-IV in WHO central nervous system tumor classification. In the past 30 years, the incidence of primary malignant brain tumors has been increasing year by year, with an annual growth rate of about 1.2%, especially in the elderly population. It is generally believed that the occurrence of malignant glioma is the result of the interaction of genetic factors within the body and external environmental factors, but the specific pathogenesis is unknown. The clinical manifestations of glioma include symptoms and signs of increased intracranial pressure and neurological deficits. At present, malignant glioma is mainly diagnosed by MRI and CT imaging, and the pathological diagnosis is clarified by tumor resection or biopsy, and the research of pathological diagnosis at molecular and genetic levels is gradually advanced. The treatment of malignant glioma adopts a comprehensive treatment based on surgery combined with radiotherapy and chemotherapy. Surgery advocates safe and maximal tumor removal, and the application of functional MRI, intraoperative MRI, and neuronavigation technologies has facilitated this purpose. Radiotherapy can kill or inhibit residual tumor cells and prolong survival. Temozolomide (TMZ) synchronized radiotherapy combined with adjuvant chemotherapy has become the standard regimen for newly diagnosed glioblastoma (GBM). 2. Diagnosis of malignant glioma The clinical manifestations of malignant glioma are not specific and are dominated by neurological deficits with symptoms of increased intracranial pressure. MRI is usually a mixed signal lesion with isosignal or low signal in T1WI and inhomogeneous high signal in T2WI, accompanied by hemorrhage, necrosis or cystic degeneration, peritumoral edema and significant occupational effect. The tumor often spreads along the white matter fiber bundle. CT scan shows heterogeneous density with hemorrhage, necrosis or cystic lesion, peritumor edema and occupying effect are obvious. Enhancement shows significant heterogeneous enhancement, irregular or ring-like enhancement. MRI special function tests (MRS, PWI, DWI, DTI), PET and SPECT are recommended, mainly for differential diagnosis, preoperative assessment and outcome evaluation. 3.Pathological diagnosis and biological markers of malignant glioma It is strongly recommended to strictly follow the 2007 WHO Classification of Tumors of Central Nervous System for pathological diagnosis and grading of malignant glioma. In order to cooperate with the treatment, efficacy observation and prognosis of glioma patients, it is strongly recommended to carry out selective molecular biological markers such as GFAP, Olig2, EMA, p53, MGMT, Ki67 and 1p/19q LOH in hospitals at all levels according to the actual situation. 4. Surgical treatment of malignant glioma It is strongly recommended for primary high-grade (WHO grade III~IV) or low-grade (WHO grade III~IV) gliomas confined to the lobes of the brain. It is strongly recommended that for primary high-grade (WHO grade III-IV) or low-grade (WHO grade II) gliomas confined to the lobes of the brain, maximum safe resection of the tumor should be pursued. Based on the swollen infiltrative growth pattern and blood supply characteristics of glioma, microscopic neurosurgical techniques are recommended to make anatomical resection along the white matter fiber bundles of tumor margins with the cerebral sulcus and gyrus as the boundary, so as to obtain maximum tumor resection with minimal tissue and neurological function damage and clear histopathological diagnosis.