What is glioma? Glioma is the most common malignant tumor of the nervous system, accounting for about half of all brain tumors. It is also classified into glioblastoma, astrocytoma, oligodendroglioma, ventricular meningioma, medulloblastoma, pineal tumor and choroid plexus papilloma. The World Health Organization (WHO) classifies gliomas into four grades (grades I-IV) according to their malignancy. The higher the grade, the more malignant it is and the worse the prognosis. The causes of glioma development are still unclear. The development of glioma is related to genetic factors, viral and bacterial infections, abnormalities of oncogenes, oncogenes and DNA mismatch repair genes, but there is no definite conclusion. Clinical manifestations of glioma are mainly symptoms of increased intracranial pressure such as headache, dizziness, nausea, vomiting, loss of vision and local pressure symptoms such as impaired limb movement and sensation, speech dysfunction, seizures and psychiatric symptoms. Tumors of different locations and sizes often have different presentations and characteristics. Ancillary diagnosis of glioma CT and MRI examinations can mostly clarify the diagnosis, especially MRI examination can clearly see the difference between tumor and surrounding normal tissues, and determine the size and location of tumor, which can provide effective help for treatment. Patients with epilepsy also need to have EEG examination. The final diagnosis can be determined only after the tumor tissue is removed during surgery and pathological examination is performed. The application of special MRI methods Blood oxygen level-dependent imaging (Bold-fMRI), diffusion tensor imaging (DTI) and proton spectroscopy (MRS) can better observe the higher functions and changes in cellular metabolism in the tumor-invaded area at the brain functional and metabolic levels. These new MRI methods can help the surgeon to make a more detailed surgical plan, which is important in guiding the surgical plan and postoperative individualized and comprehensive treatment. Since gliomas are infiltrative, poorly defined, and prone to recurrence, a combination of microsurgery, radiation therapy, chemotherapy, and immunotherapy is currently the best strategy for glioma treatment. Microsurgery for glioma Suitable for all levels of glioblastoma, maximum removal of tumor tissue under the surgical microscope while providing maximum functional protection to the surrounding normal brain tissue can achieve the best therapeutic effect and minimal side effects. The aim of surgical treatment is to remove the tumor, improve the local symptoms of the tumor and relieve the symptoms of increased intracranial pressure, while obtaining a diagnostic tumor pathology specimen to facilitate pathological analysis and molecular pathology diagnosis. Histopathology only classifies and grades tumors morphologically, while neuromolecular pathology diagnoses and classifies gliomas at the genetic and protein levels, which can accurately reflect the cell biology of tumor cells. The combination of histopathological results can better guide the implementation of postoperative individualized radiotherapy and chemotherapy, and help to judge the treatment effect and prognosis. Radiation therapy for glioma Three-dimensional conformal segmentation radiation therapy is a common radiation therapy for glioma, which can effectively kill the cells and tissues infiltrated by tumor cells around the tumor, minimize the number of tumor cells, and cause vascular occlusion, coagulation and necrosis of the tumor, and ultimately reduce the size of the tumor. Stereotactic radiation therapy is a complement to 3D conformal radiotherapy. Targeted radioimmunotherapy is a new type of internal radiation therapy, which can target tumor cells in close proximity and achieve the effect of combined radiation therapy and immunotherapy. Individualized selection and application of individualized radiation therapy for the location and morphology of the root patient’s tumor can achieve the best therapeutic effect. Individualized targeted chemotherapy for glioma Chemotherapy is a powerful complement to surgery and radiation therapy to kill residual tumor cells and invaded tumor cells in distant compartments, and to effectively prevent tumor recurrence. Since the molecular pathological characteristics of tumor cells suggest sensitivity to different chemotherapeutic drugs, individualized targeted chemotherapy based on molecular pathology and in vitro chemotherapeutic drug sensitivity testing is the best protocol for chemotherapy, which not only avoids blind and ineffective chemotherapy, but also improves the clinical chemotherapy effect. Immunotherapy and molecular targeted therapy for glioma Molecular targeted therapy is the most cutting-edge tumor treatment and method, which can specifically block the active signal transduction pathways in tumor cells and inhibit the growth of tumor cells and neovascularization without damaging normal brain tissue. Immunotherapy and gene therapy can kill the tumor cells remaining after surgery, radiotherapy and chemotherapy while improving their own immunity to achieve therapeutic significance. Radioimmunotherapy for glioma Targeted radioimmunotherapy is a new type of intra-mesenchymal radiotherapy. It is a radioisotope with targeted tumor necrosis factor injected into the tumor cavity through an Ommaya reservoir capsule placed under the scalp at the time of surgery, which targets the tumor bed with immunotherapy and radiation therapy at close range, reducing the side effects of surrounding tissues and improving the therapeutic effect, and is a method of specifically targeting tumor tissues. targeted radioimmunotherapy method. Factors associated with the prognosis of glioma The prognosis of glioma is related to the malignancy of the tumor, the location of the tumor, the patient’s age, the size of the tumor, the molecular pathological findings of the tumor, and the patient’s quality of survival score (KPS). Recurrence of glioma Despite a complete and comprehensive treatment regimen, tumors are not immune to recurrence due to the infiltrative growth and migration of gliomas to distant sites. The timing of recurrence is often closely related to the molecular pathology findings of the tumor and the malignancy grading of the tumor. Patients often experience increased intracranial pressure or new symptoms of functional deficits at the time of recurrence, and should be followed up in the hospital as soon as possible. Treatment strategy of recurrent glioma Recurrent glioma should be actively operated if it is operable. Whether surgery is performed or not, remedial chemotherapy should be administered to kill or inhibit the residual tumor cells as much as possible to prolong the patient’s life as much as possible while improving the quality of life.