Gliomas in the elderly are predominantly high-grade gliomas, with glioblastomas accounting for the majority. As most of the lesions progress rapidly, they are often found with headache, nausea, vomiting or seizures (convulsions, freezing, phantom smells, etc.), and may have focal neurological dysfunction, such as limb movement disorder, limb sensory disorder, speech disorder, visual disorder, and high-level cognitive dysfunction, and so on. As the physical function of the elderly declines, children are often worried that the elderly can not withstand the pain of surgery or radiotherapy, and are often asked, can we not operate, so that the elderly suffer less? So, can the elderly suffer less without surgery? In fact, without active treatment, especially surgery, in most cases can not be less suffering, and often sometimes suffer more. Why? The main reason is that for high-grade gliomas, especially glioblastomas, there is no specific and effective treatment other than surgery. Radiotherapy (90%) is insensitive and there are no targeted drugs. Surgery does not cure gliomas, but it is the most effective treatment. High-grade gliomas often have symptoms of cranial hypertension, patients will have frequent headaches, nausea, vomiting, do not want to eat, want to sleep all day, only rely on mannitol or diuretics to dehydrate, it can only be a reprieve, used more and more frequently, the effect will be worse. Surgery can remove the tumor, quickly release the occupying effect, release the cranial hypertension, and improve the patient’s quality of life, but less suffering. Gliomas near functional areas have been seen in patients with poor limb movement or speech that is not fluent or understandable. We may fear surgery for fear that the patient will develop hemiparesis, aphasia, and other neurological deficits that worsen after surgery. However, without surgery, as the tumor progresses, the neurological function that we want to preserve will not be preserved and will soon be lost. On the contrary, surgery will protect the function for a longer period of time because it slows down the progression of the lesion, and on the contrary, it improves the quality of life and suffers less. For functional gliomas with no obvious neurological dysfunction before surgery, the probability of postoperative dysfunction supported by scientific aids is actually not high. Of the three main methods of glioma treatment, surgery is the primary treatment and radiotherapy is the adjuvant treatment. It is like fighting a war, taking out the enemy’s main force first (surgery) and then slowly eliminating the stragglers (radiotherapy). Not having surgery basically means giving up the most important weapon to kill the enemy, often not less suffering, but more suffering, and a shorter time to live.