Gliomas are common primary intracranial tumors, accounting for 35% to 60% of intracranial tumors. The incidence rate is higher in males than females, with peaks in the ages of 10-20 years and 30-40 years, respectively, and most of them show expansive and infiltrative growths, with relatively poor prognosis.Deorah et al. reported that the 1-year survival rate of patients with glioblastoma, which accounts for half of all glioblastomas, is about 30%, and the 5-year survival rate is less than 5%. Currently, a combination of treatments (surgery, radiotherapy, and chemotherapy) is favored, and the outcome has improved but is still unsatisfactory. The treatment of glioma is still one of the biggest problems faced by neurosurgeons. In this paper, we would like to summarize the current progress of glioma treatment. 1. Surgical treatment (1) Microsurgery: In recent decades, with the wide application and improvement of microsurgical equipments, medical imaging, and neuroendoscopy, microsurgery has played a pivotal role in neurosurgery, which has greatly promoted the development of neurosurgery. According to Zhang Wei et al, 25 cases of total resection and 6 cases of near-total resection of cingulate gliomas were treated with the keyhole surgical approach. All cases showed relief of epileptic symptoms, 3 cases of transient contralateral hemiparesis, and no surgical deaths, with an average of 26 months of follow-up and no postoperative recurrences. However, there are obvious limitations of surgical resection: it is difficult to quickly and accurately determine the boundary of the tumor under the traditional surgical microscope, and it is difficult to completely resect the tumor, and intraoperative evaluation of the tumor residue is a widely recognized problem; most of the solid parts suggested by MRI and other imaging can be completely resected under the microscope, but it is difficult to define the oedema zone, the infiltration zone, and the border of the normal brain tissue, and there is a big gap between the results of histology and immunohistochemistry and the intraoperative judgment. There is a big gap between histological and immunohistochemical results and intraoperative judgment, so it is difficult to achieve total resection in the real sense even if the method of extended resection is used, especially for gliomas involving functional areas. (2) Neuro-navigation surgery: Neuro-navigation system provides real-time precise positioning for the surgical process, which can maximize the resection of tumor without damaging normal brain tissue, thus reducing surgical injury and postoperative complications. According to Nim- skyc et al, intraoperative total resection of glioma can be achieved by using neuronavigation with a very low complication rate. However, there are limitations of neuronavigation: the drift of brain tissue during surgery may lead to the displacement of the tumor border, which makes it difficult to achieve total resection in the true sense of the word. Intraoperative MRI can make up for this shortcoming. By re-registering and updating the navigation system in real time with intraoperative MRI, the effect of intraoperative brain displacement on the navigation system can be effectively overcome, which can reduce the tumor residuals after surgery, improve the rate of total resection of the tumor, and detect intracerebral hematoma in time to reduce the complications of surgery. Intraoperative MRI can also be used in combination with laser, endoscopy, focused ultrasound, cryoablation, radiofrequency ablation, and intraoperative cerebral function evaluation, and thus has a great prospect for development. However, intraoperative MRI also faces some difficulties, the biggest obstacle is the high cost, because it requires higher magnetic field strength, which puts forward higher requirements for matching equipment and instruments, and whether it is safe for surgeons to work for a long period of time under high magnetic field strength is also worth exploring. In addition, with the development of ultrasound technology in recent years, the image quality and resolution have been continuously improved, especially the emergence of three-dimensional ultrasound technology, there have been reports of ultrasound image data used in navigation systems, which may also become the main way to obtain intraoperative image data in the future. (3) Chromogenic tumor resection: The application of chromogenic technology in oncology is also one of the recent hot topics. The fluorescence-guided microsurgery with 5-aminolevulinie acid (5-ALA) can effectively remove gliomas and provide the surgeon with objective tumor boundaries, thus improving the surgical resection rate. The difference in fluorescence intensity can be used to distinguish tumor cells from nerve cells. Currently, there are two color development techniques, one is the sodium fluorescein method, using the tumor to destroy the blood-brain barrier, fluorescein leakage out of the unhealthy blood vessel wall, the application of laser activated fluorescein, through the special grating, you can determine the boundary of the tumor; the other is the non-sodium fluorescein pathway, namely, the 5-ALA method, the process needs to be involved in the enzyme of the ferroheme biosynthesis pathway enzyme. According to Rodr iguez et al, 5-ALA is a precursor substance for heme synthesis in vivo, which does not produce photosensitivity by itself, but produces protoporphyrin with strong photosensitivity under the action of a series of enzymes such as 5-ALA dehydrogenase. Zhao Shiguang et al. applied fluorescence-guided surgical resection of brain tumors, and the postoperative pathological examination showed that the total tumor resection rate reached 100%. However, this technique is still in the research stage, intraoperative fluorescence imaging is related to the degree of malignancy of the tumor, and the inflammatory reaction may also cause false-positive images, and the long-term effect needs to be further followed up. Chemotherapy for gliomas has been controversial. The traditional view is that chemotherapy is difficult to be effective and has a lot of side effects due to the blood-brain barrier and the heterogeneity of the tumor and the existence of intrinsic drug resistance. In recent years, due to the advances in chemotherapeutic agents, chemotherapy for gliomas has gradually increased its status, especially for the treatment of highly malignant gliomas, chemotherapy is often one of the most important therapeutic means.Stew at’s experiments found that chemotherapy after surgery and radiotherapy can prolong the survival of patients with gliomas. Commonly used systemic chemotherapy regimens include PCV regimen, BVM regimen, etc. Due to the influence of blood-brain barrier factors, chemotherapy drugs require a larger dosage, and the local concentration of drugs in the tumor is lower, the therapeutic efficacy is poor, and the side effects are obvious, which are often difficult for patients to tolerate. The new drug temozolomide (T Mz) has a better chemotherapeutic effect than other drugs, and the adverse effects are mild. Temozolomide has a cerebrospinal fluid/plasma concentration ratio of 30% to 40%. It has been approved for the treatment of newly diagnosed GBM (glioblastoma multiforme) in the United States and Europe. A report comparing the effects of TMz and methylbenzylhydrazine on the survival of patients with recurrent GBM showed that patients in the TMz group had significantly higher progression-free survival (21.0% vs 8.0%, P = 0.008), overall survival (60.0% vs 44.0%, P = 0.019), and remission (45.6% vs 32.7%, P < 0.05) than those in the methylbenzylhydrazine group at 6 months. methylbenzylhydrazine group. Drug resistance is the main reason for chemotherapy failure, and studies have shown that 06-methylguanine-DNA (MGMT), which can repair DNA alkylation damage, is the main reason why malignant glioma cells are resistant to nitrosoureas commonly used in chemotherapy and the new drug TMz. As reported by Zhang Junping and others, 67.2%~76.0% of gliomas were positive for MGMT, suggesting that at least half of the gliomas were resistant to nitrosoureas and TMz, which are commonly used alkylating agents. Therefore, exploring the molecular mechanism of drug resistance in gliomas may lead to a breakthrough in chemotherapy. In addition, the latest research direction is super-selective interventional chemotherapy and intratumoral chemotherapy, the advantages of which are high local drug concentration and less systemic reaction, but the disadvantages of these methods are that the drugs can also cause serious damage to the normal brain tissues innervated by blood vessels, and the technology is more complicated and expensive. In short, chemotherapy also has shortcomings, the side effects of chemotherapy, difficult to cross the blood-brain barrier, drug resistance and so on, which makes chemotherapy can only be used as an adjuvant method, unable to eliminate and control the growth and metastasis of the tumor. Radiotherapy includes conventional radiotherapy, stereotactic radiotherapy and conformal radiotherapy. Conventional radiotherapy includes brain tissues in a certain distance around the tumor, but if there are still tumor cells outside the radiation range, recurrence will be difficult to avoid. Stereotactic radiotherapy can locate the tumor accurately, but high-grade gliomas tend to have infiltrative growth, and their subclinical lesions are far beyond the range of lesions seen on imaging. Conformal radiotherapy can increase the radiation dose to the tumor to achieve the goal of increasing the rate of local control, but its shortcoming is that it is extremely dependent on imaging to identify the extent of tumor invasion, so far, there is no imaging equipment can accurately identify the boundaries of the tumor. So far, there is no imaging equipment that can accurately identify the tumor boundaries. At present, postoperative radiation therapy has become a routine, and early postoperative radiation therapy can improve the 5-year survival rate by about 20%. However, the timing and dose of radiation therapy are still controversial. Due to the different sensitivity of glioma cells to radiation therapy, the effect of radiation therapy has its own limitations, and the benefit of radiation therapy is only the killing of radiosensitive cells. The benefit of radiation therapy is only the killing of radiation-sensitive cells. Tumors are also resistant to radiation doses, and radiation therapy can only kill sensitive tumor cells, but the remaining cells can still recur. Radiation therapy for glioma can only reduce the burden of treatment but not achieve a cure, and normal brain tissue may be damaged in the course of radiation therapy. 4, Immunotherapy Immunotherapy for glioma is a new hotspot in the research of glioma treatment, also known as biotherapy, which is the fourth treatment method after surgery, radiation, chemical three conventional therapies, especially the research of tumor cell vaccine. Tumor cell vaccines have the following advantages compared with vaccines at the protein and molecular levels: (1) simple preparation; (2) containing multiple T cell epitopes, which can ensure the comprehensiveness and potency of the immunity; (3) conforming to the individualized treatment plan for heterogeneous tumors. In the early years, people failed to try lymphokine-activated killer cells (LAK), then cytokine-induced killer cells (CIK), and in recent years, NK cells have been explored, but none of them have obtained good results. Currently, more studies have been conducted on dendritic cell (DC)-based tumor vaccines. DCs are the most powerful antigen-presenting cells (APCs) known in vivo to date, with an antigen-presenting capacity hundreds of times higher than that of other presenting cells, and are able to effectively stimulate resting T cells to induce the initial immune response, which plays an important role in the recognition process of tumor antigens by T cells. DCs are able to express MH c-I and MH c-II-like molecules, co-stimulatory molecules, and adhesion molecules at high levels, thus overcoming the deficiencies of tumor cells in terms of their immunogenicity and the expression of co-stimulatory molecules and adhesion molecules. Vichcha- tom et al. reported that sensitized DCs transfected with total RNA from tumor sources could significantly enhance the role of NK-like T cells (CD3+, CD56+). However, there is still a long way to go before DC vaccines can be applied in clinical practice, and the following problems exist: how to induce a large number of DCs with high purity, the selection of specific tumor antigens, and the selection of the appropriate time, mode, frequency and dose of DC vaccines; the heterogeneity of tumor antigens or antigenic modifications can resist the immune attack mediated by a single antigen; and there is a lack of specific antigens in gliomas, and vaccines prepared by using the whole antigen of the tumor may trigger autoimmune attacks. Moreover, gliomas lack specific antigens, and vaccines prepared with whole tumor antigens are at risk of triggering autoimmune diseases. Therefore, immunotherapy for gliomas is expected to be a cure, but whether it can be realized in the clinic has yet to be verified. Photodynamic therapy (PDT), also known as photo-radiation ion therapy (PRT) or photochemotherapy (Photo chemo therapy), is an effective method for the treatment of malignant tumors and certain benign and malignant lesions on the body surface, and some of its results have been applied to the treatment of glioma. It is an effective treatment for malignant tumors and certain benign and malignant lesions on the surface of the body that is under research and development. The basic principle of photodynamic therapy for glioma is that after the body receives the photosensitizer for a certain period of time, the photosensitizer can pass the blood-brain barrier destroyed by the tumor and remain in the brain tumor tissue at a relatively high concentration, and then irradiate the tumor site with a specific wavelength of light (laser), and with the participation of oxygen, the photosensitizer undergoes a photochemical reaction, which produces chemically active singlet oxygen and/or certain free radicals, which reacts with many biomolecules in the tumor tissue and cells. The photochemical reaction of photosensitizer with the participation of oxygen will produce chemically very active singlet oxygen and/or some free radicals, which will interact with tumor tissues and intracellular biomolecules, causing dysfunctions and structural damages, and ultimately leading to the demise of tumor tissues. The application of PDT to tumors began in 1903 when Jesionek and Ta ppeiner used it to sensitize tumors with eosin, causing tumor cell destruction. In China, Liu Gang et al. showed that ALA-mediated PDT has obvious therapeutic effect on glioma, and these similar experiments and studies provide an experimental basis for the clinical application of PDT on glioma in the future. If photodynamic therapy can be performed after surgical treatment of glioma, it may further eliminate the residual cancer cells, reduce the chance of recurrence, and improve the therapeutic effect of surgery, which provides a brand-new way for the clinical treatment of glioma, but whether it can be applied to the clinic is still under exploration. Gene therapy In the process of malignant glioma, some tumor suppressors are not activated, while a considerable number of growth factors and oncogenes are overexpressed. Therefore, the goal of gene therapy is to intervene in the oncogenes or to replace the "lack of functional genes" (tumor suppressors). With the progress of research in molecular biology and molecular genetics of tumors, the deeper understanding of the pathogenesis of gliomas, and the development of DNA recombination and gene transfection technology, gene therapy for gliomas has become possible. In 1992, the National Institutes of Health (NIH) of the United States firstly applied the retrovirus-mediated HSV-tk/GCV system to carry out in vivo gene therapy for human gliomas, and since then, the world has set off a wave of research on gene therapy for gliomas. At present, the main research hotspot of gene therapy is combination gene therapy, which includes: the combination of immune factor gene therapy, antisense gene-oriented combination gene therapy, suicide gene therapy-based combination gene therapy, the combination of suicide genes and immune genes, the combination of blocking cancer-related genes, and the combination of gene therapy and RNA interference, etc. In addition, lysosomal virus is also used as a gene therapy for human gliomas, which can be used to treat gliomas. In addition, lysovirus is also one of the most popular therapies for gliomas. Gliber tson and Rich's research shows that the interaction between tumor stem cells and blood vessels forms stem cell nests, and at the same time, the stem cell nests maintain the tumor stem cells. If tumor stem cells can be specifically killed by angiogenesis inhibitory factor genes mediated by lysosomal viruses, the cure rate can be increased and the recurrence rate can be reduced. In China, Zhu Guidong and Liu Fusheng reported that lysogenic virus has strong cell lysis properties, which opens up a new way for the treatment of glioma. Currently, gene therapy is being carried out in foreign countries, with the construction of new vectors and the improvement of transfection efficiency, gene therapy may achieve the purpose of curing malignant tumors. Combined gene therapy also has problems, although gene therapy has great potential, but the current work is still exploratory. Due to the existence of the blood-brain barrier, the occurrence of cerebral edema, as well as the deep infiltration of gliomas, all of these bring many difficulties to the gene therapy of gliomas. In recent years, with the deepening of Chinese medicine research, studies on Chinese medicine treatment of glioma have been emerging, and these clinical and experimental studies have shown that the use of Chinese medicine in the treatment of brain tumors can also obtain certain curative effects. Some physicians have discussed the etiology and pathogenesis of glioma. Chen Yuan believes that most of the gliomas are caused by the emptiness of the medulla oblongata, the entry of evils into the brain by evils, the stagnation of evils in the brain, and the coalescence of phlegm and stagnation of phlegm. When the veins and channels are blocked, the phlegm, stasis and toxins are agglomerated into lumps. According to Wang Yan, when poison invades the brain, qi and blood are weak, qi stagnation and blood stasis occur, and blood stasis forms lumps over time, qi stagnation blocks qi, water and fluid cannot be properly transported and stay, resulting in water-dampness, phlegm and drink, and dampness and toxin coalesce to form cancerous tumors. Due to mental stress, environmental pollution, and bad emotions, the qi of the internal organs is blocked, and toxicity arises from depression; toxicity arises from heat, and heat and toxicity stagnate and do not go away, and cancerous tumors will develop in the long run. Traditional Chinese medicine has its own characteristics and advantages, which can improve the effect of surgery, reduce the reaction of radiotherapy, improve the quality of patients' survival and prolong the survival time. At present, there are a lot of researches on the clinical treatment of brain glioma with traditional Chinese medicine underway. To sum up, the traditional surgical resection of glioma is the main treatment method at this stage, which can achieve the four diagnostic and therapeutic purposes of reducing the number of glioma cells, relieving symptoms, lowering intracranial pressure, and completing the pathological diagnosis of the tumor, etc. However, the surgery will activate the dormant tumor cells to enter into the proliferative stage rapidly, which will result in the malignant degree of the tumor escalating in the short term after the surgery and the tumor will recur. Of course, no single method can guarantee the complete eradication of glioma. Surgery is only the beginning of the treatment, and it is also necessary to apply multiple methods of comprehensive treatment step by step and in multiple stages according to the relevant knowledge of tumor biology, cell dynamics, radiotherapy, pharmacology and immunology. In conclusion, with the continuous development of various therapeutic options for glioma and the continuous improvement of combined treatment options, glioma patients will definitely be blessed.