In the outpatient clinic, we often encounter patients with MRI or CT films seeking diagnosis, and they often say, “I have been examined locally, and it is a glioma, and you are an expert in this field, so I hope you can help me to confirm the diagnosis,” or “My local doctor is not sure if this MRI is a glioma, so please help me as a specialist to confirm it. I would like to ask you, as a specialist, to help me to confirm it”. I can understand the shock and confusion of someone who has been perfectly healthy before and is suddenly told that he has a glioma in his brain. However, as a neurosurgeon, I can only tell them objectively what are the chances of considering glioma based on the current imaging tests, but ultimately the pathology of the tumor tissue is needed to confirm the diagnosis. Gliomas can be simply divided into low-grade gliomas and high-grade gliomas, and there are dozens of exact types of gliomas according to the latest World Health Organization’s pathologic staging and classification, and such a diagnosis cannot be accomplished based on a pre-surgical MRI or CT alone. I often use the analogy that we can tell the gender, looks, and other basic information about a person from his or her photo, but we can’t tell his or her personality and other internal things from the photo. As an experienced neurosurgeon or imaging doctor, he or she can judge whether a tumor is a tumor, whether it is a high-grade or low-grade glioma, and the general type of the tumor through the tumor’s “photo” (MRI or CT). Most of the time, this judgment is correct, but sometimes there may be errors. Pathological diagnosis of tumor tissues and detection of tumor gene changes are the most accurate methods to reflect the essential characteristics and biological behaviors of tumors. However, to obtain the tumor tissue specimen for pathological diagnosis, it is necessary to do it through surgery. In other words, only by obtaining tumor tissue through surgery can the pathological diagnosis be completed and the final diagnosis of glioma be confirmed. There are two common surgical methods for obtaining glioma tissue, one is stereotactic biopsy, which is less invasive, but the purpose of the surgery is only to obtain the tumor tissue to confirm the diagnosis. There is also a craniotomy, which can be performed to confirm the diagnosis and remove the tumor at the same time.