Mr. Zhang went to the hospital for seizures and was considered to have a diffuse glioma in the left frontotemporal insula with diffuse lesions, and the doctor back home said that it could not be cut and there was no point in cutting it. After the family did some homework from the internet, they found me on Good Doctor Online in February 2020. The MRI is as follows I gave the plan: maximum safe resection Pros: It is the current standard treatment method to remove the maximum lesion, and with our ability, near total resection can be achieved. Disadvantages: Due to the relatively diffuse lesion and large lesion volume, maximum resection of the tumor will most likely bring about a decrease in the patient’s higher cognitive function and inevitable decrease in social adaptation. Since Mr. Zhang is the mainstay of the family, bearing 90% of the family’s economic resources. Once the cognitive decline is over, the family will not be able to work in the same job, and the family will not be able to survive. I gave a second option: biopsy to clarify the nature: after confirming the glioma, chemotherapy is given first to see the effect; if it works well, chemotherapy is continued, and if it is not sensitive, then maximum safe removal is done. Advantages: give yourself a chance to have a high quality of life and predict whether the tumor is chemo-sensitive or not. Disadvantages: Not the method recommended by the guidelines. Without intensive review, the disease may be delayed. The atmosphere of the conversation was heavy. The family’s greatest fear was to make the choice, and as a lay person, it was difficult for the family to make a scientific decision. After much thought, the family decided to go the second way, to give the patient a chance and the family a chance. It is recommended to come to our hospital to take a biopsy, because although the biopsy procedure is simple, but there is a preoccupation with the extraction site, which means that the extraction target should be scientifically based. Mr. and Mrs. Zhang wanted to do the biopsy in their hometown. This is one of the many patients who will be able to come back for follow-up and what will be done in the end, I do not know. The biopsy was done at the local hospital and the pathology report was sent from home I suggested a consultation at another hospital, which they also went to Both hospitals did not give a positive diagnosis, and Mr. and Mrs. Zhang were again in confusion, was the biopsy done for nothing? Why did the pathology not give a positive diagnosis either? The question came back to me, what should we do next? Combining the imaging and pathology reports, I concluded that the diagnosis of glioma was clear and suggested that Mr. Zhang take oral temozolomide and review it intensively, and remove it in case the result was not satisfactory. In June 2020 (3 months after taking the drug), Mr. and Mrs. Zhang came to see me once in the clinic, wanting to be reviewed at our hospital and ready for chemotherapy-ineffective surgery. I prescribed an MRI for them and needed to wait a few days for it to be done. Something happened at home and they went back without the MRI and continued to take medication on their own. Due to the recurring reasons of the new crown epidemic and the fact that the patients felt well after taking temozolomide, they did not have a repeat MRI until November 2020, and fortunately the MRI showed a significant reduction in the lesion. The hanging heart finally fell, if the effect was not obvious, the disease progressed badly to face. In March 2021 and July 2021, the tumor continued to decrease. …… At present, Mr. Zhang has been taking Temozolomide and has been the mainstay of the family, engaged in his original job and the family is living happily. We understand very well that Mr. Zhang’s disease is not just cured, we are maintaining a high quality of life for a person and normal functioning of a family at a relatively small cost. Once the lesion is no longer shrinking on review or if the lesion starts to progress again, we will perform surgical resection and then radiotherapy afterwards. Now that the lesion has shrunk significantly, even if we operate again, the extent of resection is significantly reduced, and the patient’s higher cognition will be significantly less affected, and most likely will not affect his or her current job. Not every case will have such an effect, and it requires a professional doctor to select the right case. The treatment of glioma is both standardized and individualized, and we have to consider the patient’s age, physical fitness, financial ability, social attributes, possible pathological type, possible pathological grade, lesion location, degree of diffusion, etc. Together with the patient’s family, we will make a reasonable choice. We will continue to update you on Mr. Zhang’s follow-up treatment. Attachment: several MRI reviews showing progressive lesion reduction