How Glioma is Treated

  Since glioma grows infiltratively and has no obvious boundary with brain tissues, it is difficult to remove all of them except for small tumors in early stage and located in appropriate areas. We should strive to make early diagnosis and timely treatment to improve the treatment effect. Late stage is not only difficult to operate, but also dangerous and often has neurological deficits. Especially for tumors with high malignancy, they often recur within a short period of time.  Surgical treatment: The principle is to remove the tumor as much as possible while preserving the neurological function. In early stage, all tumors should be removed if they are small. For shallow tumors, cortical incision should be made around the tumor, and for white matter tumors, cortical incision should be made avoiding important functional areas. When separating the tumor, it should be done at a certain distance from the tumor and within the normal brain tissue, not close to the tumor. Especially for more benign tumors such as astrocytoma and oligodendroglioma in frontal or anterior temporal lobes or cerebellar hemispheres, better results can be obtained.  For larger tumors located in the frontal or anterior temporal lobes, lobectomy can be performed to remove the tumor together with the tumor. If the frontal or temporal lobe tumor is too wide to be removed, the tumor can be removed and the frontal pole or frontal pole can be removed for internal decompression, which can also prolong the recurrence time.  If the tumor is located in motor and speech area without obvious hemiparesis and aphasia, attention should be paid to maintain the neurological function to remove the tumor appropriately to avoid serious sequelae. The tumor can be decompressed by sub-temporal muscle or debridement flap at the same time. Or, decompression can be performed after biopsy only. If the thalamus tumor compresses and obstructs the third ventricle, a shunt can be performed.  For ventricular tumor, the brain tissue can be incised from the non-important functional area to enter the ventricle according to the location, and the tumor can be removed as much as possible to relieve the ventricular obstruction. Care should be taken to avoid damaging the hypothalamus or brainstem adjacent to the tumor to prevent danger. Except for small nodular or cystic tumors, brain stem tumors can be resected, and those with increased intracranial pressure can be shunted. If the tumor is difficult to be resected, shunt can also be performed.  For those who are in critical condition, dehydration medication should be given to the supratentorial tumor first, and the diagnosis should be confirmed by examination as soon as possible, and then surgery should be performed immediately. For posterior cranial fossa tumor, ventricular drainage can be performed first, and then surgery can be performed 2-3 days later when the condition improves and stabilizes.  Radiation therapy: generally there are high voltage x-ray therapy machine, cobalt 60 therapy machine, gamma knife and so on. Radiation therapy is recommended to be carried out as soon as possible after the recovery of general condition after surgery. The sensitivity of various types of glioma to radiation therapy varies. It is generally believed that poorly differentiated tumors are more sensitive than well differentiated ones. Medulloblastoma is the most sensitive to radiotherapy, followed by ventriculoblastoma, glioblastoma multiforme is only moderately sensitive, and astrocytoma, oligodendroglioma and pineal cell tumor are even worse.  Chemotherapy: chemotherapeutic drugs with high lipolytic properties that cross the blood-brain barrier are suitable for cerebral gliomas. At present, continuous local chemotherapy in the tumor cavity or super-selective perfusion chemotherapy in the tumor blood supply artery can be performed to increase the concentration of local chemotherapy drugs and improve the therapeutic effect.  Other treatments: gene therapy, immunotherapy, molecular chemotherapy, etc., are mostly in the research stage and their efficacy is not yet certain.