Glioma is one of the most common intracranial tumors, accounting for about half of brain tumors. The tumor mostly grows invasively, and surgery is not easy for total excision and poor treatment effect. Among systemic tumors, malignant glioma has the third highest 5-year mortality rate after pancreatic cancer and lung cancer, and the 5-year survival rate is less than 5%. In the past 20 years, there has been no revolutionary progress in the efficacy and prognosis of glioma, so it is urgent to seek effective treatment measures. To achieve this goal, the first issue that must be addressed is to clarify the pathogenesis of glioma. The underlying causes of glioma development are infinite proliferation and inhibition of apoptosis. The continuous in-depth research on the disorders of cellular value-added and apoptosis control is one of the important advances in glioma in the last decade, which provides important insights to further explore the molecular mechanisms of glioma pathogenesis. The prognosis of glioma patients is closely related to pathological grading, and survival is measured in weeks, even with various treatments. Low-grade gliomas are pathologically nearly benign and less aggressive. Even so, about half of the patients survive no more than 5 years. The tumor will progress from a less malignant glioma to a more malignant glioma, and eventually the patient almost always dies from tumor recurrence, local spread, or local invasion. Although surgical resection, radiotherapy and chemotherapy, molecular targeted therapy and gene therapy and immunotherapy are currently under clinical research, the overall treatment effect is still unsatisfactory. Based on the principle of minimally invasive, the Glioma Treatment Center of Beijing Tiantan Hospital integrates the use of modern neuroimaging, intraoperative ultrasound, arousal anesthesia, intraoperative brain electrophysiological monitoring, functional localization and monitoring and other technical means to remove the tumor tissue to the maximum extent while ensuring the patient’s neurological functions such as speech and movement, so as to lay a good foundation for subsequent treatment. Then, combined with molecular pathology examination, corresponding radiotherapy and chemotherapy programs and molecular targeted therapy are formulated to truly individualize the treatment program for different patients. The Glioma Treatment Center has successfully treated more than 2,000 patients with glioma since 2004, and has achieved encouraging results. Molecular neuropathology has been developed in recent years by combining the results of molecular biology and molecular genetics with traditional histopathology, and using relevant molecular biology techniques. Neuromolecular pathology can detect changes in receptors, growth factors, chromosomes, oncogenes, and oncogenes of tumor cells at the gene and protein levels, which can provide valuable reference for clinicians to develop targeted and individualized treatment plans. Common techniques used in neuromolecular pathology diagnosis include immunohistochemistry, genetic analysis, chromosome detection, in situ hybridization, fluorescence in situ hybridization, polymerase chain reaction, comparative genomic hybridization and array, tissue microarray and other technical means. In addition to P53, PTEN, EGFR, MMPs, VEGF, PCNA, Ki-67 antigen, P-glycoprotein (P170), Topoisomerase II (Topo II), Glutathione II, etc., which are related to glioma resistance to chemotherapy, are commonly used in neurological pathology. Topo II), glutathione S-transferase (GST-π), O6-methylguanine-DNA-methyltransferase (MGMT), and detection of heterozygous deletion of chromosome 1p/19q. All these tests have clear clinical significance, such as MMP-9 positivity suggests more aggressive tumor and easy recurrence, MGMT positivity suggests tumor insensitivity to alkylating classes, while Topo II positivity suggests sensitivity to Topo II inhibitors, etc. Neuroimaging plays the most important role in making surgical plans for glioma, especially the sagittal-coronal-axial scan of MRI. MRI images are useful to show whether the tumor is aggressive in the left and right cerebral hemispheres, whether it is invading downward along the pyramidal tract, whether it is compressing or invading structures such as the central sulcus and ventricles, and whether it is infiltrative or expansive growth, etc. MRI can also be used as a means of postoperative follow-up. With the development and increasing maturity of MRI software and hardware, functional imaging based on morphology, including perfusion imaging (PWI), wave spectral imaging (MRS), blood oxygen level-dependent functional MRI (BOLD-fMRI), diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) have also begun to be used in clinical practice. While showing the anatomical structure of brain tissues and brain tumors, MRI is also trying to reveal the intrinsic biological behavior, metabolic status, cytoarchitecture and hemodynamics of tumors non-invasively, as well as to show the anatomical relationship between brain tumors and adjacent important cortical functional areas and important brain white matter fiber bundles in vivo and individually to optimize the surgical plan. In recent years, with the application and development of neuroimaging, neuronavigation, and intraoperative neurophysiological monitoring technologies in clinical practice, neurosurgery has transformed from the traditional anatomical model to the modern anatomical-functional model, which has greatly improved the quality of surgery and surgical outcomes. Neuroimaging techniques related to neurosurgery such as blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI), diffusion tensor imaging (DTI), and magnetoencephalography (MEG) have emerged in recent years to help preoperative evaluation of the relationship between lesions and functional brain areas and surgical outcomes. Intraoperative identification of cortical and subcortical nerve fibers in functional brain areas is the most important aspect of neurosurgery to protect brain function and avoid postoperative dysfunction. Clinical observation shows that the anatomical structures of important functional areas are deformed and displaced due to individual differences and lesion occupancy effects, so the traditional anatomical localization resection cannot effectively protect the brain function. Intraoperative electrophysiological cortical functional area localization is currently the only method that can reliably determine the functional brain areas. For lesions located in or near functional brain areas such as language and motor as well as corticospinal tract conduction pathways such as the corona radiata, internal capsule, and thalamus, intraoperative cortical evoked potential or cortical stimulation localization should be used to monitor cortical and subcortical functional areas in real time. Modern arousal craniotomy techniques began more than 50 years ago, and with the advent of new anesthetics, quick and safe arousal anesthesia has been widely used in neurosurgery, especially in the surgical treatment of functional gliomas. Waking effect can be achieved by using simple local anesthesia or needle anesthesia, but it is difficult to be accepted by patients and used by operators because of the short analgesic time and the patient’s fear and easy fatigue for a long time during the operation. Foreign countries routinely apply intraoperative wake-up methods of intravenous laryngeal mask anesthesia to achieve satisfactory analgesic and sedative effects. The application of electrical stimulation technology for brain function monitoring in the wake state is currently an effective way to remove lesions in functional brain areas while protecting brain function as much as possible. Intraoperative direct electrical stimulation to determine the functional brain area has high requirements for intraoperative arousal in general anesthesia, requiring adequate analgesia during cranial opening and closing so that the patient can tolerate the surgery, requiring smooth transition between anesthesia and waking process so that the patient is awake enough to cooperate with neurological function testing during intraoperative cortical electrical stimulation, requiring effective intraoperative airway control and no respiratory depression, and at the same time ensuring that the patient is comfortable without misaspiration and no limb and trunk The patient should be comfortable and free of inhalation, limb and trunk movement. Current anesthesia methods include intravenous general anesthesia or conscious analgesia, local anesthesia with a compound surgical incision, or regional nerve block anesthesia. In recent years, due to the new understanding of pharmacokinetic and pharmacodynamic principles, more and more new anesthetics such as rapid-acting and ultra-short-acting intravenous anesthetics, long-acting and safe local anesthetics have been produced, and the birth of new intravenous anesthesia delivery methods and techniques have led to epoch-making changes in anesthesia methods. The method of wake-up anesthesia is also becoming more and more mature, finally meeting the clinical requirements of protecting brain function while removing as many lesions as possible in functional brain areas. Intraoperative arousal anesthesia techniques can be used for localization of functional brain areas, surgery for intractable epilepsy in functional areas, localization of deep brain nuclei and conduction tracts, and surgical treatment of refractory central pain. At present, the Glioma Treatment Center has successfully performed more than 300 surgeries under arousal anesthesia without any cases of complications such as poor analgesia and postoperative psychological disorders.