Gliomas are the most common primary malignant tumors of the central nervous system, accounting for about 30-50% of intracranial tumors. High-grade tumors grow rapidly, and even with aggressive surgical treatment and traditional radiotherapy, patients mostly die of recurrence within 1-2 years after surgery. As a class of CNS malignant tumors that seriously affect the life and health of adults, exploring ways to delay tumor recurrence or effective treatments has always been a difficult problem in neurosurgery. Postoperative chemotherapy is an important link in the comprehensive treatment of glioma, which is important for further killing residual tumor cells and preventing and delaying tumor recurrence. Arterial hyperselective chemotherapy versus conventional chemotherapy for gliomas Traditional chemotherapy for gliomas is still administered by intravenous or oral routes. The drugs given through these two routes have high binding rates to plasma proteins, low local concentration in the tumor, and poor therapeutic efficacy. In recent years, the arterial route of drug delivery has been gradually replaced by the arterial route of drug delivery. Foreign animal experiments have shown that the drug content in the cerebral hemisphere is 2-3 times higher than that in the intravenous route when chemotherapeutic drugs are infused through the internal carotid artery. Foreign scholars have shown that, according to the characteristics of human physiology and pharmacokinetics, the infusion of chemotherapeutic drugs through the internal carotid artery is better than intravenous drug delivery, which is conducive to improving the local drug concentration, increasing the utilization rate of drugs, greatly reducing the rate of drug binding to plasma proteins and reducing the systemic toxic side effects. Drug delivery through the common carotid artery has the advantages of low treatment cost and patients’ willingness to accept, but requires more experienced people to operate to avoid drug leakage in the extravascular and local blood leakage after drug delivery and other complications. Due to the disadvantages of visual impairment and cerebral leukoencephalopathy, it has been gradually replaced by super-selective intra-arterial chemotherapy delivered by microcatheter to the ophthalmic segment of the internal carotid artery. super-selective chemotherapy directly delivers the drug to the blood vessels of the tumor through the catheter instead of going through the body circulation and pulmonary circulation as in the case of intravenous chemotherapy, which greatly enhances the concentration of the drug in the intra-tumoral vascular bed of the tumor. the application of PET scanning in the Namba experiment confirmed that the arterial route of drug delivery was different from the intravenous route. PET scanning technology was applied in the Namba experiment, which confirmed that the concentration of drugs in the tumor was more than 50 times higher after arterial route administration than after intravenous administration. Since the drug passes through the target area before returning to the venous system and then to the body circulation, the toxic side effects of the drug on the systemic system are greatly reduced and the patient’s tolerance of chemotherapy is improved. How to improve the effect of superselective chemotherapy for glioma The existence of the blood-brain barrier affects the passage of antitumor drugs, and lipid-soluble drugs and small molecules can easily pass through the blood-brain barrier, while some other large molecules and water-soluble drugs are difficult to pass. Therefore, most scholars advocate the use of mannitol to open the blood-brain barrier before or during the operation of super-selective chemotherapy, so as to increase the efficacy of chemotherapy by increasing the permeability of chemotherapeutic drugs. However, some scholars believe that opening the blood-brain barrier has little effect on the efficacy of fat-soluble chemotherapeutic drugs, and is mainly applied selectively to water-soluble chemotherapeutic drugs. In addition, preoperative application of glucocorticoids and phenobarbital sodium to enhance the efficacy of the method has also been reported in the literature. The poor efficacy of conventional chemotherapy in a considerable number of patients was thought to be due to the influence of the blood-brain barrier, which makes it difficult for chemotherapeutic drugs to reach the tumor cells. In recent years, [5] found that there are many reasons affecting the efficacy of chemotherapy for gliomas. In addition to the resistance of glioma cells to chemotherapeutic drugs, the failure to select sensitive drugs for sensitive chemotherapy for different types of tumors and different tumor individuals is also an important reason. Therefore, it is necessary to adopt a simple, rapid and economical drug sensitivity test method to guide the clinical individualized chemotherapy. The molecular pathology of the pathological specimens from the patients’ surgery can be used to screen for drug-resistant genes, and at the same time, in vitro primary cell culture can be performed, and multi-drug combination drug sensitivity test can be performed in cases with drug-resistant genes, and then sensitive drugs can be selected according to the molecular pathology of the tumor and the results of the in vitro drug sensitivity, and then the catheter can be inserted into the blood supplying blood vessels of the secondary branches of the tumor in the cranium to carry out the drug infusion through the femoral arterial cannula and the sheathing micro-catheter technology. It can achieve local high concentration drug delivery, increase the therapeutic effect, reduce the dose of drugs, and decrease the incidence of drug side effects. Super-selective chemotherapy for glioma under the guidance of drug sensitivity requires high experimental techniques and skillful neuro-interventional means, although it has good clinical application value, limited to the patient’s economic status and the subjective and objective conditions to carry out this work, this treatment method is not popular in China at present. How to choose super-selective chemotherapeutic drugs for glioma According to the characteristics of blood-brain barrier, chemotherapeutic drugs need to have high fat solubility, small molecular weight, and be able to be injected into arteries, etc. ACNU mainly acts on the G1 phase and S phase of tumor cells, and is effective for both proliferative and non-proliferative groups, with an alcohol-water distribution coefficient of 0.2, and molecular weight of 309.15, which is easy to pass through the blood-brain barrier and be injected into arteries, and is more effective for the treatment of gliomas. VM-26 is a synthetic onychotoxin derivative, which is a cycle-specific cytotoxic drug, affecting the S and G2 phases of the cell cycle, blocking mitosis, and inhibiting type II topoisomerase to cause single and double stranded DNA breaks, with low toxicity, high fat solubility, small molecular weight, and easy to pass through the blood-brain barrier. Studies have shown that the multidrug resistance genes of gliomas with higher malignant degree are significantly higher than those of gliomas with lower malignant degree, so they are more resistant to drugs, especially recurrent gliomas, which have already received multiple drug treatments and are more likely to be resistant to drugs. Combination of drugs enhances the efficacy of drugs and is the best way to deal with drug-resistant tumors. Lopez-Gonzalez et al[3] reported that ACNU combined with VM-26 was used in the treatment of malignant gliomas, and through synergistic effects, it could kill tumor cells in different proliferative cycles. The synergistic effect of ACNU and VM-26 in the treatment of malignant gliomas can kill tumor cells in different proliferative cycles, and the combination of one non-specific drug and the other specific drug has a significant synergistic effect. Indications for arterial super-selective chemotherapy (1) Patients with brain tumors who have lost the chance of surgery, such as deep tumors and multiple brain metastases. (2) Adjuvant treatment after surgery, malignant glioma (glioblastoma/astrocytoma grade III or above patients), 2 weeks after surgery, stable condition; systemic conditions are still good, estimated survival for more than 2 months; normal liver and renal function; the total number of leukocytes is more than 4 × 109/L, platelets more than 10 × 109/L. (3) Treatment before radiotherapy. (4) Patients with recurrence after surgery. Contraindications to arterial superselective chemotherapy (1) Severe allergy to contrast agents and chemotherapeutic drugs. (2) Significantly increased intracranial pressure. (3) Patients with poor general condition who cannot tolerate or do not cooperate with arterial cannulation. (4) Severe liver and kidney dysfunction. (5) Abnormalities of the hematopoietic system or coagulation function. Toxic side effects and treatment of arterial super-selective chemotherapy (1) Gastrointestinal reactions, manifested as vomiting, nausea and other discomforts, should be treated symptomatically with gastrofibromyalgia and preoperative dexamethasone. (2) Myelosuppressive reaction: about 2 weeks after chemotherapy, white blood cells can be significantly decreased, giving leukocyte-boosting drugs, more than 4 weeks can gradually return to normal; at the same time, should enhance immunity, pay attention to warmth, and prevent upper respiratory tract infections. (3) Cerebral leukomalacia, manifested as softening of cerebral white matter, necrosis, severe cerebral edema, etc. Reasonable dosage and combined chemotherapy can reduce or avoid this complication. (4) Other adverse reactions caused by chemotherapeutic drugs: cerebral edema, epilepsy, liver function impairment, etc. Timing and treatment course of arterial hyperselective chemotherapy for glioma Some scholars believe that early postoperative chemotherapy is effective, and the literature reports that the first course of chemotherapy can be carried out 3-5 days after surgery. Due to the surgical blockage of some blood vessels and surgical interference, the blood supply to the tumor area of patients with glioma is obviously reduced within 1 week after surgery, which will definitely affect the effective use of drugs, and the blood supply to the tumor area usually tends to be normal in about 2 weeks, thus, arterial hyperselective chemotherapy can be carried out in the first 1-2 weeks after surgery if the general condition of patients permits and the wounds are healed. The second chemotherapy can be started after 4 weeks after the first super-selective chemotherapy without myelosuppression, and 3-4 super-selective chemotherapy can be carried out if the general condition of the patient permits. It is generally believed that intra-arterial perfusion chemotherapy should be carried out before radiotherapy after surgery, because radiotherapy will change the structure of the tissue around the tumor, thicken the endothelium of the capillaries, and reduce the absorption of drugs in the process of chemotherapy, so it is usually more certain that chemotherapy should be carried out before the implementation of radiotherapy.