New ideas about glioma treatment

  Glioma is the most common tumor of the central nervous system (CNS), with an increasing incidence year by year, for unknown reasons. Gliomas are intracranial tumors with malignant components and can be classified as WHO grade I-IV according to WHO classification, the higher the grade, the greater the malignancy. The prognosis for WHO grade III-IV tumors is poor, with a survival period of <6 months without medical intervention.  The surgical resection is the most critical first step in the comprehensive treatment strategy of glioma. The main objectives of surgery include: (1) radical resection of the tumor (e.g. hairy cell astrocytic glioma); (2) reduction of tumor volume to create favorable conditions for adjuvant radiotherapy; (3) clear pathological diagnosis; (4) chemotherapy drug screening; (5) reduction of intracranial pressure; (6) relief of neurological dysfunction to gain time for subsequent treatment.  With the progress of society and the improvement of people's quality of life, there is a new change in the concept of surgical treatment for glioma internationally, that is, from the priority of "Maximal Resection" in the past to "Maximal Safety". Only by removing the tumor to the greatest extent possible and keeping the patient's neurological function intact, can follow-up radiotherapy and chemotherapy be carried out better and faster to win a longer survival time and better quality of life. Better quality of life.  Surgical techniques and strategies: Glioma usually grows in a swollen infiltrative manner, but is easily restricted by the cerebral sulcus and gyrus, and mostly expands along the white matter fiber bundles. Based on the growth pattern and blood supply characteristics of gliomas, microscopic neurosurgical techniques are recommended to make anatomical resection along the white matter fiber bundles at the edge of the tumor, using the cerebral sulcus and gyrus as the boundary, in order to obtain maximum tumor resection with minimal tissue and neurological damage, and to clarify the histopathological diagnosis. In addition, some gliomas invade and grow along the alignment of the nerve conduction tracts, so it is important to be familiar with the local alignment of the nerve conduction tracts for better tumor resection and neurological protection.  Knowledge 1: The figure below shows a common frontal lobe tumor. The tumor invades and metastasizes through the corpus callosum, and it is very important to understand the alignment of these nerve conduction bundles for total resection of the tumor.  This kind of infiltration and growth of tumor between different lobes is likely to be achieved along the alignment of nerve conduction bundles. Knowing the alignment of nerve conduction bundles around these tumors is important for better resection of tumors and better protection of brain nerve function.  During the meeting, the professor proposed the first clinical conjecture of priority of vascular invasion and metastasis of high-grade glioma and priority of neural invasion and metastasis of low-grade glioma in China, which aroused enthusiastic participation and discussion among the participants. All the participating professors believed that these understandings are important for guiding clinical surgery, helping total tumor resection and postoperative radiotherapy target design.  4. Brain nerve function protection strategy in surgery: Magnetic resonance nerve conduction bundle imaging is the only method that can show the nerve conduction bundle alignment in human brain in vivo, and it can clearly show the normal or compressed nerve conduction bundles around the tumor through brain nerve conduction bundle imaging, which plays an important role in guiding the preservation of normal nerve function in surgery.  Related knowledge: The figure below shows the magnetic resonance nerve conduction bundle alignment of the normal intracerebral arcuate bundle, which clearly shows the relationship between the nerve alignment of the conduction bundle and the location of the cerebral cortex, which provides important guidance for the protection of normal nerve function during surgery.  5.Postoperative adjuvant therapy for glioma: For low-grade glioma, if the surgical tumor is completely removed and there is no tumor residue on review, it can be observed regularly. There is not enough evidence to confirm that active radiation therapy or chemotherapy after total resection of low-grade glioma will delay recurrence, besides, ineffective treatment will make the subsequent treatment after recurrence more difficult. Aggressive radiation therapy and chemotherapy after surgery for high-grade gliomas can result in longer remission times.