Strategies in the surgical management of malignant gliomas

The overall prognosis for patients with malignant gliomas remains poor. The infiltrative nature of the tumor into normal brain and the presence of tumor foci in regions remote from the main tumor burden make cure with current therapies virtually impossible. Management therefore consists of tumor control while maintaining the patient's quality of life. Surgery comprises only one arm of the overall treatment plan. Biopsy allows diagnosis and tumor grading even when tumors are located in eloquent or deep areas of brain. Craniotomy decreases overall tumor burden and provides room for the normal brain, edema and recurrent tumor. Many adjuncts are available to assist in gaining surgical access to tumors with minimal violation of normal functioning brain. Important among these are stereotaxy and surgery within a specially designed magnetic resonance scanner. The strategies for the surgical management of alignant eliomas utilized at our institution will be discussed.