Stereotactically guided serial biopsy based on structural and metabolic imaging (MRI/PET) is used to establish the diagnosis.
Primary therapy of gliomas [modified according to].
| Gliomas | Operation | Further |
| Astrocytoma (WHO grade II) | Surgery or biopsy | and observational waiting (“watchful waiting”) or radiotherapy |
| Pilocytic astrocytoma (WHO grade I) | Surgery | |
| Anaplastic astrocytoma, oligodendroglioma/oligoastrocytoma (WHO grade III). | Surgery (or biopsy | And chemotherapy (or radiotherapy) |
| Glioblastoma (WHO grade IV) | Surgery (or biopsy)Note: R0 resection (no residual tumor) is usually not possible | And radiotherapy and chemotherapy (temozolomide). |
1st order
- Brain tumors: If possible, complete resection (surgical removal) of the tumor (by stereotaxy if necessary).
- Brain metastases* :
- With a diameter of ≥ 3 cm
- Metastases in the posterior fossa with space-occupying effect and compression of the 4th ventricle with resulting hydrocephalus occlusus (occlusive hydrocephalus)
* Note: The infiltration zone of brain metastases, according to current knowledge, is in a range of up to 5 mm.
Surgical indications for recurrent gliomas:
- Tumor easily accessible and significant reduction of the remaining residual tumor mass is to be expected
- Localization of the tumor suggests that postoperative improvement in neurologic status may occur
- Patient is in a general condition that can be described as satisfactory
Further notes
- Patients with low-grade glioma benefit more from surgery than from watchful waiting in the long term: overall survival was 5.8 years (95% confidence interval: 4.5-7.2 years) in the watchful waiting group and 14.4 years (95% confidence interval: 10.4-18.5 years) in the surgery group.
