neurosurgery is indicated.in patients with radiological suspicion of a high grade glioma, unless there is a contraindication to surgery because of poor general medical or neurological status
NICE guidance on the effectiveness and use of intra operative carmustine chemotherapy in patients in whom at least 90 per cent of the tumour is removed has fuelled interest in radical surgery for high grade glioma
Resection techniques
if a radiologically-enhancing suspected high-grade glioma, and the multidiscliplinary team thinks that surgical resection of all enhancing tumour is possible
5-aminolevulinic acid (5-ALA)-guided resection may be used as an adjunct to maximise resection at initial surgery
intraoperative MRI should be considered to help achieve surgical resection of both low-grade and high-grade glioma while preserving neurological function, unless MRI is contraindicated. Consider intraoperative ultrasound to help achieve surgical resection of both low-grade and high-grade glioma
diffusion tensor imaging overlays in addition to standard neuronavigation techniques should be considered to minimise damage to functionally important fibre tracts during resection of both low-grade and high-grade glioma
an awake craniotomy should be considered for people with low-grade or high-grade glioma to help preserve neurological function
discuss awake craniotomy and its potential benefits and risks with the person and their relatives and carers (as appropriate) so that they can make an informed choice about whether to have it
this procedure should only be considered if the person is likely not to be significantly distressed by it.
specialists as appropriate, such as neuropsychologists and speech and language therapists, before, should be involved during and after awake craniotomy
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