A glioma is any tumor that arises from the cells of the brain. The most common gliomas are astrocytomas, cells that support the neurons in your brain. Many people ask whether gliomas are malignant. In other types of tumors, people view malignancy to mean a tendency for the tumor to spread to other parts of the body. This is not the case for gliomas. Except in select circumstances, gliomas do not spread to other parts of the body. However, gliomas can be considered malignant if they grow quickly, or recur quickly after treatment.
Gliomas are different from many other types of solid organ tumors in that they can be infiltrating. Many tumors develop a boundary/capsule around them that separates them from surrounding normal tissue. Such capsules allow the surgeon to cut around the visible tumor and have a degree of certainty that they removed the whole tumor. Infiltrating tumors don’t behave this way. They send microscopic finger-like projections through normal surrounding tissue, even to sites distant from the main tumor. These projections are so small surgeons cannot see them even with a microscope. This makes it difficult to determine if an infiltrating tumor is ever “completely” removed. This is true for many gliomas. The goal of treatment is to remove as much of the visible tumor as possible, and relieve the patient of symptoms caused by the tumor. Many gliomas will require additional treatment after surgery comprised of medication, radiation, or both.
The aggressiveness of gliomas is characterized by grading them on a scale of 1 to 4. Grade 1 gliomas are frequently considered “curable” because they can frequently be completely removed. Grade 2-4 gliomas are infiltrating tumors and most surgeons do not believe “complete” removal can be achieved. Grade 3 and 4 gliomas are aggressive tumors, which grow quickly and have a high likelihood of recurring after treatment. Additional treatment of Grade 3 and 4 gliomas after surgery is generally recommended. Another factor taken into consideration is the location in the brain that the glioma occurs, the location will affect how much of it can be safely removed and the severity of symptoms it causes.
Our neurosurgeons at Dallas Brain, Spine and Skull Base Surgery (DBS) have a specific interest in gliomas. We feel that earnest efforts at early control offers our patients the best outcomes in terms of symptom relief and reduction of tumor recurrence. Our group is the one of the first groups in North Texas approved to use intraoperative immunofluorescence, which studies have shown to improve surgical outcomes and disease control. Additionally, our neurosurgeons have access to clinical research trials and continually make efforts to advance proven surgical techniques and treatment protocols of these tumors.
When caring for glioma patients, our neurosurgeons’ primary goal is balancing disease control with neurologic function and quality of life. Favorable functional outcome is our primary goal. Our desire is to see our glioma patients live the life they want to live, minimizing the impact a glioma (and its treatment) has in the both short and long term. Gliomas are frequently a life-long illness. Our neurosurgeons follow glioma patients for many years with brain imaging and neurologic exams. At DBS, we feel the job is not finished when the surgery is done. Some of our most fulfilling interactions as physicians are with our glioma patients.