Understanding Gliomas: A Patient’s Guide
By Dr. Benjamin Yim, Neurosurgeon
The following is a guide to help address any questions you may have about gliomas, especially if you or a loved one has recently been diagnosed with one. This guide explains what a glioma is, common symptoms caused by them, and available treatment options such as surgery.
What Is a Glioma?
The term “glioma” refers to brain tumors that originate from glial cells. Glial cells are the supportive cells in the brain and spinal cord that assist in protecting and insulating neurons that transmit signals throughout the brain. Gliomas include astrocytomas, oligodendrogliomas, ependymomas, and glioblastomas. Of these four, glioblastomas are the most aggressive.
Gliomas are classified by grade based on how quickly they grow and how abnormal the cells appear during examination. Low-grade gliomas (Grade 1-2) generally grow slowly, whereas high-grade gliomas (Grade 3-4) grow quickly and aggressively. Glioblastoma is an example of a high-grade glioma.
Symptoms
Size and location of the tumor can dictate what symptoms patients may experience. Some patients experience a sudden development of their symptoms whereas some experience a gradual progression. Not all patients experience the same symptoms, and not all gliomas are diagnosed as result of symptom analysis; some are incidentally discovered during imaging studies for other unrelated conditions or as part of annual check-ups. Common symptoms include:
- Headaches, particularly in the morning
- Seizures
- Weakness or numbness in your arm or leg
- Difficult speaking or processing language
- Changes in memory or personality
- Changes in vision
- Nausea
- Vomiting
The Diagnosis of a Glioma
Evaluation to determine the presence of a glioma includes the following:
- MRI with contrast is the most detailed imaging option for brain tumors.
- Functional MRIs (FMRIs) or tractography can be used to map important regions of the brain that control functions such as language or mobility.
- Neurocognitive testing allows the doctor to assess memory, attention, or language.
- Surgery or biopsy procedures are utilized to confirm the diagnosis of a glioma and to determine the specific grade and type of the tumor.
For many patients, surgery is performed as both a diagnostic and therapeutic measure. It allows for the confirmation of tumor type while allowing for the removal of as much tumor as safely possible.
Treatment Options
Treatment plans for gliomas are built based on the type, grade, size, and location of the tumor, with consideration of the patient’s overall health.
Options include:
Surgery:
Surgical intervention is often the first step in treatment for many patients. Surgery is used to remove as much tumor as possible, reduce pressure on the brain, preserve neurological function, and obtain tissue for diagnosis and additional treatment planning.
Dr. Yim uses different techniques in surgery to ensure maximum safety:
- Neuronavigation, which works similar to GPS-like guidance
- Intraoperative brain mapping particularly near the speech or motor areas of the brain
- Awake craniotomy when needed to monitor for maximal safety
- Bone cement reconstruction to perform long-lasting, smooth skull closures
Radiation Therapy:
After surgery, radiation therapy is often recommended as an additional treatment to remove any remaining tumor cells. This therapy is usually completed over the course of several weeks.
Chemotherapy:
Chemotherapy involves the intake of medication, either orally or intravenously, to particularly target high-grade tumors. An example of a medication used in this type of treatment is temozolomide (Temodar).
Targeted or Clinical Trial Therapies:
In some cases, a patient’s glioma is eligible for genetic profiling which can allow patients to enroll in clinical trials or other targeted treatment options.
What Comes Next?
Gliomas may be serious, but they are treatable. Low-grade gliomas can grow slowly over several years. On the other hand, high-grade gliomas grow more rapidly and can require more comprehensive care.
Glioma treatment outcomes depend on a few factors. These include the type and grade of glioma, how much can be safely removed during surgical intervention, a patient’s age and overall health, and whether the tumor has molecular markers such as IDH mutation, MGMT methylation or 1p/19q co-deletion.
Dr. Yim, alongside his team and and the neuro-oncologists/radiation oncologists on the case, will create personalized care plans to maximize patients’ quality of life and long-term outcomes.
You Are Not Alone
Glioma diagnoses can be overwhelming, but you and your loved ones are not alone. Dr. Yim and his team at Golden State Neurosurgery are committed to providing support and guidance throughout your care with compassion, expertise, and the latest treatment options. If you or a loved one has been diagnosed with a glioma, please feel free to contact our office to schedule a consultation visit with Dr. Yim.
Glioma Surgery: What Patients Should Know
Our clinic is here to support you and your family through a glioma diagnosis. The following information will hopefully explain what gliomas are, why surgery might be the recommended treatment plan, how the procedure works, and what recovery looks like.
What Is a Glioma?
Gliomas are a form of brain tumor that originate from your body’s glial cells. These are the cells that surround neurons in the brain and offer them protection. Gliomas are categorized as either low-grade (slow-growing) or high-grade (more aggressive – for example, glioblastomas). Gliomas typically do not spread past the brain. Nevertheless, they can still lead to serious concerns depending on location, size, and growth rate of the tumor.
Why Is Surgery Needed?
Surgery is often an integral part of glioma treatment plans. The overall goal is to maximize safe resection (or removal) while avoiding injury to critical cognitive and functional areas of the brain such as control centers for speech, movement, vision, or memory. Some of its possible benefits (depending on your glioma) are:
- Relieves pressure on the brain that may be the cause of headaches/weakness
- Improves preservation of brain function
- Obtains a diagnosis; by surgically resecting the tumor, we can submit the tumor tissue to pathology to get further diagnostic details on your tumor
- Reduces tumor burden before beginning radiation or chemotherapy
- Improves long-term outcomes; this is particularly true when the tumor can be significantly resected
How does the procedure work?
Most procedures involve a craniotomy, performed by Dr. Yim. Craniotomies involve temporarily removing a small portion of the skull to access the brain. State-of-the-art neurosurgical devices/tools and imaging are used in every case to maximize precision and safety. These advanced technologies include the following:
- Stealth neuronavigation (brain GPS): guides the approach during the procedure using your MRI scan
- KINEVO robotic surgical microscope: provides high-resolution magnification and image integration
- Ultrasonic aspiration (CUSA): gently removes tumor tissue with minimal impact on the surrounding healthy tissue
- Intraoperative neuromonitoring: tracks brain and nerve function during the procedure
- Phase reversal mapping: allows for localization of movement pathways when tumors are near the motor strip
- Awake craniotomy: performed if needed to protect critical function (typically used if tumor is near speech or motor centers and there is need for additional surveillance measures)
Once the tumor has been resected, Dr. Yim will reconstruct the skull with bone cement, a smooth and safe material that fits your skull completely. This method allows for a natural contour and does not require the use of metal plates.
What to Expect After Surgery
After surgery, patients recover in the neuro ICU overnight and are closely monitored by the medical team. Most patients remain in the hospital for 3-5 days. An MRI scan will be performed within 24-72 hours after your operation to evaluate the success of the resection. Pathology results from the collected tissue sample are usually available 5-7 days after the procedure and will be used to assess the next steps of your treatment plan. Patients typically return home and after a short period of rest, can gradually return to their daily activities.
Potential Risks
Brain surgery comes with risks, but they can be minimized with careful planning and the use of modern technology. These risks can include temporary or permanent changes to strength/speech/vision, infection or bleeding, seizures (often can be controlled with medication), cerebrospinal fluid (CSF) leak, and need for additional treatment if complete tumor resection was not possible. Dr. Yim uses intraoperative monitoring, brain mapping, and high-precision techniques to minimize these risks as much as possible.
What Is the Long-Term Outlook?
Your long-term outlook can depend on several essential factors. These can include the type and grade of glioma, how much of the tumor was safely removed during surgery, your overall health, and how you respond to follow-up therapy. Typically, after surgery, patients are advised to complete radiation therapy, chemotherapy, or targeted therapies. Long-term MRI monitoring is also essential to continuous management. Dr. Yim and his multidisciplinary team will continue to work with you and your family to build personalized plans to support your recovery and long-term health.
Summary
Surgery is an important first step in your glioma treatment plan and can relieve symptoms, improve quality of life, and help lead to the best possible outcomes. Dr. Yim uses his technical expertise and advanced technology to perform each operation. He carefully plans your care to maximize your safety and the effectiveness of surgery. Each decision is personalized for your needs, and Dr. Yim will personally provide compassionate and expert care throughout the entire treatment.
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