Glioblastoma & Other Gliomas

Gliomas are tumors that arise from the brain's supporting (glial) cells. They span a wide range — from slow-growing, low-grade tumors that can be stable for years to high-grade gliomas, of which glioblastoma is the most common and most aggressive. Unlike metastases, gliomas start in the brain; unlike meningiomas, they grow within the brain tissue itself rather than pressing on it from outside.

What defines a glioma today is not just its appearance under the microscope but its molecular profile — markers such as IDH mutation and MGMT methylation now shape the diagnosis, the treatment, and the honest conversation about what to expect. Two tumors that look similar on an MRI can behave very differently, which is why tissue diagnosis anchors everything.

Gliomas infiltrate — they blend into surrounding brain at their edges rather than stopping at a border. That single fact explains most of how they are treated: surgery removes what can safely be removed, and radiation and medical therapy address what infiltrating cells remain.

The evaluation moves quickly and deliberately: detailed MRI, a candid discussion of what the imaging does and does not tell us, and a surgical plan matched to the tumor's location — including functional imaging when the tumor sits near speech, language, or movement.

For tumors that may be high-grade, surgery is enhanced with 5-ALA fluorescence guidance: you drink a medication hours before the operation, high-grade glioma cells take it up, and under a special blue light on the microscope the tumor glows pink — showing infiltrating edges the naked eye and even the MRI can miss. For tumors near critical function, awake mapping lets us protect abilities we cannot see on any scan.

From the first visit, the plan is multidisciplinary. Neurosurgery, neuro-oncology, and radiation oncology work from the same table: surgery first where it helps most, then radiation and chemotherapy tailored to the tumor's molecular profile. Where a clinical trial fits, we collaborate with and refer through our oncology colleagues to get you there.

For most gliomas, surgery is the foundation: it relieves pressure, provides the tissue that defines the diagnosis and treatment, and — for both low- and high-grade tumors — the extent of safe resection is one of the factors most consistently associated with better outcomes. "Maximal safe resection" means exactly that: as much tumor as possible, and no function spent to get it.

When a tumor sits where removal would cost more than it gives — or when the diagnosis alone changes management — a stereotactic biopsy answers the question with the smallest possible operation. And after surgery, we remain part of the team: follow-up imaging, treatment decisions, and the honest conversations at each step are walked together, not handed off.