Gliomas in adults

Abstract

Background: Primary brain tumors are among the ten most common causes of cancer-related death. There is no screening test for them, but timely diagnosis and treatment improve the outcome. Ideally, treatment should be provided in a highly specialized center, but patients reach such centers only on the referral of their primary care physicians or other medical specialists from a wide variety of fields. An up-to-date account of basic knowledge in this area would thus seem desirable, as recent years have seen major developments both in the scientific understanding of these tumors and in clinical methods of diagnosis and treatment.

Methods: Selective search of the pertinent literature (PubMed and Cochrane Library), including the guidelines of the German Societies of Neurosurgery, Neurology, and Radiotherapy.

Results and conclusion: Modern neuroradiological imaging, in particular magnetic resonance imaging, can show structural lesions at high resolution and provide a variety of biological and functional information, yet it is still no substitute for histological diagnosis. Gross total resection of gliomas significantly improves overall survival. New molecular markers can be used for prognostication. Chemotherapy plays a major role in the treatment of various different kinds of glioma. The median survival, however, generally remains poor, e.g., 14.6 months for glio-blastoma.

Figure 1

Magnetic resonance images of a glioblastoma: centrally necrotic mass with strong peripheral contrast enhancement and marked perifocal edema.

Figure 2

Magnetic resonance images of a pontine glioma with anatomical fiber tracking. Figure 2 a) (axial) shows color-coded fiber pathways; the craniocaudal fibers on the left side are clearly displaced and spread apart. Figure 2 b) shows the same finding in a three-dimensionally reconstructed color image.