Biopsy first or surgical resection right away? Leading neurosurgeon on progress in surgical and non-surgical treatment of high grade gliomas. GBM, glioblastoma multiforme. High-grade glioma brain tumor, glioblastoma multiforme (GBM). Dr. Anton Titov, MD. Glioblastoma is the most aggressive primary tumor of the brain. It's also one of the most frequent. Dr. Anton Titov, MD. What are the treatment options today for patients with glioblastoma? Dr. Mika Niemela, MD. First, we do surgery if the brain tumor is in such a location that we think it's easily reachable. It doesn't mean that we operate on all of high-grade gliomas. Sometimes glioblastoma is multifocal, it is very central, or glioblastoma is close to some very eloquent areas. Then we may take only a biopsy. Dr. Mika Niemela, MD. We treat multifocal glioblastoma by chemotherapy or radiotherapy. Usually, we start first with radiotherapy. Then chemotherapy. But nowadays more glioblastomas can be operated on straight away. Dr. Mika Niemela, MD. We don't take biopsy first. Then operate. Sometimes we think brain tumor is operable. We operate and try to remove as much brain tumor as possible. We use all the modern technology. We use neuronavigation, of course, modern neuroanaesthesia, modern techniques in surgery as well as gliolan. Gliolan is a dye that is given to the patient. Under the microscope, we can see that the brain tumor looks pink after gliolan. Then we can see more of the tumor borders. Because high-grade gliomas and glioblastomas are not sharply circumscribed. We use ultrasonic aspirator, of course. This is the standard way to remove many brain tumors. Dr. Mika Niemela, MD. Then we do post-operative MRI to check the results. Intraoperative MRI is something we will get in our new building. But modern dyes can be used to identify brain tumor during surgical operation. We use the microscope with different wavelengths of the light. Dr. Anton Titov, MD. This technology have been replacing a need for intraoperative MRI. First, we do brain tumor surgery, then we use radiotherapy. Then we use chemotherapy. It depends on the exact brain tumor pathology. Treatment also depends on potential genetic defects that are found in the brain tumor tissue. Some malignant brain tumors may be more reactive to chemotherapy. Then the patients are followed thoroughly with brain MRIs. Dr. Mika Niemela, MD. We also do detailed clinical checkups. Patients with brain tumors are doing better and better. We see more and more 5-year surviving patients. Of course, the malignant high-grade glioma or glioblastoma often recurs. Unfortunately, glioma recurs at the surgical resection site. Dr. Anton Titov, MD. Repeat brain cancer resections are also possible. It is something that you are doing. Exactly. We do repeat surgery for glioblastomas when indicated and needed.