Glioma · Maximal Safe Resection vs Biopsy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Site/resectability + grade
   Site/eloquent area? Grade? Diffuse/multifocal?
   • Accessible, non-eloquent area → Accessible → maximal safe resection
   • Deep/eloquent area/multifocal diffuse → Deep/eloquent → stereotactic biopsy
   • High-grade (GBM), resectable → GBM → resection + Stupp
2. [End] Accessible → maximal safe resection
   Accessible, non-eloquent → maximal safe resection (extent of resection affects prognosis); intraoperative navigation/awake anesthesia/electrophysiology to protect function; adjuvant therapy by pathology and molecular markers (IDH/1p19q/MGMT).
3. [End] Deep/eloquent → stereotactic biopsy
   Deep/eloquent/multifocal diffuse → stereotactic biopsy to establish pathology and molecular subtype, then plan chemoradiation; do not force a disabling resection.
4. [End] GBM → resection + Stupp
   High-grade (GBM) resectable → maximal safe resection + Stupp protocol (radiotherapy + concurrent and adjuvant temozolomide); MGMT methylation predicts benefit; tumor-treating fields are an option.

Source guidelines & references

• Glioma management (NCCN/EANO; maximal safe resection; Stupp protocol)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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