OPINION STATEMENT: Treatment of @entity1 with high-grade @entity11 (HGG) should begin with thorough evaluation by a specialized multidisciplinary team to determine whether or not the @entity1 is appropriate for surgery, chemotherapy and radiotherapy. Particular attention should be paid to the performance status and neurological function. Surgery is the first step in therapeutic intervention. @entity1 undergo either biopsy, debulking surgery or maximal resection depending on the anatomical location of the @entity5 and the @entity1 's clinical condition. Extent of resection has a prognostic value. In @entity1 who are 'fit for surgery', the aim is to remove all contrast-enhancing @entity5 without causing @entity51 . If microsurgical resection is not feasible, then a biopsy, either open or stereotactic, should be performed to confirm high-grade @entity11 diagnosis and to perform molecular genetic analyses (MGMT methylation status, loss of heterozygosity in 1p/19q, @entity818 status) as this has treatment implications. Over the past decade, much @entity11 research has focussed on novel surgical approaches to improve long-term outcomes. The evidence to support the benefit of maximizing extent of resection is growing. Advances in neurosurgical techniques allow safer, more aggressive surgery to maximize @entity5 resection whilst minimizing @entity51 . Surgical adjuncts including advanced neuronavigation, intraoperative magnetic resonance imaging, high-frequency ultrasonography, fluorescence-guided microsurgery using intraoperative fluorescence, functional mapping of motor and language pathways, and locally delivered therapies are extending the armamentarium of the neurosurgeon to provide @entity1 with the best outcome. Operating on elderly @entity1 and those with recurrent disease, although controversial, is becoming more common due to emerging neurosurgical approaches. Here, we discuss the emerging surgical techniques and comment on the future of HGG surgery.

Novel Surgical Approaches to High-Grade XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumour'] @entity11 :: ('MESH:D005910', 'Disease') :: ['glioma'] @entity51 :: ('MESH:D009461', 'Disease') :: ['neurological deficit'] @entity818 :: ('3417', 'Gene') :: ['IDH1']
@entity11 :: (MESH:D005910,Disease) :: ['Gliomas']
