Adults · Conditions
Glioma and astrocytoma
Tumours arising from the supporting cells of the brain. Treatment is planned with the oncology team and may include awake craniotomy.
What is it?
Gliomas are tumours that arise from the glial (supporting) cells of the brain. They include astrocytomas, oligodendrogliomas and glioblastoma. They are graded from 1 to 4 under the WHO classification, which combines how the cells look with molecular tests such as IDH mutation and 1p/19q status. Lower-grade gliomas tend to grow slowly; glioblastoma (grade 4) grows more quickly.
What symptoms can it cause?
Seizures are a common first symptom, particularly with lower-grade gliomas. Others include headaches, weakness, numbness, difficulty with speech, and changes in memory, concentration or personality.
How is it assessed?
An MRI scan with contrast is the main test, sometimes with advanced MRI such as perfusion or functional MRI to plan surgery. The diagnosis is confirmed by examining tumour tissue, including molecular tests. Your care is planned with a multidisciplinary team, which may include neuro-oncologists, radiation oncologists, neuroradiologists and neuropathologists.
What are the treatment options?
Treatment usually combines surgery with radiotherapy and/or chemotherapy, depending on the type and grade. Surgery aims to remove as much tumour as is safely possible, or to obtain a biopsy when removal is not safe. For tumours near areas that control speech or movement, awake craniotomy may be offered: you are asleep for the opening, then woken and comfortable while speech or movement is tested, so that these areas can be identified and protected. Intraoperative neurophysiological monitoring and fluorescence guidance may also be used.
For selected people with glioblastoma, particularly a small area of tumour that has come back after standard treatment, Gamma Knife radiosurgery may be considered alongside other options.
When might surgery be considered?
Surgery is usually advised early, both to confirm the diagnosis and because the extent of removal can affect outcome. Some small, slow-growing tumours may first be monitored. The options, benefits and risks, including whether awake surgery is suitable for you, are discussed in detail.
What to expect from recovery and follow-up
Most people stay in hospital for a few days. Further treatment with the oncology team usually starts within weeks. Follow-up includes regular MRI scans. Driving after seizures or brain surgery needs specific advice.
When to seek urgent help
If you have a sudden severe headache, a seizure, new weakness, confusion, difficulty speaking, or loss of bladder or bowel control, go to the nearest emergency unit or call 10177. If you are under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600).
Dr Labuschagne's publications on this topic
- Mofatteh M, Mashayekhi MS, Arfaie S, et al (incl. Labuschagne JJ). Awake craniotomy in Africa: a scoping review of literature and proposed solutions to tackle challenges. Neurosurgery. 2023;93(2).
PubMedRequest a copy from the author
- Labuschagne JJ, Chetty D. Glioblastoma multiforme as a secondary malignancy following stereotactic radiosurgery of a meningioma: case report. Neurosurg Focus. 2019;46(6):E11.
PubMedRequest a copy from the author
This page is general information. Your doctor will advise on what applies to you.