Preface

Contemporary treatment of gliomas is perhaps one of the best examples of teamwork and collaboration in neurosurgical subspecialties. Along with the neurosurgeon, the neuroradi‐ ologist, neuropathologist, neuro-oncologist, radiation oncologist, physiatrist, clinical nurse practitioner coordinator, and others are irreplaceable team members. Furthermore, surgical neuro-oncology has proven to be one of the most resilient neurosurgical subspecialties.

Despite the lack of significant progress in the treatment of high-grade gliomas and the sur‐ vival of high-grade glioma patients over many years, slow and steady persistence coupled with discoveries in various areas have yielded noticeable improvement in patient survival and quality of life. For example, postoperative survival of more than 2 years for glioblasto‐ ma multiforme (GBM) patients has become increasingly frequent. In addition, long-term survivors of the same disease are not necessarily found in rare case reports. Nonetheless, we remain far from meaningful, long-term success in the treatment of those patients.

In the past decade, there has been significant surgical improvement in this field. Improve‐ ment of surgical anatomical understanding of the white matter tracts is because of practice by the surgeon and research of brain anatomy acquired during surgical anatomy labs for white matter fiber dissection techniques, as well as the development of more advanced magnetic resonance imaging tractography software. Furthermore, intraoperative frameless navigation systems have become more sophisticated, and intraoperative ultrasound guidance of tumor resection has become more advanced. There have also been further technological improve‐ ments of ultrasound tumor aspirators. Every year, surgical microscope manufacturers add more technological features that improve their effectiveness. In addition, 5-aminolevulinic acid fluorescence-guided resection of malignant glioma has recently been gaining popularity.

Molecular diagnostics in gliomas has complemented histopathological analysis, and we are now able to distinguish less aggressive subtypes of GBMs from the more aggressive ones. Treatment protocols matching different molecular characteristics have been established, in‐ cluding protocols for tumor recurrence. Finally, the introduction of portable devices deliver‐ ing low intensity, intermediate frequency, and alternating electric fields using non-invasive disposable transducer arrays has become the standard of care in the treatment of malignant gliomas.

Given the steady increase in available options in the treatment of malignant gliomas, one should remain cautiously optimistic that significant thresholds in the improvement of pa‐ tient longevity and quality of life will continue to be achieved.

### **Ibrahim Omerhodžić, MD**

**Chapter 1**

**Provisional chapter**

**Introductory Chapter: Glioma - Merciless Medical**

**Introductory Chapter: Glioma - Merciless Medical** 

DOI: 10.5772/intechopen.82863

Is not this still the truth? Or, are we today, over 100 years after the first glioma operation, however, nearer to the option that we can treat, even cure, most of gliomas or at least keep the disease under control for very many years? The most frequent primary brain tumor, glioma, is still a nightmare for neurooncologists, neuropathologists, neurosurgeons, and other related

If we look at the results of the papers published in the influential *Medline* database (accessed in December 2018), we will find a paper on glioma published back in 1870 [1]. For the next almost 150 years, in this base alone, we can find more than 87,000 papers on the same topic. On the other hand, in the same base only in the past 5 years, over 22,000 papers have been published having basically a story on gliomas (almost a quarter of all publications on gliomas). Does this mean that in the recent years the glioma field research has been more fruitful than ever before? Does this promise, or at least give hope, that we will find the way to put this

In the USA, primary brain tumors account for about 2% of all cancers, with an overall annual incidence of 22 per 100,000 population, with nearly 80,000 new cases of which one-third will

The past three decades have been marked with huge enthusiasm of scientists' and professionals' efforts to bring this serious disease into the context of curable or even cured one. Brain glioma patient treatment has significantly changed over time. Undoubtedly, the architect of this fight, Hurvey Chusing, early in the twentieth century, tried to solve the problem surgically and by tumor removal from the brain. History would very soon show

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

**Diagnosis**

**Diagnosis**

Ibrahim Omerhodžić

**1. Introduction**

serious disease under control?

be malignant [2, 3].

Additional information is available at the end of the chapter

professionals, but for patients and their families first of all.

Ibrahim OmerhodžićAdditional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.82863

Department of Neurosurgery Sarajevo University Clinical Center Sarajevo, Bosnia and Herzegovina

### **Kenan Arnautović, MD, PhD, FAANS, FACS**

Professor of Neurosurgery Semmes-Murphey Clinic and Department of Neurosurgery Health Science Center University of Tennessee Memphis, TN, USA

### **Introductory Chapter: Glioma - Merciless Medical Diagnosis Introductory Chapter: Glioma - Merciless Medical Diagnosis**

DOI: 10.5772/intechopen.82863
