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Severe headache with vomiting and drowsiness, a first seizure, or rapidly worsening weakness need emergency care today. These may indicate raised pressure inside the skull or bleeding into the tumour. Both need assessment where you are, not travel.

Home  /  Treatments  /  Neurosurgery  /  Glioma and malignant brain tumours

Glioma and malignant brain tumours

Tumours arising from the supporting cells of the brain itself. Unlike a meningioma pushing the brain aside, a glioma grows within brain tissue, which is why complete removal is rarely possible and why the aim is maximal safe resection.

The grade and the molecular profile matter more than the size. Two tumours that look identical on a scan can carry entirely different treatment and outlook depending on tests performed on the tissue.

Clinically reviewed by Dr. Annie Varughese, Consultant Neurosurgeon Clinical oversight Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Aim of surgery
Maximal safe resection
Removing as much as possible without new deficit
Decides treatment
Molecular testing
IDH, 1p/19q and MGMT on the tissue
Near speech or movement
Awake craniotomy
Allows safer, more complete removal
Time in India
4 to 6 weeks
Longer if radiotherapy follows
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What a glioma is

Gliomas arise from glial cells, the supporting tissue of the brain. They are graded from one to four, and the grade describes how aggressively the tumour behaves rather than how large it is. Low-grade gliomas grow slowly over years; grade four glioblastoma grows over weeks to months.

What separates gliomas from most other brain tumours is that they infiltrate. Tumour cells extend into apparently normal brain well beyond the edge visible on a scan, which is why surgery alone does not cure them and why the aim is to remove as much as can be taken safely rather than to achieve a clean margin.

Molecular testing has transformed how these tumours are classified. Mutation of the IDH gene, loss of chromosome arms 1p and 19q, and methylation of the MGMT promoter all change both the expected behaviour of the tumour and the treatment given. A pathology report describing only a grade, without molecular results, is now considered incomplete.

Because gliomas frequently sit near areas controlling speech or movement, the question is rarely whether the surgeon can remove the tumour but how much can be taken before function is lost. Awake craniotomy and intraoperative monitoring exist precisely to push that boundary safely.

Symptoms

Symptoms and warning signs

Common symptoms
  • Headache, often worse in the morning or on lying down
  • A first seizure in an adult
  • Progressive weakness or numbness on one side
  • Difficulty finding words or understanding speech
  • Personality or memory change noticed by family before the patient
  • Visual disturbance or loss of part of the visual field
  • Nausea and vomiting with headache
Warning signs of an emergency
  • Severe headache with vomiting and drowsiness
  • A seizure lasting more than five minutes
  • Rapidly worsening weakness over hours
  • New confusion or reduced consciousness
  • Sudden severe headache unlike any before
  • Visual loss developing over hours

Insist on molecular testing of the tumour tissue

IDH mutation status, 1p/19q co-deletion and MGMT promoter methylation are now part of the standard classification of gliomas. They determine which chemotherapy is appropriate, how the tumour is expected to behave, and what the realistic outlook is. If your pathology report gives only a grade and a name, ask whether molecular testing was done — it can usually be performed on the tissue already stored, without another operation.

Diagnosis

How it is diagnosed

Imaging suggests the diagnosis; tissue confirms it and molecular testing completes it.

Initial tests

  • MRI with contrast — the primary imaging, showing the tumour, its enhancement pattern and surrounding swelling
  • Diffusion and perfusion sequences — help distinguish tumour from abscess and from tuberculoma
  • MR spectroscopy — assesses the chemical signature, useful where infection is a possibility
  • Blood tests and general assessment before surgery

The deciding tests

  • Tissue diagnosis — by resection or, where resection is unsafe, by stereotactic biopsy
  • Molecular testing — IDH, 1p/19q, MGMT and increasingly a wider panel
  • Functional MRI and tractography — map speech and motor pathways before surgery near eloquent areas
  • Post-operative MRI within 48 hours — documents how much tumour was removed, which correlates with outcome

Send the images, not just the report

A radiologist's report describes what they saw; a neurosurgeon needs to see it themselves, particularly the enhancement pattern and the tumour's relationship to speech and motor areas. Ask your hospital for the images on a disc or through their app. If you have earlier scans, send those too — how fast a lesion has changed is one of the most informative things available.

Options

Treatment options

Almost all patients need more than one treatment, in a defined sequence.

Option one

Maximal safe resection

Removing as much tumour as can be taken without causing new neurological deficit. The extent of removal correlates with survival in both low and high-grade gliomas, which is why the surgeon's technique and the technology available matter so much. Fluorescence guidance makes high-grade tumour tissue visible during surgery and increases the proportion removed.

Usually appropriate whenThe tumour is accessible and resection can be achieved without unacceptable functional cost.
Option two

Awake craniotomy with mapping

For tumours adjacent to speech or motor areas, part of the operation is performed with you awake so that function can be tested continuously as tumour is removed. It allows the surgeon to approach the functional boundary far more closely than would otherwise be safe. Most patients tolerate it much better than they expect.

Usually appropriate whenThe tumour lies close to areas controlling speech, movement or other critical function.
Option three

Stereotactic biopsy

Where the tumour is deep, multifocal or in a region that cannot be resected safely, a needle biopsy through a small opening obtains tissue for diagnosis and molecular testing without attempting removal. This is the correct operation where lymphoma is suspected, because resection does not help and can compromise the diagnosis.

Usually appropriate whenResection is unsafe, the lesion is deep or multifocal, or lymphoma is in the differential.
Option four

Radiotherapy and chemotherapy

Radiotherapy follows surgery in most high-grade gliomas, usually with chemotherapy alongside and continuing afterwards. The choice and duration depend on grade and molecular profile. Radiotherapy requires daily attendance for several weeks and must be given in India; some chemotherapy can continue at home.

Usually appropriate whenAfter surgery in high-grade tumours, and in selected low-grade tumours with higher-risk features.
The decision

How the choice is made

Grade and molecular profile

These determine the drug treatment and the expected behaviour of the tumour. They come from the tissue, which is why obtaining a proper sample matters.

Location relative to function

Whether the tumour sits near speech, motor or visual pathways determines how much can be removed and whether awake surgery is needed.

Your general condition

Performance status strongly influences what treatment is reasonable. A patient who is well tolerates aggressive treatment; one who is not may be harmed by it.

Where the imaging is atypical, we will suggest a biopsy rather than a resection. Being operated on extensively for a lymphoma or a tuberculoma is a real and avoidable harm.

Urgency

How urgent is your case

Usually safe to plan travel
  • Stable symptoms, alert and oriented
  • Seizures controlled on medication
  • Imaging complete, planning surgery
  • Post-operative and planning further treatment
Needs local assessment before travel
  • Drowsiness or reduced consciousness
  • Severe headache with vomiting
  • Seizures not controlled on medication
  • Rapidly progressive weakness
  • Visual loss developing over hours

We will tell you which column you are in

Raised pressure inside the skull is not safe to fly with. If there is drowsiness, vomiting or rapid deterioration, that needs a scan and treatment locally today.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • MRI with contrast — report and images
  • Any earlier scans for comparison
  • Pathology report if a biopsy or surgery has been done
  • Molecular testing results if performed

Also helpful

  • Details of seizures and current anti-epileptic medication
  • Steroid dose if you are taking dexamethasone
  • A description of current function — walking, speech, memory
  • Any radiotherapy or chemotherapy already given
Send my reports for review See published cost ranges
Questions

Questions patients ask

Almost never in the strict sense, because glioma cells extend into brain tissue that looks normal on any scan. That is why the goal is maximal safe resection rather than clear margins, and why radiotherapy and chemotherapy follow. The proportion removed does matter — it correlates with survival — which is why the surgeon and the technology available are important.

It describes how aggressively the tumour behaves. Low-grade gliomas grow slowly over years and may be watched in selected cases. Grade four glioblastoma grows over weeks to months and needs prompt treatment. Grade is determined on the tissue, not on the scan, though imaging often suggests it.

Because it changes both the classification and the treatment. An IDH-mutant tumour behaves quite differently from an IDH-wildtype one of the same appearance. MGMT methylation predicts response to a particular chemotherapy. A modern glioma diagnosis is incomplete without these results, and they can usually be run on tissue already stored.

Most patients find it far less difficult than they anticipate. You are asleep for the opening and closing, awake only while the tumour near functional areas is removed, and you feel no pain because the brain itself has no pain receptors. The team talks with you throughout. It exists to protect your speech and movement, and it does that better than any scan.

It is worth checking, particularly for patients from regions where tuberculosis and neurocysticercosis are common. Tuberculoma, abscess, parasitic cysts and lymphoma can all mimic a glioma on MRI, and all are treated without a major resection. Where the imaging is atypical we recommend additional sequences or a biopsy first.

It depends on what is available where you are. If a centre near you performs glioma surgery regularly with intraoperative monitoring and a neuro intensive care unit, local surgery avoids delay and is reasonable. Where those are absent, or where the tumour is near eloquent areas and awake mapping is not available, travelling is genuinely worthwhile. Send the scans and we will give you an honest view.

RelatedOn this site
Neurosurgery in IndiaRead → MeningiomaRead → Brain tumours in childrenRead → Cancer treatment in IndiaRead → Brain and spinal tuberculosisRead →
Contact

Send us your reports

Send the MRI report and, if you can, the images themselves. Any earlier scans are valuable — how quickly a lesion has changed tells us a great deal.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

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