Initial Management at Presentation
Typically, HGGs are initially managed surgically. The reasons are as follows:
- Diagnosis: A definite tissue diagnosis should be accomplished.
- Decompression: Surrounding normal structures should be decompressed to relieve presenting neurological symptoms and signs.
- Maximal resection: A maximal resection should be the goal of surgery. The desire for an aggressive surgical resection should, however, always be tempered by the possibility of inflicting a neurological deficit. The gross total resection of a HGG that will knowingly cause a neurological deficit may not be warranted, especially if further adjuvant therapy is anticipated.
- Radiation and chemotherapy: Surgery alone for HGGs is not curative. Consequently, adjuvant treatments are used in addition to surgery in all but the most unusual cases. In children these treatments include chemotherapy and, if age appropriate, radiotherapy.
- Immunotherapy: More recently, immunotherapy treatments have also begun to be explored.
- Follow with multidisciplinary team: Children with HGGs are usually followed by a multidisciplinary team that includes a medical oncologist and radiation oncologist in addition to the neurosurgeon. The frequency of visits will vary according to the protocol being used to treat the child, as will the frequency and type of follow-up imaging.