High-Grade Gliomas: A Multidisciplinary Approach

patients to a wide variety of treatment results, as every patient will have a different path through this illness. Patients must be evaluated individually, and therapeutic decisions must be made according to the specifi c patient and tumor characteristics. Glioblastoma, anaplastic astrocytoma, and anaplastic oligodendroglioma provide clear examples of the importance of teamwork by all specialists involved in the treatment of high-grade gliomas. A multidisciplinary approach is the key to success. But, what is considered a “successful treatment” in highgrade gliomas? In the past 2 decades, advances in surgical techniques and intraoperative technology have allowed the neurosurgeon to offer considerable improvement in survival and quality of life. When it comes to a disease without a cure, this could be considered success. Achieving a better prognosis for patients depends not only on development of effective treatments; it is also necessary to create systems for an effective organization within all the specialists involved to ensure the patient will receive those treatments at the best time and in the best possible way. Patients with the diagnosis of high-grade glioma provide one of the best examples of how the communication among the various specialists is essential to obtain the best results. It has been demonstrated that patients’ prognosis is much better at centers where subspecialized surgeons in the various disciplines of neurosurgery take care of patients as compared with centers that do not have the appropriate organization. The main objectives in the creation of an oncologic neurosurgery clinic are: 1) to discuss the best treatment option for each patient with a brain tumor; and 2) to perform close follow-up of every case by having an open channel for communication among the various specialists. A system for multidisciplinary communication is the basis to create an oncologic neurosurgery clinic (Figure 1). Today, the standard treatment for a patient with a highgrade glioma consists of gross total resection followed by radiation therapy concomitant with chemotherapy and at least 6 cycles of adjuvant chemotherapy. Until now, it could be considered that the multidisciplinary team comprises the neurosurgeon, the radiation oncologist, and the neurooncologist. However, successful treatment of these patients depends on more than 3 specialists. Treatment is complex, and it is necessary to ensure after every phase that treatment will not generate a new neurologic defi cit or