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Malignant gliomas are characterized by their propensity to invade surrounding brain parenchyma. The median survival of patients is less than 2 years with maximal surgical resection, chemotherapy, and radiotherapy. Although there have been controversial arguments about the role of surgical resection, there is increasing evidence that a safe and radical removal of malignant glioma is associated with a better survival outcome. Surgery is still essential to obtain brain tissue for pathological analysis, and reduce mass effect. Intraoperative magnetic resonance imaging, neuronavigation, ultrasonography, and fluorescence-guided surgery are the most used tools worldwide. 5-Aminolevulinic acid surgery, combined with Stupp protocol, produces a median survival of 15 months. The objectives of perioperative positioning are to enhance optimal exposure, prevent injury related to position, and maintain normal body alignment without excess flexion, extension, or rotation. Advances in surgical techniques have contributed to enhanced recovery after tumor resection, improved postoperative functional status, and decreased length of stay in the hospital. This chapter presents the current literature related to the surgical management of high-grade gliomas.

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