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Craniotomy for glioma, planned by a neuro-oncology MDT.

A patient guide to surgery for diffuse and anaplastic astrocytoma and oligodendroglioma - awake mapping where the tumour demands it, molecular subtyping that drives the adjuvant plan, and a surveillance schedule you can hold on to.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private craniotomy for glioma costs in London.

In short

£38,000–£60,000, post-op MRI within 48 hours.

Pathway step Indicative range
Neuro-oncology MDT review (imaging only) £450–£900
Stereotactic needle biopsy £8,000–£14,000
Craniotomy under GA (standard) £28,000–£45,000
Awake craniotomy with cortical mapping £38,000–£60,000
Craniotomy with intraoperative MRI £45,000–£75,000
Molecular profiling (IDH, 1p/19q, MGMT) £850–£1,600

Prices vary by hospital, by which neurosurgeon leads, by whether awake mapping and intraoperative MRI are used, and by length of stay. Adjuvant radiotherapy and chemotherapy are quoted separately once the integrated diagnosis is back.

The problem

The right MDT, the right surgeon, the right timing.

Glioma outcomes are shaped as much by how the decision is made as by how the operation goes. A single-surgeon opinion, an old watch-and-wait reflex or missing molecular data can quietly close doors the RTOG 9802 evidence has just opened.

  • Eloquent cortex on the scan?

    If the tumour touches language, motor or vision, awake mapping protects function. Not every neurosurgeon offers it - we route accordingly.

  • Molecular subtype clear?

    IDH mutation, 1p/19q co-deletion and MGMT status change the adjuvant plan. If pathology is not integrated with molecular data, the plan is incomplete.

When it helps

When a craniotomy for glioma is the right step.

The presentations we see most, plus the one red flag that means an emergency rather than an appointment.

  • Diffuse astrocytoma (grade 2)

    A slow-growing IDH-mutant glioma often presenting with a first seizure - early maximal safe resection now favoured over watch-and-wait.

  • Anaplastic astrocytoma (grade 3)

    A more aggressive IDH-mutant or wildtype astrocytoma - resection plus adjuvant radiotherapy and temozolomide is the mainstay.

  • Oligodendroglioma (grade 2 or 3)

    An IDH-mutant, 1p/19q co-deleted glioma - chemosensitive and typically treated with resection followed by radiotherapy and PCV chemotherapy.

  • Tumour in eloquent cortex

    A glioma near language, motor or visual areas - awake craniotomy with cortical and subcortical mapping protects function while maximising resection.

  • Progression on surveillance MRI

    A previously stable low-grade glioma that begins to enlarge or enhance - re-resection or a change of adjuvant strategy is often warranted.

  • First seizure with a new mass

    A focal or generalised seizure in an adult with a newly identified brain lesion - the standard route is MDT review, tissue diagnosis, then a resection plan.

  • Suspected malignant transformation

    New enhancement or rapid growth in a known low-grade glioma raises the concern of transformation to a higher grade - tissue is needed to decide next steps.

  • Red flag: reduced consciousness

    A drop in GCS, a new severe headache with vomiting, or a fixed pupil is a neurosurgical emergency - A&E the same hour, not a clinic booking.

Treatment options

Biopsy, resection, mapping, adjuvant - the options in one place.

What each option actually involves - and which fits which glioma.

  • Stereotactic needle biopsy

    A small burr-hole biopsy under image guidance - used when the tumour is deep, diffuse or the patient is unfit for open resection.

  • Watch-and-wait surveillance

    Interval MRI for small, incidental, non-eloquent low-grade lesions - but RTOG 9802 evidence now favours early treatment for most symptomatic grade 2 gliomas.

  • Craniotomy under GA

    Standard asleep resection with neuronavigation. Suitable when the tumour is well away from language and motor cortex.

  • Awake craniotomy with mapping

    You are woken intra-operatively for cortical and subcortical stimulation - mapping the exact edges of language, motor and other function before resecting.

  • 5-ALA or sodium fluorescein guidance

    A fluorescent dye taken up by tumour cells makes the resection margin visible under a special microscope - most useful for higher-grade components.

  • Intraoperative MRI

    A scan performed mid-operation to confirm extent of resection and detect residual tumour while you are still on the table.

  • Adjuvant radiotherapy

    Focal fractionated radiotherapy delivered over five to six weeks after recovery - standard for grade 3 and high-risk grade 2 gliomas.

  • Adjuvant PCV or temozolomide

    PCV (procarbazine, CCNU, vincristine) for 1p/19q co-deleted oligodendrogliomas; temozolomide for most other grade 3 astrocytomas.

Risks and what to watch for

What to expect afterwards - honestly.

Craniotomy for glioma is a well-established neurosurgical operation with real risks. Knowing what is normal, what is a warning sign, and what surveillance looks like is part of good care.

  • Progression on surveillance MRI

    Even a well-resected low-grade glioma can enlarge over years - a defined surveillance MRI schedule is part of the plan from day one.

  • Malignant transformation

    Grade 2 gliomas can transform into grade 3 or 4 tumours. New enhancement, growth or symptoms must trigger fresh imaging and MDT review.

  • Radionecrosis after radiotherapy

    Late tissue injury from radiotherapy can look like tumour progression on MRI - advanced imaging and MDT judgement distinguish the two.

  • Cognitive change

    Attention, word-finding and processing speed can be affected by both the tumour and the treatment - formal neuropsychological review is offered.

  • Seizures on eloquent-cortex resection

    New or worsening seizures can follow resection near motor or language cortex - anti-seizure medication is planned and adjusted with a neurologist.

  • DVT and PE

    Glioma patients are at above-average risk of venous thromboembolism. Mechanical prophylaxis is standard and chemical prophylaxis is introduced when safe.

  • Pseudo-progression

    In the first three to six months after chemoradiotherapy, MRI can look worse without true progression - the MDT reviews before changing treatment.

  • Corticosteroid dependence

    Dexamethasone reduces oedema but has real long-term costs - we taper as fast as symptoms allow.

  • Red flags

    A drop in consciousness, new severe headache with vomiting, sudden weakness or a fixed pupil after surgery is an emergency - A&E the same hour.

Reading your pathology report

Your integrated report in four parts. Read the last one first.

Whichever operation was performed, the neuropathology report and MDT letter keep to the same shape.

A neuropathologist reviewing an integrated glioma report on a workstation in a London clinic

A quiet reminder

Pathology language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the integrated diagnosis before your MDT clinic, just ask.

  1. 01 Header

    Diagnosis and WHO grade

    The integrated histological and molecular diagnosis - for example, oligodendroglioma, IDH-mutant and 1p/19q co-deleted, WHO grade 3.

  2. 02 Molecular

    IDH, 1p/19q, MGMT and Ki-67

    The molecular signature that drives prognosis and treatment choice - IDH mutation is favourable, 1p/19q co-deletion predicts chemosensitivity, MGMT methylation predicts temozolomide response.

  3. 03 Findings

    Extent of resection on post-op MRI

    Gross-total, near-total, subtotal or biopsy - measured against the pre-operative volume on the MRI performed within 48 hours.

  4. 04 Impression

    Adjuvant plan and surveillance schedule

    Read this first: radiotherapy timing, PCV or temozolomide, and the interval MRI schedule for the next five years.

Recognised by major UK insurers

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Cover for glioma surgery and adjuvant treatment varies by insurer and by policy.

Frequently asked

Everything patients ask about craniotomy for glioma.

Quick answers on watch-and-wait versus surgery, awake mapping, molecular subtyping and surveillance MRI.

  • What is a glioma, and how is it different from a glioblastoma?

    Glioma is the umbrella term for tumours arising from the brain’s glial cells. This page covers the lower- and intermediate-grade gliomas - diffuse astrocytoma (grade 2), anaplastic astrocytoma (grade 3) and oligodendroglioma (grade 2–3). Glioblastoma is the WHO grade 4 astrocytoma, which is covered on a separate page and behaves very differently.

  • Watch-and-wait or early surgery?

    Historically some grade 2 gliomas were watched with interval MRI. The RTOG 9802 trial and its long-term follow-up now favour early maximal safe resection followed by radiotherapy and PCV for most symptomatic grade 2 gliomas. A truly incidental, small, non-eloquent lesion is one of the few remaining watch-and-wait scenarios - and even then, MDT review is essential.

  • Why does IDH mutation status matter so much?

    IDH-mutant gliomas behave far better than IDH-wildtype tumours of the same grade - they respond better to treatment and patients live substantially longer. IDH status is the single most important molecular marker in the 2021 WHO classification.

  • What is 1p/19q co-deletion?

    Co-deletion of chromosome arms 1p and 19q defines oligodendroglioma. These tumours are chemosensitive and typically treated with resection followed by radiotherapy and PCV - with median survival measured in many years, not months.

  • What is an awake craniotomy, and will I really be awake?

    For tumours near language, motor or other eloquent cortex, you are woken during the operation - usually pain-free thanks to scalp blocks and sedation - so a neuropsychologist can test speech and movement while the neurosurgeon stimulates and maps the cortex. It is well tolerated, and it is how we protect function while removing as much tumour as safely possible.

  • What is 5-ALA?

    5-aminolevulinic acid is a drink given a few hours before surgery. Tumour cells convert it to a fluorescent compound that glows pink under a special microscope, helping the neurosurgeon see the edge of the tumour intra-operatively. It is most useful for higher-grade tumour components.

  • What is intraoperative MRI?

    An MRI scanner in - or moved into - the operating theatre, letting the neurosurgeon scan you mid-operation to confirm extent of resection and go back for any residual tumour before closing.

  • What adjuvant treatment will I need?

    It depends on grade and molecular profile. Grade 3 tumours typically receive radiotherapy plus PCV (for 1p/19q co-deleted oligodendrogliomas) or temozolomide (for astrocytomas). High-risk grade 2 tumours are increasingly treated similarly. The MDT tailors this to your integrated diagnosis.

  • What does the surveillance MRI schedule look like?

    Typically MRI at three months, then every three to six months for two to three years, then every six to twelve months out to at least five years - adjusted for grade, molecular profile and extent of resection. NICE NG99 and EANO guidance underpin the schedule.

  • When should I go to A&E rather than wait for a clinic?

    A drop in consciousness, a new severe headache with vomiting, sudden weakness or numbness, a new fixed pupil, or a first-ever seizure are all reasons to seek same-hour emergency care.

Clinical sources

What this guide is built on.

Reviewed 2026-07-30. Next review 2027-07-30. Reviewer: Pulse Atlas Editorial Board, .

Related treatments

Looking for something else?

In practice, in London

Booking craniotomy for glioma privately in London - what actually happens

For craniotomy for glioma, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. The wait for craniotomy for glioma on the NHS depends heavily on where you live and how urgently the referral is graded. Central and West London private clinics can normally book within a week, with imaging or a procedure slot to follow shortly after. It’s worth being honest about the reason for going private: usually it’s time, not a fundamentally different test.

In practice, a private craniotomy for glioma appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For craniotomy for glioma in particular, we bias towards consultants who do this every week rather than every month.

There are dozens of consultants in London who see craniotomy for glioma - but not all of them are the right fit for every case. The right first appointment saves you from repeating yourself later.