Image diagnosis should be made by CT scan with contrast or MRI scan (CT or MRI are not accurate predictors of tumour type therefore histological confirmation must be actively considered and usually undertaken)

Performance status should be recorded before surgery—for example, Karnofsky

News of the diagnosis and information about the prognosis should be imparted in an appropriate environment (a quiet, private place rather than a public setting; ideally no more than two health professionals should be present. Most patients want a partner/close relative there when being told of the diagnosis)

After each consultation and treatment a brief written summary of specific rather than general details of what has been disclosed should be included in the notes

An opportunity should be made for relatives to ask further questions when the full impact of the diagnosis has been absorbed

Ensure the patient has a clear enough idea of prognosis to be able to weigh up the merits and drawbacks of treatment

Treatment centres should develop written guidelines for the use of steroids

Patients and their relatives must be given written guidance about steroid medication and instructions about the manner in which the dosage may be altered

Steroid dosage should be reduced to the lowest amount compatible with the control of neurological symptoms and discontinued, if possible, after radiotherapy treatment

Resection of a malignant glioma is justified to give rapid relief from distressing symptoms (for example, raised ICP) or when the tumour is in a non-eloquent area and the risks of resection are considered acceptable

When debulking is carried out complete macroscopic resection is preferable to partial removal

Where biopsy is considered in preference to more extensive resection, image directed biopsy should be used rather than freehand needle biopsy (histological reporting should be available if necessary at the time of operation)

Histological reporting should use one of the accepted grading systems (WHO or Daumas Duport)

Provide clear written information explaining basic facts about the disease and its treatment, to back up consultations and reduce the chance of patients receiving conflicting information about their disease

Early postoperative imaging (48−72 hours) should determine the extent of tumour resection

Performance status should be recorded in case notes before discharge

Patients should be informed of legal requirement to inform the driving licence authority (DVLA) and this documented in the notes