ABSTRACT
Surgical resection of infiltrating glial neoplasms has proven to improve quality of life and confer a significant survival benefit. As accumulating evidence cements the role of surgery in grade 4 gliomas, there is a general trend to transition away from traditional large craniotomies to smaller 'keyhole' approaches, which aim to reduce the trauma and complication profiles associated with large exposures. A keyhole approach uses a small craniotomy positioned perfectly to reach at least all the target structures that a conventional approach would reach. We present a case series of operated butterfly gliomas grade 4 patients through keyhole approaches. All three operated patients have better survival than the literature biopsy groups. The resection of butterfly gliomas should be considered in selected cases. For some patients, it is feasible with the technology used nowadays, with improved quality of life and better survival prognosis.