## Clinical Context This patient presents with imaging findings highly suggestive of a high-grade glioma (likely WHO Grade III–IV glioblastoma), characterized by: - Large size (4 cm) with heterogeneous signal - Significant perilesional edema and mass effect - Necrosis and patchy enhancement (hallmarks of high-grade glioma) - Acute neurological symptoms (seizures, raised intracranial pressure signs) ## Immediate Management Priorities **Key Point:** In a patient with imaging-confirmed intracranial mass causing mass effect and neurological compromise, the immediate step is **symptomatic management and neurosurgical consultation**, not awaiting histology. ### Rationale for Correct Answer 1. **Dexamethasone for cerebral edema:** High-dose corticosteroids (typically 8–16 mg/day in divided doses) reduce perilesional edema and intracranial pressure, providing symptomatic relief and preventing further deterioration. 2. **Neurosurgical consultation:** Maximal safe resection is the standard of care for suspected high-grade gliomas and improves overall survival, progression-free survival, and quality of life. 3. **Histopathology informs adjuvant therapy:** Definitive WHO grading and molecular markers (IDH1/2, MGMT methylation status, 1p/19q codeletion) guide post-operative chemoradiation decisions. **Clinical Pearl:** Dexamethasone should be given immediately upon diagnosis of a mass lesion with edema; neurosurgical resection is the definitive diagnostic and therapeutic intervention. Histology is obtained intraoperatively or from resected tissue. ## Why Immediate Resection? **High-Yield:** Maximal safe resection of high-grade gliomas: - Improves median overall survival (14–15 months for GBM with resection vs. 8–10 months without) - Allows tissue diagnosis and molecular profiling - Reduces mass effect and seizure burden - Enables better response to adjuvant therapy [cite:Robbins 10e Ch 28; Harrison 21e Ch 375] 
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