Observational Connectomics in Adults Undergoing Resection of WHO II-IV Glioma

Inclusion Criteria:

1. Age \> 18 years.
2. Newly diagnosed patients (by MRI) suspected of having a brain tumor (WHO II,III, or IV) who will undergo surgery with histological confirmation or patients undergoing surgery for recurrent brain tumor (WHO grades II, III, IV) whose histology confirms glioma and/or treatment effect.
3. Diffuse astrocytomas, multifocal gliomas, oligodendrogliomas, midline and brainstem gliomas are included.
4. Previously treated (progressive, recurrent) gliomas are included. Thus, prior surgery, radiation therapy, anti-angiogenic therapy, electrical field therapy are not exclusions.
5. Patient must be able to give informed consent. S/he must be able to read and understand English or there must be a qualified interpreter.
6. Must be able to undergo sequential MRI in a facility that can perform 30-directional MRI for connectomic analyses.

Exclusion Criteria:

1. Juvenile pilocytic glioma (WHO I)
2. Histology that is non-glioma, e.g., brain metastases, craniopharyngioma, ependymoma, medulloblastoma, meningioma, lymphoma, tumefactive (demyelinative) plaque, abscess, germinoma, arachnoid cyst, epidermoid, PXA, DNET, ganglioglioma, central neurocytoma,
3. Inability to give informed consent.
4. Tissue samples obtained at surgery are insufficient/ or non-diagnostic for glioma
5. Expected survival \< 90 days due to primary disease or medical co-morbidities. (e.g. sepsis, pneumonia, organ failure)
6. Inability to have a MRI due to cardiac pacemaker, implants, claustrophobia, allergy to gadolinium,
7. Pregnancy. Because of potential risk of serial MRI to fetus, women of child-bearing age will need a pregnancy test and agree to contraceptive practices during the course of the study.
8. Vulnerable population
9. Medications. There are no restrictions on medications. Patients will receive best standard of care.
10. Clinical Trials. Patients may also be enrolled in a clinical trial as a clinical trial is always recommended for patients with a glioma per NCCN guidelines.
11. KPS \< 40.
12. Age \< 17.