When malignant gliomas involve either deep structures or more than one lobe in the dominant hemisphere, radical surgery has little to offer. Yet, because such lesions may mimic treatable conditions, it is usual to insist on a tissue diagnosis. An alternative to major surgery (craniotomy) is needle biopsy. In a series of 60 cases of suspected malignant or inoperable gliomas, the diagnosis was made with the use of needle biopsy in 53 (88%); only seven patients required craniotomy. Needle biopsy through a burr hole has proved safe and reliable and can be done under local anesthesia. (JAMA 228:1417-1418, 1974)