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Despite multimodal therapy malignant gliomas remain fatal diseases of the CNS. Glioblastomas, the most aggressive and malignant type, shows a median survival of almost one year. Although survival time of malignant gliomas has not improved over the last three decades, progresses in minimal invasive neurosurgery, neuroanesthesiology and radiotherapy led to decreased therapeutic morbidity in the light of palliative treatment. Chemotherapy additionally maintain quality of life. Palliative care of epilepsy with new anticonvulsant drugs show low side effects and little drug interactions. Long-term therapy of brain edema with steroids needs special attention regarding side effects like steroid-myopathy. Patients with malignant gliomas carry a high risk of thromboembolism. A treatment with low molecular weight heparin can be performed without increased risk of cerebral bleeding. In terminal stages of the disease severe neurological symptoms and loss of consciousness often require specialised professionals with palliative care experience.