A Review on the Surgical Management of Insular Gliomas

Abstract

The surgical treatment of insular gliomas requires specialized knowledge. Over the last three decades, increased momentum in surgical resection of insular gliomas shifted the focus from one of expectant management to maximal safe resection to establish a diagnosis, characterize tumor genetics, treat preoperative symptoms (i.e., seizures), and delay malignant transformation through tumor cytoreduction. A comprehensive review of the literature was performed regarding insular glioma classification/genetics, insular anatomy, surgical approaches, and patient outcomes. Modern large, published series of insular resections have reported a median 80% resection, 80% improvement in preoperative seizures, and postsurgical permanent neurologic deficits of less than 10%. Major complication avoidance includes recognition and preservation of eloquent cortex for language and respecting the lateral lenticulostriate arteries.

Surgical treatment for insular gliomas. A systematic review and meta-analysis on behalf of the EANS neuro-oncology section

“…The pertinent literature contains several systematic reviews and a few meta-analyses investigating the published experience with insular glioma surgery ( Di Carlo et al, 2020 ; Lu et al, 2019 ; Papadopoulou & Kumar, 2024 ; Zhang et al, 2022 ). Some narrative reviews have also been published in recent years ( Duffau, 2018 ; Hervey-Jumper & Berger, 2019 ; Murrone et al, 2019 ; Przybylowski et al, 2021 ; Renfrow et al, 2023 ). Limitations of the literature may include the somewhat limited scope of many publications.…”

What is the cognitive footprint of insular glioma?

“…Insular gliomas, which comprise roughly 25% of low-grade gliomas (LGG) and 10% of high-grade gliomas (HGG), pose a unique challenge to neurosurgeons given their complex anatomy ( Duffau and Capelle, 2004 ; Renfrow et al, 2023 ). Cognitive impairment has a profound detrimental impact on long-term outcomes of glioma surgery including quality of life (QoL) and return to work status ( Liu et al, 2009 ; Sanai et al, 2011 ; Hameed et al, 2018 ; Noll et al, 2018 ; Li et al, 2020 ).…”