Surgical strategy and predicator of insular glioma in a tertiary centre

Abstract

Introduction: The insular glioma is a rare condition in neurosurgical practice. The treatment of insular glioma lacks a distinct approach. This study aims to review the outcomes of insular glioma surgery and discuss strategies to minimise the risk in adults who have undergone initial or repeat resection of insular gliomas of all grades.

Methods: An observational study was done among 50 patients with insular gliomas who were admitted to the Department of Neurosurgery of a tertiary care centre during January 2015-August 2025. The treatment decisions and neurosurgical outcomes of the patients with insular glioma were analysed. All patients were assessed with either computed tomography, magnetic resonance imaging, or both.

Results: Among the admitted patients, the youngest patient was 25 years, and the oldest was 76 years, while there were 30 males and 20 females. Most of the patients, 42 (84%), presented with headache and 32 (64%) presented with seizures of sudden onset. Right-sided insular gliomas were observed in 27 (54%) patients, but 23 (46%) patients had left-sided tumours, and 27 (57%) patients were operated on with the Transylvanian approach and 20 (42%) patients with the transcortical approach. Extent of resection above 90% or above was achieved in 52% of cases, and EOR of 70-90% in 48% of cases.

Conclusion: The surgical approach for insular gliomas requires technical mastery of intraoperative technologies to minimise postoperative morbidity.