Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 Patients
Gliomas within the insular region represent one of the most challenging problems in neurosurgical oncology. There are two main surgical approaches to address the complex vascular network and functional areas around the insula: the transsylvian approach and the transcortical approach. In the literatu...
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MDPI AG
2025-02-01
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| Online Access: | https://www.mdpi.com/1718-7729/32/2/98 |
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| author | Alberto Morello Francesca Rizzo Andrea Gatto Flavio Panico Andrea Bianconi Giulia Chiari Daniele Armocida Stefania Greco Crasto Antonio Melcarne Francesco Zenga Roberta Rudà Giovanni Morana Diego Garbossa Fabio Cofano |
| author_facet | Alberto Morello Francesca Rizzo Andrea Gatto Flavio Panico Andrea Bianconi Giulia Chiari Daniele Armocida Stefania Greco Crasto Antonio Melcarne Francesco Zenga Roberta Rudà Giovanni Morana Diego Garbossa Fabio Cofano |
| author_sort | Alberto Morello |
| collection | DOAJ |
| description | Gliomas within the insular region represent one of the most challenging problems in neurosurgical oncology. There are two main surgical approaches to address the complex vascular network and functional areas around the insula: the transsylvian approach and the transcortical approach. In the literature, there is not a clear consensus on the best approach in terms of safety and efficacy. The purpose of this study is to evaluate the effectiveness of these approaches and to analyze prognostic factors on the natural history of insular gliomas. Patients with newly diagnosed high-grade insular gliomas who underwent surgery between January 2019 and June 2024 were analyzed. The series was analyzed according to the classification of Berger–Sanai and Yaşargil. The Karnofsky performance score (KPS), extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were considered the outcome measures. A total of 58 primary high-grade insular glioma patients were enrolled in this study. The IDH mutation was found in 13/58 (22.4%); specifically, 3/13 (23.1%) were grade 4, and 10/13 (76.9%) were grade 3. Furthermore, 40/58 patients (69%) underwent gross total resection (GTR), 15 patients (26%) subtotal resection, and 3 patients (5%) partial resection. Middle cerebral artery encasement negatively affected the OS. GTR, radiotherapy, KPS, and autonomous deambulation at a month after surgery positively affected the OS. The surgical approach used was transsylvian and transcortical in 11 and 47 cases, respectively. The comparison between the two different approaches did not display differences in terms of neurological deficits and OS (<i>p</i> > 0.05). The transcortical approach was related to the greater achievement of GTR (<i>p</i> = 0.031). According to the Berger–Sanai classification, the transcortical approach has higher EOR and postoperative KPS when the lesion is in zone III-IV (<i>p</i> = 0.029). Greater resection of insular gliomas can be achieved with an acceptable morbidity profile and is predictive of improved OS. Both the transsylvian and transcortical corridors to the insula are associated with low morbidity profiles. The transcortical approach with intraoperative mapping is more favorable for achieving greater EOR, particularly in gliomas within the inferior border of the Sylvian fissure. |
| format | Article |
| id | doaj-art-31d8f3a267914fdcb28b046bef9bc19a |
| institution | DOAJ |
| issn | 1198-0052 1718-7729 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | MDPI AG |
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| spelling | doaj-art-31d8f3a267914fdcb28b046bef9bc19a2025-08-20T02:44:53ZengMDPI AGCurrent Oncology1198-00521718-77292025-02-013229810.3390/curroncol32020098Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 PatientsAlberto Morello0Francesca Rizzo1Andrea Gatto2Flavio Panico3Andrea Bianconi4Giulia Chiari5Daniele Armocida6Stefania Greco Crasto7Antonio Melcarne8Francesco Zenga9Roberta Rudà10Giovanni Morana11Diego Garbossa12Fabio Cofano13Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyNeurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyNeurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyNeurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyDepartment of Neurosurgery, Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neuroscience, 16132 Genoa, ItalyBCAM Bilbao Center for Applied Mathematics—Mazarredo Zumarkalea, 48009 Bilbao, SpainA.U.O. “Policlinico Umberto I”, Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00185 Rome, ItalyMagnetic Resonance Imaging Service, R.I.B.A. and Larc Centers, 10128 Turin, ItalyNeurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyNeurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyDivision of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyDivision of Neuroradiology, Department of Diagnostic Imaging and Radiotherapy, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyNeurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyNeurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città Della Salute e Della Scienza” University Hospital, University of Turin, 10126 Turin, ItalyGliomas within the insular region represent one of the most challenging problems in neurosurgical oncology. There are two main surgical approaches to address the complex vascular network and functional areas around the insula: the transsylvian approach and the transcortical approach. In the literature, there is not a clear consensus on the best approach in terms of safety and efficacy. The purpose of this study is to evaluate the effectiveness of these approaches and to analyze prognostic factors on the natural history of insular gliomas. Patients with newly diagnosed high-grade insular gliomas who underwent surgery between January 2019 and June 2024 were analyzed. The series was analyzed according to the classification of Berger–Sanai and Yaşargil. The Karnofsky performance score (KPS), extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were considered the outcome measures. A total of 58 primary high-grade insular glioma patients were enrolled in this study. The IDH mutation was found in 13/58 (22.4%); specifically, 3/13 (23.1%) were grade 4, and 10/13 (76.9%) were grade 3. Furthermore, 40/58 patients (69%) underwent gross total resection (GTR), 15 patients (26%) subtotal resection, and 3 patients (5%) partial resection. Middle cerebral artery encasement negatively affected the OS. GTR, radiotherapy, KPS, and autonomous deambulation at a month after surgery positively affected the OS. The surgical approach used was transsylvian and transcortical in 11 and 47 cases, respectively. The comparison between the two different approaches did not display differences in terms of neurological deficits and OS (<i>p</i> > 0.05). The transcortical approach was related to the greater achievement of GTR (<i>p</i> = 0.031). According to the Berger–Sanai classification, the transcortical approach has higher EOR and postoperative KPS when the lesion is in zone III-IV (<i>p</i> = 0.029). Greater resection of insular gliomas can be achieved with an acceptable morbidity profile and is predictive of improved OS. Both the transsylvian and transcortical corridors to the insula are associated with low morbidity profiles. The transcortical approach with intraoperative mapping is more favorable for achieving greater EOR, particularly in gliomas within the inferior border of the Sylvian fissure.https://www.mdpi.com/1718-7729/32/2/98gliomaglioblastomainsulainsular gliomaoncology |
| spellingShingle | Alberto Morello Francesca Rizzo Andrea Gatto Flavio Panico Andrea Bianconi Giulia Chiari Daniele Armocida Stefania Greco Crasto Antonio Melcarne Francesco Zenga Roberta Rudà Giovanni Morana Diego Garbossa Fabio Cofano Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 Patients Current Oncology glioma glioblastoma insula insular glioma oncology |
| title | Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 Patients |
| title_full | Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 Patients |
| title_fullStr | Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 Patients |
| title_full_unstemmed | Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 Patients |
| title_short | Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 Patients |
| title_sort | safety and efficacy in the transcortical and transsylvian approach in insular high grade gliomas a comparative series of 58 patients |
| topic | glioma glioblastoma insula insular glioma oncology |
| url | https://www.mdpi.com/1718-7729/32/2/98 |
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