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Published on: July 16, 2018
Insular gliomas: the case for surgical management
Matthias Simon1, Georg Neuloh, Marec von Lehe
1Neurochirurgische Klinik, Universitätskliniken Bonn, Klinikum rechts der Isar, München, Germany.
Journal of Neurosurgery
|December 23, 2008
Summary
Microsurgical resection offers oncological benefits for insular gliomas, with good outcomes in younger patients. A cautious approach is advised for glioblastomas or older patients.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- Insular (paralimbic) gliomas present complex treatment challenges.
- Microsurgical resection is a potential therapeutic option, but its efficacy and safety remain debated.
Purpose of the Study:
- To evaluate the outcomes of microsurgical resection for insular gliomas.
- To identify predictors of functional outcomes and survival after surgery.
Main Methods:
- Analysis of 101 operations in 94 patients between 1995 and 2005.
- Assessment of complications, functional outcomes (Karnofsky Performance Scale Score), and survival rates.
- Statistical analysis to identify independent predictors of outcomes.
Main Results:
- Achieved >90% resection in 42% and 70-90% in 51% of cases.
- Good functional outcomes (KPS 80-100) in 91% of neurologically intact patients <40 years with WHO Grade I-III tumors.
- Favorable survival rates for anaplastic gliomas (5-year survival 80% for oligodendroglial tumors); predictors included younger age, favorable histology, and extent of resection.
Conclusions:
- Microsurgery for insular gliomas has substantial complication rates but offers oncological benefits.
- Microsurgery is recommended as primary treatment for most WHO Grade I-III insular gliomas.
- Glioblastomas and patients >60 years necessitate a more cautious surgical approach.
