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Radionuclide Therapy Integrated Multimodal Transsylvian Microneurosurgical Management of Type 5 Insular and
Jinshan Wang1, Jian Wang2, Ao Zhu1
1Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Background:
Type 5 insular and paralimbic gliomas are surgically challenging because resection is limited by perforator-rich vascular anatomy and eloquent subcortical pathways, often leaving clinically relevant residual disease. We evaluated a precision-oncology workflow integrating multimodal preoperative planning, transsylvian microneurosurgical resection, and postoperative radionuclide-oriented stratification.
Methods:
This retrospective study included 38 adults with type 5 insular and paralimbic gliomas treated through a transsylvian approach. Structural magnetic resonance imaging (MRI), T2/fluid-attenuated inversion recovery imaging, diffusion tensor tractography, and vascular mapping were integrated to define operative corridors and safety boundaries. Early postoperative MRI was used to assess extent of resection, neurologic outcome, and residual-disease category, which was then linked to standard follow-up, radionuclide-oriented reassessment, or targeted radionuclide therapy candidacy.
Results:
Gross total resection was achieved in 72% of patients, subtotal resection in 21%, and partial resection in 7%. No new neurologic deficit occurred in 80% of patients, transient deficits in 15%, and permanent deficits in 5%, yielding a neurologic preservation rate of 95%. Residual disease was categorized as no significant residual in 55%, surgically constrained residual in 30%, and biologically high-risk residual in 15%.
Conclusions:
This integrated workflow achieved high rates of maximal safe resection and neurologic preservation while providing a structured postoperative framework for biologically informed residual-disease assessment, radionuclide-oriented reassessment, and targeted radionuclide therapy candidate selection in surgically complex gliomas.
Insights
A novel precision oncology workflow for type 5 insular gliomas improved maximal safe resection rates to 72% and maintained a 95% neurologic preservation rate. This approach enables better residual disease assessment and targeted therapy selection for complex brain tumors.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Type 5 insular and paralimbic gliomas present surgical challenges due to complex vascular anatomy and critical neural pathways.
- Standard resection often results in significant residual disease, impacting patient outcomes.
- A precision oncology approach is needed to optimize surgical outcomes and subsequent management.
Purpose of the Study:
- To evaluate an integrated precision oncology workflow for surgically complex type 5 insular and paralimbic gliomas.
- To assess the efficacy of a transsylvian microneurosurgical approach combined with advanced imaging and radionuclide-based stratification.
- To determine rates of maximal safe resection and neurologic preservation.
Main Methods:
- Retrospective analysis of 38 adult patients with type 5 insular/paralimbic gliomas.
- Integration of multimodal imaging: structural MRI, T2/FLAIR, DTI tractography, and vascular mapping for operative planning.
- Transsylvian microneurosurgical resection followed by postoperative MRI for resection assessment and residual disease categorization.
Main Results:
- Gross total resection achieved in 72% of patients; 95% neurologic preservation rate observed.
- No new permanent neurologic deficits occurred in 95% of patients.
- Postoperative stratification identified residual disease in 45% of patients (surgically constrained or biologically high-risk).
Conclusions:
- The integrated workflow facilitates maximal safe resection and high neurologic preservation in challenging gliomas.
- This approach provides a structured framework for postoperative assessment of residual disease.
- It enables informed selection of patients for radionuclide-oriented reassessment and targeted radionuclide therapy.
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