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Updated: Jun 20, 2026
DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions
Published on: August 26, 2014
Insular Gliomas: White Fiber Tract: Based Topography and Focused Surgical Strategy: Analysis of 69 Surgically Treated
Abhidha Shah1, Jash Doshi2, Ravikiran Vutha3
1Department of Neurosurgery, K.E.M Hospital and Seth G.S. Medical College, Parel, Mumbai, India; Department of Neurosurgery, K. J Somaiya Medical College, Hospital and Research Center, Mumbai, India; Apollo Hospitals, Navi Mumbai, India.
Background:
In this study, insular gliomas were classified based on their fiber tract origin and extension. The presenting clinical features and surgical decisions were based on such anatomic extensions.
Methods:
During the period June 2016-January 2025, 69 cases of insular low-grade gliomas were surgically treated. The tumors were classified into localized type when they arose from short association fibers and diffuse type when they arose from long association, commissural, and projection fibers. The clinical features were stratified according to the classification. The surgical transsylvian or transcortical access was based on the fiber tract origin. Our previously described surgical strategy of en masse tumor resection was modified according to location and extension and critical brain areas and vital blood vessels in the neighborhood. The aim of surgical treatment was radical tumor resection using standard techniques.
Results:
The follow-up period ranged from 6-86 months (mean, 26 months). A gross total resection was possible in 24 of 32 patients in the localized group and in 10 of 37 patients in the diffuse group.
Conclusions:
Gliomas involving the insula have defined pattern of origin and extension. The classification of these tumors according to the presumed white fiber tract origin can facilitate understanding of clinical presenting features, designing surgical strategy, predicting extent of possible resection, and prognosticating the ultimate outcome.
