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Prognostic Factors and Oncofunctional Outcomes of WHO 2021-Classified Insular Gliomas Undergoing Awake Brain Mapping
Kazuya Motomura1, Koichi Mitsuya2, Yuji Kibe1
1Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, Japan; Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
World Neurosurgery
|July 24, 2026
Summary
Awake brain mapping for insular gliomas improves neurocognitive function and preserves neurological status. Key survival predictors include tumor pathology, IDH mutation status, and achieving over 90% extent of resection.
Area of Science:
- Neurosurgery
- Neuro-oncology
- Brain Mapping
Background:
- Insular gliomas present unique surgical challenges due to their location.
- Awake brain surgery with functional mapping is increasingly utilized for eloquent area tumors.
Purpose of the Study:
- To evaluate prognostic factors and oncofunctional outcomes in patients with insular gliomas undergoing awake brain mapping.
- To assess neurological and neurocognitive preservation post-surgery.
Main Methods:
- Retrospective analysis of 36 patients with insular gliomas (WHO 2021 classification) who underwent awake surgery.
- Utilized awake brain mapping to guide tumor resection and assess functional preservation.
Main Results:
- Postoperative neurocognitive scores (Wechsler Memory Scale-Revised) showed significant improvement in General Memory and Delayed Recall.
- Median overall survival was significantly longer for IDH-mutant lower-grade gliomas compared to IDH-wildtype glioblastomas.
- Tumor pathology (GBM vs. LrGG), IDH mutation status, and extent of resection (EOR ≥90%) were significant predictors of overall survival.
Conclusions:
- Histological GBM, IDH mutation status, and achieving an EOR ≥90% are significant predictors of overall survival in insular gliomas.
- Awake functional mapping is a valuable approach for insular gliomas, minimizing deficits and preserving neurocognitive function.
