Transcortical versus Transsylvian Approach for Insular Gliomas: A Systematic Review and Meta-Analysis

Area of Science:

• Neurosurgery
• Oncology
• Systematic Review

Background:

• Insular gliomas present unique surgical challenges.
• Resection can be achieved via transcortical (TC) or transsylvian (TS) approaches.
• Each approach has distinct advantages and limitations regarding surgical access and potential complications.

Purpose of the Study:

• To compare the efficacy and safety of the TC and TS approaches for insular glioma resection.
• To evaluate differences in extent of resection (EOR), postoperative deficits, and complications.

Main Methods:

• A systematic review of studies published until November 20, 2022, was conducted.
• Databases searched included PubMed, Scopus, and Web of Science.
• Data on EOR, postoperative deficits, and complications were extracted and analyzed using random-effects models.

Main Results:

• The TC approach demonstrated a higher pooled proportion for gross total resection (0.44) compared to the TS approach.
• The TS approach showed a higher pooled proportion for subtotal resection (0.47).
• Postoperative speech deficits (0.04) and motor deficits (0.10) were more frequent with the TS approach.

Conclusions:

• The transcortical approach is associated with a higher rate of gross total resection for insular gliomas.
• The TC approach appears to result in fewer postoperative speech and motor deficits compared to the TS approach.
• These findings support the TC approach for achieving optimal resection outcomes in insular gliomas.