Sharpening the Surgeon's Knife: Value of Extent of Resection for Glioma in Molecular Age

Surgical strategy for insular glioma

PURPOSE

The goal of this article is to review the outcomes of insular glioma surgery and discuss strategies to minimize postoperative morbidity.

METHODS

The authors reviewed the published literature on low- and high-grade insular gliomas with a focus on glioma biology, insular anatomy, and surgical technique.

RESULTS

Maximal safe resection of insular gliomas is associated with improved survival and is the primary goal of surgery. Protecting patient speech and motor function during insular glioma resection requires versatile integration of insular anatomy, cortical mapping, and microsurgical technique. Both the transsylvian and transcortical corridors to the insula are associated with low morbidity profiles, but the transcortical approach with intraoperative mapping is more favorable for gliomas within the posterior insular region.

CONCLUSIONS

Surgical strategy for insular gliomas is dependent on biological, anatomical, and clinical factors. Technical mastery integrated with intraoperative technologies can optimize surgical results.