Transsylvian Insular Glioma Surgery: New Classification System, Clinical Outcome in a Consecutive Series of 79 Cases. Issue 6 (2nd March 2021)

• Record Type: Journal Article
• Authors: Pitskhelauri, David; Bykanov, Andrey; Konovalov, Alexander; Danilov, Gleb; Buklina, Svetlana; Sanikidze, Alexander; Sufianov, Rinat
• Is Part Of: Operative neurosurgery. Volume 20:Issue 6(2021)
• Page Start: 541
• Page End: 548
• Publication Date: 2021-03-02
• Subjects: Insular glioma surgery -- Outcome -- Transsylvian approach -- Oncology -- Classification; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opab051
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND: Surgery of insular glial tumors remains a challenge because of high incidence of postoperative neurological deterioration and the complex anatomy of the insular region. OBJECTIVE: To explore the prognostic role of our and Berger-Sanai classifications on the extent of resection (EOR) and clinical outcome. METHODS: From 2012 to 2017, a transsylvian removal of insular glial tumors was performed in 79 patients. The EOR was assessed depending on magnetic resonance imaging scans performed in the first 48 h after surgery. RESULTS: The EOR ≥90% was achieved in 30 (38%) cases and <90% in 49 (62.0%) cases. In the early postoperative period, the new neurological deficit was observed in 31 (39.2%) patients, and in 5 patients (6.3%), it persisted up to 3 mo. We proposed a classification of insular gliomas based on its volumetric and anatomical characteristics. A statistically significant differences were found between proposed classes in tumor volume before and after surgery ( P < .001), EOR ( P = .02), rate of epileptic seizures before the surgical treatment ( P = .04), and the incidence of persistent postoperative complications ( P = .03). In the logistic regression model, tumor location in zone II (Berger-Sanai classification) was the predictor significantly related to less likely EOR of ≥90% and the maximum rate of residual tumor detection ( P = .02). CONCLUSION: The proposed classification of the insular gliomas was an independent predictor of the EOR and persistent postoperative neurological deficit. According to Berger-Sanai classification, zone II was a predictor of less EOR through the transsylvian approach. Graphical Abstract: