Skip to main content
SpringerLink
Log in

Transcortical approach for insular gliomas: a series of 253 patients

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

The object of this study was to identify the distribution characteristics of insular gliomas and evaluate the efficiency of transcortical approach.

Methods

Insular gliomas patients who underwent transcortical approach for the first time between March 2011 and July 2019 at our institute were analyzed.

Results

A total of 253 primary insular gliomas patients were enrolled in the study. Of all patients, 176 patients (69.6%) underwent gross total resection, 61 patients (24.1%) underwent subtotal resection and 16 patients (6.3%) underwent partial resection. According to Berger-Sanai classification, the gross total resection rates of different types of insular gliomas were as follows: Zone I (90.1%), zone II (50.0%), zone III (40.0%), zone IV (89.5%), zone I + II (43.5%), zone I + IV (74.6%), zone II + III (44.4%), zone III + IV (41.7%), Giant (34.5%). According to our modified classification, the gross total resection rates were as follows: anterior type (84.9%), posterior type (45.8%), anterior–posterior type (42.9%), giant type (34.5%). After surgery, new limb motor deficit was observed in 28 patients (11.1%), and 5 patients (2.0%) were left long-term limb motor disability. New language impairment occurred in 23 patients (9.1%), and 3 patients (1.2%) were left long-term language disability. The patients were followed up for 1 to 89.2 months (average, 39.9 ± 20.3 months). At the end of follow-up, tumor progression occurred in 98 (38.7%) patients and 71 (28.1%) patients died of their disease.

Conclusion

This study demonstrated that the maximal safe resection of insular gliomas can be achieved by transcortical approach. Insular gliomas had the characteristic of forward distribution, anterior transcortical approach can provide enough surgical freedom for anterior type of insular gliomas. If anterior tumors can make route to the posterior parts, anterior transcortical approach was also applied to some anterior–posterior and giant types of insular gliomas without resection of excessive brain, which may reduce the incidence of neurological complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30. https://doi.org/10.3322/caac.21442

    Article  Google Scholar 

  2. Ostrom QT, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS (2016) CBTRUS Statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009–2013. Neuro-Oncology 18(suppl_5):v1–v75. https://doi.org/10.1093/neuonc/now207

    Article  PubMed  Google Scholar 

  3. Ostrom QT, Bauchet L, Davis FG, Deltour I, Fisher JL, Langer CE, Pekmezci M, Schwartzbaum JA, Turner MC, Walsh KM, Wrensch MR, Barnholtz-Sloan JS (2014) The epidemiology of glioma in adults: a "state of the science" review. Neuro-Oncology 16(7):896–913. https://doi.org/10.1093/neuonc/nou087

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Wen PY, Kesari S (2008) Malignant gliomas in adults. N Engl J Med 359(5):492–507. https://doi.org/10.1056/NEJMra0708126

    Article  PubMed  CAS  Google Scholar 

  5. McGirt MJ, Chaichana KL, Attenello FJ, Weingart JD, Than K, Burger PC, Olivi A, Brem H, Quinones-Hinojosa A (2008) Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 63(4):700–707. https://doi.org/10.1227/01.neu.0000325729.41085.73. (author reply 707–708)

    Article  PubMed  Google Scholar 

  6. Nabors LB, Portnow J, Ammirati M, Baehring J, Brem H, Butowski N, Fenstermaker RA, Forsyth P, Hattangadi-Gluth J, Holdhoff M, Howard S, Junck L, Kaley T, Kumthekar P, Loeffler JS, Moots PL, Mrugala MM, Nagpal S, Pandey M, Parney I, Peters K, Puduvalli VK, Ragsdale J 3rd, Rockhill J, Rogers L, Rusthoven C, Shonka N, Shrieve DC, Sills AK Jr, Swinnen LJ, Tsien C, Weiss S, Wen PY, Willmarth N, Bergman MA, Engh A (2017) NCCN guidelines insights: central nervous system cancers, Version 1.2017. J Natl Compr Cancer Netw 15(11):1331–1345. https://doi.org/10.6004/jnccn.2017.0166

    Article  Google Scholar 

  7. Sanai N, Polley MY, Berger MS (2010) Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. J Neurosurgery 112(1):1–9. https://doi.org/10.3171/2009.6.jns0952

    Article  Google Scholar 

  8. Duffau H, Capelle L (2004) Preferential brain locations of low-grade gliomas. Cancer 100(12):2622–2626. https://doi.org/10.1002/cncr.20297

    Article  PubMed  Google Scholar 

  9. Rey-Dios R, Cohen-Gadol AA (2013) Technical nuances for surgery of insular gliomas: lessons learned. Neurosurg Focus 34(2):E6. https://doi.org/10.3171/2012.12.focus12342

    Article  PubMed  Google Scholar 

  10. Tanriover N, Rhoton AL Jr, Kawashima M, Ulm AJ, Yasuda A (2004) Microsurgical anatomy of the insula and the sylvian fissure. J Neurosurg 100(5):891–922. https://doi.org/10.3171/jns.2004.100.5.0891

    Article  PubMed  Google Scholar 

  11. Benet A, Hervey-Jumper SL, Sanchez JJ, Lawton MT, Berger MS (2016) Surgical assessment of the insula. Part 1: surgical anatomy and morphometric analysis of the transsylvian and transcortical approaches to the insula. Journal of neurosurgery 124(2):469–481. https://doi.org/10.3171/2014.12.jns142182

    Article  PubMed  Google Scholar 

  12. Hervey-Jumper SL, Li J, Osorio JA, Lau D, Molinaro AM, Benet A, Berger MS (2016) Surgical assessment of the insula. Part 2: validation of the Berger-Sanai zone classification system for predicting extent of glioma resection. J Neurosurgery 124(2):482–488. https://doi.org/10.3171/2015.4.jns1521

    Article  Google Scholar 

  13. Ture U, Yasargil MG, Al-Mefty O, Yasargil DC (2000) Arteries of the insula. J Neurosurg 92(4):676–687. https://doi.org/10.3171/jns.2000.92.4.0676

    Article  PubMed  CAS  Google Scholar 

  14. Michaud K, Duffau H (2016) Surgery of insular and paralimbic diffuse low-grade gliomas: technical considerations. J Neuro-Oncol 130(2):289–298. https://doi.org/10.1007/s11060-016-2120-2

    Article  Google Scholar 

  15. Safaee MM, Englot DJ, Han SJ, Lawton MT, Berger MS (2016) The transsylvian approach for resection of insular gliomas: technical nuances of splitting the Sylvian fissure. J Neuro-Oncol 130(2):283–287. https://doi.org/10.1007/s11060-016-2154-5

    Article  Google Scholar 

  16. Sparacino G, Tombolato C, Cobelli C (2000) Maximum-likelihood versus maximum a posteriori parameter estimation of physiological system models: the C-peptide impulse response case study. IEEE Trans Bio-Med Eng 47(6):801–811. https://doi.org/10.1109/10.844232

    Article  CAS  Google Scholar 

  17. Duffau H, Capelle L, Lopes M, Faillot T, Sichez JP, Fohanno D (2000) The insular lobe: physiopathological and surgical considerations. Neurosurgery 47(4):801–810 discussion 810-801

    Article  CAS  Google Scholar 

  18. Duffau H (2009) A personal consecutive series of surgically treated 51 cases of insular WHO Grade II glioma: advances and limitations. J Neurosurg 110(4):696–708. https://doi.org/10.3171/2008.8.jns08741

    Article  PubMed  Google Scholar 

  19. Ture U, Yasargil DC, Al-Mefty O, Yasargil MG (1999) Topographic anatomy of the insular region. J Neurosurg 90(4):720–733. https://doi.org/10.3171/jns.1999.90.4.0720

    Article  PubMed  CAS  Google Scholar 

  20. Goucha T, Friederici AD (2015) The language skeleton after dissecting meaning: a functional segregation within Broca's Area. NeuroImage 114:294–302. https://doi.org/10.1016/j.neuroimage.2015.04.011

    Article  PubMed  Google Scholar 

  21. Duffau H, Moritz-Gasser S, Gatignol P (2009) Functional outcome after language mapping for insular World Health Organization Grade II gliomas in the dominant hemisphere: experience with 24 patients. Neurosurg Focus 27(2):E7. https://doi.org/10.3171/2009.5.focus0938

    Article  PubMed  Google Scholar 

  22. Benzagmout M, Gatignol P, Duffau H (2007) Resection of World Health Organization Grade II gliomas involving Broca’s area: methodological and functional considerations. Neurosurgery 61(4):741–752. https://doi.org/10.1227/01.neu.0000298902.69473.77(discussion 752–743)

    Article  PubMed  Google Scholar 

  23. Wiebe S, Blume WT, Girvin JP, Eliasziw M (2001) A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345(5):311–318. https://doi.org/10.1056/nejm200108023450501

    Article  PubMed  CAS  Google Scholar 

  24. Eseonu CI, ReFaey K, Garcia O, Raghuraman G, Quinones-Hinojosa A (2017) Volumetric analysis of extent of resection, survival, and surgical outcomes for insular gliomas. World Neurosurgery 103:265–274. https://doi.org/10.1016/j.wneu.2017.04.002

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Natural Science Foundation of China (81771792) and Beijing Municipal Science & Technology Commission (Z171100000117002).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China

    Zhenye Li, Gen Li, Zhenxing Liu, Zonggang Hou, Liang Wu, Zhenxing Huang & Jian Xie

  2. Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China

    Yazhuo Zhang

  3. China National Clinical Research Center for Neurological Diseases, Beijing, China

    Zhenye Li, Gen Li, Zhenxing Liu, Yuesong Pan, Zonggang Hou, Liang Wu, Zhenxing Huang, Yazhuo Zhang & Jian Xie

Authors
  1. Zhenye Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhenxing Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuesong Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zonggang Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhenxing Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yazhuo Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jian Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jian Xie.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of Beijing Tiantan Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, Z., Li, G., Liu, Z. et al. Transcortical approach for insular gliomas: a series of 253 patients. J Neurooncol 147, 59–66 (2020). https://doi.org/10.1007/s11060-020-03390-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-020-03390-2

Keywords

Search

Navigation