{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T01:12:48Z","timestamp":1775610768006,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Gliomas within the insular region represent one of the most challenging problems in neurosurgical oncology. There are two main surgical approaches to address the complex vascular network and functional areas around the insula: the transsylvian approach and the transcortical approach. In the literature, there is not a clear consensus on the best approach in terms of safety and efficacy. The purpose of this study is to evaluate the effectiveness of these approaches and to analyze prognostic factors on the natural history of insular gliomas. Patients with newly diagnosed high-grade insular gliomas who underwent surgery between January 2019 and June 2024 were analyzed. The series was analyzed according to the classification of Berger\u2013Sanai and Ya\u015fargil. The Karnofsky performance score (KPS), extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were considered the outcome measures. A total of 58 primary high-grade insular glioma patients were enrolled in this study. The IDH mutation was found in 13\/58 (22.4%); specifically, 3\/13 (23.1%) were grade 4, and 10\/13 (76.9%) were grade 3. Furthermore, 40\/58 patients (69%) underwent gross total resection (GTR), 15 patients (26%) subtotal resection, and 3 patients (5%) partial resection. Middle cerebral artery encasement negatively affected the OS. GTR, radiotherapy, KPS, and autonomous deambulation at a month after surgery positively affected the OS. The surgical approach used was transsylvian and transcortical in 11 and 47 cases, respectively. The comparison between the two different approaches did not display differences in terms of neurological deficits and OS (p &gt; 0.05). The transcortical approach was related to the greater achievement of GTR (p = 0.031). According to the Berger\u2013Sanai classification, the transcortical approach has higher EOR and postoperative KPS when the lesion is in zone III-IV (p = 0.029). Greater resection of insular gliomas can be achieved with an acceptable morbidity profile and is predictive of improved OS. Both the transsylvian and transcortical corridors to the insula are associated with low morbidity profiles. The transcortical approach with intraoperative mapping is more favorable for achieving greater EOR, particularly in gliomas within the inferior border of the Sylvian fissure.<\/jats:p>","DOI":"10.3390\/curroncol32020098","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T12:12:16Z","timestamp":1739362336000},"page":"98","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Safety and Efficacy in the Transcortical and Transsylvian Approach in Insular High-Grade Gliomas: A Comparative Series of 58 Patients"],"prefix":"10.3390","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7114-7787","authenticated-orcid":false,"given":"Alberto","family":"Morello","sequence":"first","affiliation":[{"name":"Neurosurgery Unit, Department of Neuroscience \u201cRita Levi Montalcini\u201d, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neuroscience \u201cRita Levi Montalcini\u201d, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6019-4735","authenticated-orcid":false,"given":"Andrea","family":"Gatto","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neuroscience \u201cRita Levi Montalcini\u201d, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2800-5384","authenticated-orcid":false,"given":"Flavio","family":"Panico","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neuroscience \u201cRita Levi Montalcini\u201d, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1014-0731","authenticated-orcid":false,"given":"Andrea","family":"Bianconi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neuroscience, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4432-773X","authenticated-orcid":false,"given":"Giulia","family":"Chiari","sequence":"additional","affiliation":[{"name":"BCAM Bilbao Center for Applied Mathematics\u2014Mazarredo Zumarkalea, 48009 Bilbao, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Armocida","sequence":"additional","affiliation":[{"name":"A.U.O. \u201cPoliclinico Umberto I\u201d, Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Greco Crasto","sequence":"additional","affiliation":[{"name":"Magnetic Resonance Imaging Service, R.I.B.A. and Larc Centers, 10128 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Melcarne","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neuroscience \u201cRita Levi Montalcini\u201d, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Zenga","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neuroscience \u201cRita Levi Montalcini\u201d, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, Italy"},{"name":"Skull Base and Pituitary Surgery Unit, \u201cCitt\u00e0 della Salute e della Scienza\u201d University Hospital, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Rud\u00e0","sequence":"additional","affiliation":[{"name":"Division of Neuro-Oncology, Department of Neuroscience \u201cRita Levi Montalcini\u201d, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Morana","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Department of Diagnostic Imaging and Radiotherapy, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2692-7133","authenticated-orcid":false,"given":"Diego","family":"Garbossa","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neuroscience \u201cRita Levi Montalcini\u201d, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Cofano","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neuroscience \u201cRita Levi Montalcini\u201d, \u201cCitt\u00e0 Della Salute e Della Scienza\u201d University Hospital, University of Turin, 10126 Turin, 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