Journal of Neurosurgery. 2026;145(2):347–361
Objective
To evaluate the safety and oncological value of maximum resection in a large contemporary series of insular gliomas.
Methods
Single-center retrospective study of 502 resections performed in 394 patients between 1997 and 2022. The series included newly diagnosed and recurrent low- and high-grade gliomas treated using a transcortical approach with cortical and subcortical mapping.
Main results
Among newly diagnosed grade 2 gliomas, persistent motor or language deficits occurred in fewer than 4% of patients. Transient motor and language deficits occurred in 9.5% and 20%, respectively. A residual tumor volume below 2.7 cm³ was associated with longer overall survival in grade 2 glioma. In newly diagnosed IDH-wildtype glioblastoma, resection of more than 88.6% of the contrast-enhancing tumor was associated with improved progression-free and overall survival. Permanent limb weakness was independently associated with worse survival (HR 2.06; 95% CI 1.14–3.74).
Interpretation
Extensive insular glioma resection can be achieved with relatively low permanent morbidity when modern mapping techniques are used. Functional preservation remains essential because permanent deficits may eliminate the survival benefit of aggressive resection.
Limitations
Retrospective, single-center experience spanning 25 years, during which imaging, molecular classification and adjuvant treatments changed considerably.
Clinical takeaway
The goal should be maximum safe—not simply maximum—resection, guided by functional boundaries and postoperative residual volume.
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