2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T43c,Overall, 316 (165 LGG, 151 HGG) newly diagnosed and 186 (69 LGG, 117 HGG) recurrent cases were included. Grade 2 gliomas were typically larger than grade 4 IDH-wildtype gliomas (43 cm3 vs 17.5 cm3, p < 0.001). Persistent postoperative motor and language deficits occurred in < 4% of cases with newly diagnosed grade 2 tumors, although transient deficits occurred more frequently (9.5% of cases with transient motor deficit and 20% of cases with transient language deficit). For patients with newly diagnosed grade 2 insular gliomas, OS was improved when the residual tumor volume was < 2.7 cm3. Minimizing residual tumor volume was also associated with prolonged PFS and OS for recurrent grade 2 insular gliomas. Similarly, contrast-enhancing tumor EOR > 88.6% was associated with improved PFS and OS for patients with newly diagnosed IDH-wildtype glioblastoma. Overall, surgical and medical complications occurred in < 3% of cases. Finally, new permanent arm or leg weakness was significantly associated with worse OS in multivariable analyses (HR 2.06, 95% CI 1.14-3.74; p = 0.017).31:Ta4a,Insular gliomas present a unique surgical challenge due to their location near critical vascular structures and proximity to functional brain regions. While different surgical approaches to insular tumors exist, language and motor stimulation mapping are critical for a transcortical approach. The aim of this study was to determine if the transcortical approach to resection of insular gliomas remains a safe and effective strategy by assessing tumor characteristics, surgical outcomes, and postoperative functional outcomes in patients with newly diagnosed or recurrent tumors. This retrospective analysis included 502 newly diagnosed and recurrent low-grade gliomas (LGGs) and high-grade gliomas (HGGs) of the insula (in 394 unique patients) resected between September 1997 and December 2022 at a single center. Tumors were classified based on the Berger-Sanai zone schema, and contrast-enhancing and non-contrast-enhancing tumor volumes were manually segmented on MRI and used to calculate the extent of resection (EOR). Patient morbidity was assessed at multiple time points from the initial presentation to at least 6 months of follow-up. Progression-free survival (PFS) and overall survival (OS) were compared between subgroups using unadjusted and propensity score-adjusted Kaplan-Meir and Cox regression analyses. Overall, 316 (165 LGG, 151 HGG) newly diagnosed and 186 (69 LGG, 117 HGG) recurrent cases were included. Grade 2 gliomas were typically larger than grade 4 IDH-wildtype gliomas (43 cm3 vs 17.5 cm3, p < 0.001). Persistent postoperative motor and language deficits occurred in < 4% of cases with newly diagnosed grade 2 tumors, although transient deficits occurred more frequently (9.5% of cases with transient motor deficit and 20% of cases with transient language deficit). For patients with newly diagnosed grade 2 insular gliomas, OS was improved when the residual tumor volume was < 2.7 cm3. Minimizing residual tumor volume was also associated with prolonged PFS and OS for recurrent grade 2 insular gliomas. Similarly, contrast-enhancing tumor EOR > 88.6% was associated with improved PFS and OS for patients with newly diagnosed IDH-wildtype glioblastoma. Overall, surgical and medical complications occurred in < 3% of cases. Finally, new permanent arm or leg weakness was significantly associated with worse OS in multivariable analyses (HR 2.06, 95% CI 1.14-3.74; p = 0.017). Maximum safe resection using a transcortical approach and cortical and subcortical mapping continues to be a robust surgical strategy with low surgical morbidity for patients with newly diagnosed and recurrent insular gliomas.32:Td9b, OBJECTIVE Insular gliomas present a unique surgical challenge due to their location near critical vascular structures and proximity to functional brain regions. While different surgical approaches to insular tumors exist, language and motor stimulation mapping are critical for a transcortical approach. The aim of this study was to determine if the transcortical approach to resection of insular gliomas remains a safe and effective strategy by assessing tumor characteristics, surgical outcomes, and postoperative functional outcomes in patients with newly diagnosed or recurrent tumors. METHODS This retrospective analysis included 502 newly diagnosed and recurrent low-grade gliomas (LGGs) and high-grade gliomas (HGGs) of the insula (in 394 unique patients) resected between September 1997 and December 2022 at a single center. Tumors were classified based on the Berger-Sanai zone schema, and contrast-enhancing and non–contrast-enhancing tumor volumes were manually segmented on MRI and used to calculate the extent of resection (EOR). Patient morbidity was assessed at multiple time points from the initial presentation to at least 6 months of follow-up. Progression-free survival (PFS) and overall survival (OS) were compared between subgroups using unadjusted and propensity score–adjusted Kaplan-Meir and Cox regression analyses. RESULTS Overall, 316 (165 LGG, 151 HGG) newly diagnosed and 186 (69 LGG, 117 HGG) recurrent cases were included. Grade 2 gliomas were typically larger than grade 4 IDH-wildtype gliomas (43 cm 3 vs 17.5 cm 3 , p < 0.001). Persistent postoperative motor and language deficits occurred in < 4% of cases with newly diagnosed grade 2 tumors, although transient deficits occurred more frequently (9.5% of cases with transient motor deficit and 20% of cases with transient language deficit). For patients with newly diagnosed grade 2 insular gliomas, OS was improved when the residual tumor volume was < 2.7 cm 3 . Minimizing residual tumor volume was also associated with prolonged PFS and OS for recurrent grade 2 insular gliomas. Similarly, contrast-enhancing tumor EOR > 88.6% was associated with improved PFS and OS for patients with newly diagnosed IDH-wildtype glioblastoma. Overall, surgical and medical complications occurred in < 3% of cases. Finally, new permanent arm or leg weakness was significantly associated with worse OS in multivariable analyses (HR 2.06, 95% CI 1.14–3.74; p = 0.017). CONCLUSIONS Maximum safe resection using a transcortical approach and cortical and subcortical mapping continues to be a robust surgical strategy with low surgical morbidity for patients with newly diagnosed and recurrent insular gliomas. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"High-Grade Glioma: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on High-Grade Glioma (condition). Clinician-written summaries and actionable practice insights. 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clinicians should interpret pediatric findings with caution.","value_numeric":null},{"paper_doi":"10.1200/jco-25-02604","tag_type":"warning","value":"Study design is observational (registry); absence of a control arm means survival associations with EOA and lesion size should be interpreted as hypothesis-generating rather than definitive.","value_numeric":null},{"paper_doi":"10.1200/jco-25-02604","tag_type":"warning","value":"The registry includes a heterogeneous mix of primary and metastatic tumor subtypes; subgroup-level survival data with absolute numbers are not reported in the abstract, limiting precision of outcome estimates.","value_numeric":null}],"summaries":{"what_studied":"The LAANTERN prospective multicenter registry evaluated clinical outcomes of Laser Interstitial Thermal Therapy (LITT) using the Monteris NeuroBlate System in 787 patients (445 primary, 342 metastatic brain tumors) across 25 US centers from 2015–2023.","key_result":"Adverse event rate was 12.8% (65.5% transient); mortality was 0.25%; median hospital stay was 32.4 hours; 62.6% avoided ICU admission; 80% stopped steroids and 30–40% stopped anticonvulsants post-LITT; QoL remained stable up to 3 years; greater extent of ablation (EOA) improved survival in high-grade glioma, and smaller lesion size improved outcomes in recurrent metastases.","limitations":"Registry-based observational design without a randomized control arm limits causal inference; patient selection bias across 25 centers may affect generalizability; pediatric subgroup was very small (n=18), limiting conclusions in that population.","practice_takeaway":"LITT appears safe and feasible for both primary and metastatic brain tumors, with short stays and low complication rates — consider maximizing extent of ablation in glioblastoma and selecting smaller metastatic lesions to optimize survival benefit."}},{"doi":"10.3171/2025.12.jns251889","pmid":"42102401","title":"Maximum safe resection of insular gliomas: update on surgical outcomes from 500 cases","journal_title":"Journal of Neurosurgery","journal_issn":"0022-3085","published_at":"2026-05-08T00:00:00.000Z","url":"https://doi.org/10.3171/2025.12.jns251889","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-11","doi":"10.3171/2025.12.jns251889","days":"7","issn":"1933-0693","rank":"9","field":"Clinical Medicine","score":"7","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.3171/2025.12.JNS251889","title":"Maximum safe resection of insular gliomas: update on surgical outcomes from 500 cases.","journal":"Journal of neurosurgery","methods":"","results":"$30","abstract":"$31","keywords":["brain mapping","diffuse glioma","extent of resection","insular glioma","oncology","transcortical approach","tumor"],"pubmed_id":"42102401","conclusions":"","publication_date":"2026-05-08T00:00:00"},"crossref":{"DOI":"10.3171/2025.12.jns251889","URL":"https://doi.org/10.3171/2025.12.jns251889","ISSN":["0022-3085","1933-0693"],"link":[{"URL":"https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2025.12.JNS251889/article-10.3171-2025.12.JNS251889.xml","content-type":"text/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https://thejns.org/downloadpdf/journals/j-neurosurg/aop/article-10.3171-2025.12.JNS251889/article-10.3171-2025.12.JNS251889.xml","content-type":"text/html","content-version":"vor","intended-application":"syndication"},{"URL":"https://thejns.org/downloadpdf/journals/j-neurosurg/aop/article-10.3171-2025.12.JNS251889/article-10.3171-2025.12.JNS251889.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"1-17","type":"journal-article","issue":null,"score":1,"title":["Maximum safe resection of insular gliomas: update on surgical outcomes from 500 cases"],"author":[{"given":"Jacob S.","family":"Young","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco;"}]},{"given":"Nadeem N.","family":"Al-Adli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco;"}]},{"given":"Daniel","family":"Quintana","sequence":"additional","affiliation":[{"name":"School of Medicine, University of California, San Francisco, California;"}]},{"given":"Grazia","family":"Menna","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco;"},{"name":"Department of Neurosurgery, USZ Foundation Università Cattolica del Sacro Cuore, Rome, Italy; and"}]},{"given":"Jasper K. W.","family":"Gerritsen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco;"},{"name":"Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco;"}]},{"given":"Ramin A.","family":"Morshed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco;"}]},{"given":"Shawn L.","family":"Hervey-Jumper","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco;"}]},{"given":"Mitchel S.","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco;"}]}],"issued":{"date-parts":[[2026,5,1]]},"member":"1754","prefix":"10.3171","source":"Crossref","volume":null,"created":{"date-time":"2026-05-09T01:53:46Z","timestamp":1778291626000,"date-parts":[[2026,5,9]]},"indexed":{"date-time":"2026-05-13T10:07:43Z","timestamp":1778666863052,"date-parts":[[2026,5,13]]},"subject":[],"abstract":"$32","relation":{},"resource":{"primary":{"URL":"https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2025.12.JNS251889/article-10.3171-2025.12.JNS251889.xml"}},"subtitle":[],"deposited":{"date-time":"2026-05-13T09:08:21Z","timestamp":1778663301000,"date-parts":[[2026,5,13]]},"issn-type":[{"type":"print","value":"0022-3085"},{"type":"electronic","value":"1933-0693"}],"published":{"date-parts":[[2026,5,1]]},"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","reference":[{"DOI":null,"key":"b1","year":"2019","issue":"4","author":"Morshed RA","volume":"63","first-page":"450","unstructured":"Morshed RA, Young JS, Hervey-Jumper SL, Berger MS. 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Improved survival was associated with smaller residuals in grade 2 (residual < 2.7 cm3) and with contrast-enhancing tumor EOR > 88.6% in newly diagnosed IDH-wildtype glioblastoma; new permanent limb weakness predicted worse OS (HR 2.06, 95% CI 1.14–3.74; p = 0.017).","limitations":"Retrospective, single-center design. Heterogeneous cohort including newly diagnosed and recurrent tumors across low- and high-grade gliomas.","practice_takeaway":"Transcortical, mapping-guided resection of insular gliomas showed low permanent deficit and complication rates, and survival improved when residual tumor was minimized or EOR thresholds were met. Avoid new permanent motor deficits, which were linked to worse overall survival."}},{"doi":"10.3171/2025.9.jns25526","pmid":"41687103","title":"Ventricular entry and postoperative leptomeningeal metastasis after resection of supratentorial high-grade glioma","journal_title":"Journal of Neurosurgery","journal_issn":"0022-3085","published_at":"2026-02-14T00:00:00.000Z","url":"https://doi.org/10.3171/2025.9.jns25526","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-21T13:29:56.744Z","updated_at":"2026-06-21T13:29:56.744Z","tags":[{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"condition","value":"High-Grade Glioma","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"condition","value":"Leptomeningeal Metastasis","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"modality","value":"Neurosurgical Resection","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"sample_size","value":"n=884","value_numeric":884},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"warning","value":"LM is likely under-detected in this retrospective series; the true incidence and relative risk may differ with systematic surveillance protocols.","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the direct surgical guidance offered, but the retrospective single-center design limits generalizability pending prospective validation.","value_numeric":null},{"paper_doi":"10.3171/2025.9.jns25526","tag_type":"warning","value":"The study spans 1993–2021, a period covering major shifts in HGG treatment (e.g., introduction of temozolomide), which may confound survival and LM outcome comparisons. Subgroup consistency across eras is not reported.","value_numeric":null}],"summaries":{"what_studied":"Retrospective cohort study (1993–2021) at MD Anderson examining whether ventricular entry (VE) or ependymal contact (EC) during first resection of supratentorial high-grade glioma (HGG) affects leptomeningeal metastasis (LM) incidence and overall survival (OS) in 884 patients.","key_result":"VE did not significantly predict LM (HR 1.32, 95% CI 0.57–3.04, p=0.520) or OS (HR 1.03, p=0.744). In contrast, EC independently increased LM risk (HR 3.97, 95% CI 1.43–11.01, p=0.008) and worsened OS (HR 1.33, 95% CI 1.1–1.6, p=0.003). VE improved complete resection rates in EC tumors (58% vs 47% without VE).","limitations":"Retrospective single-institution design spanning nearly three decades introduces selection bias and treatment heterogeneity. LM diagnosis likely under-ascertained given its rarity and variable surveillance practices across the study period.","practice_takeaway":"Surgeons should not avoid ventricular entry to prevent leptomeningeal spread — VE does not increase LM risk and can improve extent of resection in ependymal-contact tumors. Patients whose tumors abut the ependyma warrant closer post-op surveillance given their independently higher LM risk and shorter OS."}}],"initialOffset":3,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"High-Grade Glioma"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"High-Grade Glioma"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"High-Grade Glioma"}}}]]

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