gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Insular gliomas: indications for surgical management

Operationsindikationen bei Inselgliomen

Meeting Abstract

  • corresponding author M. Simon - Neurochirurgische Klinik, Universitätskliniken Bonn
  • G. Neuloh - Neurochirurgische Klinik, Universitätskliniken Bonn
  • M. von Lehe - Neurochirurgische Klinik, Universitätskliniken Bonn
  • B. Meyer - Neurochirurgische Klinik, Technische Universität München, Klinikum rechts der Isar
  • J. Schramm - Neurochirurgische Klinik, Universitätskliniken Bonn

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.01.03

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Simon et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Treatment for insular (paralimbic) gliomas is controversial. There is little follow-up data available. Since 1995, we have routinely offered surgery to most patients with insular tumors. The present analysis summarizes our experience with microsurgical resections in these cases.

Methods: A retrospective chart review was performed. Complications, functional outcomes and survival were recorded in a series of 101 operations in 94 patients, performed from 1995 to 2005.

Results: A >90% resection was achieved in 42%, and a 70-90% tumor removal in 51% of cases. Functional outcomes varied considerably between patient subgroups. In neurologically intact patients <40 years with WHO grade I-III tumors, good outcomes (KPI 80-100) were seen in 91% of cases. Predictors of an adverse functional outcome included glioblastoma histology, advanced age, and a low preoperative KPI. 78% of patients presenting with epilepsy were seizure-free or experienced only isolated, non-debilitating seizures one year after surgery. Surprisingly good survival rates were seen after surgery for anaplastic gliomas. Median survival for anaplastic astrocytomas WHO grade III was 5 years, and the 5 year survival rate for anaplastic oligodendroglial tumors was 81%. Independent predictors of survival included younger age, favorable histology (WHO grade I and oligodendroglial tumors), Yasargil 5A/B tumors with frontal extensions, and more extensive resections.

Conclusions: Insular tumor surgery carries substantial complication rates. However, surprisingly similar figures have been reported in large unselected craniotomy series, and also after alternative treatment regimens. In view of the oncological benefits of resective surgery, our data would therefore argue for microsurgery as the primary treatment for (most) patients with a presumed WHO grade I-III tumor. Patients with glioblastomas and/or >60 years require a more cautious approach.