Comparative Prognostic Assessment of Integrated Insular Phenotype in Insular Glioma Surgery

Overview

This study compared the prognostic performance of the Integrated Insular Phenotype (IIP) classification against the Berger–Sanai and Yasargil systems in 167 patients undergoing insular glioma surgery. IIP demonstrated superior predictive value for extent of resection, seizure control, and persistent neurological deficits at 90 days postoperatively.

Background

Insular glioma surgery is challenging due to the tumor's proximity to critical vascular and white matter structures, with goals of maximal safe resection and seizure control. Traditional classifications like Berger–Sanai and Yasargil provide limited prognostic information as they do not fully capture tumor complexity or functional barriers. The newly proposed IIP classification integrates topographic features into an ordinal scale reflecting surgical complexity, potentially improving outcome prediction.

Data Highlights

Key Findings

• IIP classification stratifies tumors by increasing surgical complexity: IIP-L (localized), IIP-H (multizonal or adjacent extension), and IIP-M (multizonal with critical area involvement).
• IIP showed stronger prognostic associations with extent of resection compared to Berger–Sanai and Yasargil classifications.
• Seizure control outcomes correlated better with IIP levels, reflecting tumor spread and complexity.
• Persistent neurological deficits at 90 days post-surgery were more accurately predicted by IIP than by traditional systems.
• Functional and navigational intraoperative techniques were selectively used but not included in prognostic comparisons, emphasizing the topographic focus of IIP.

Clinical Implications

The IIP classification provides a more nuanced and reproducible framework for preoperative assessment of insular gliomas, aiding surgical planning and risk stratification. Its ordinal scale better informs expectations regarding resection extent, seizure control, and neurological outcomes, potentially guiding patient counseling and tailored surgical strategies.

Conclusion

The Integrated Insular Phenotype classification outperforms traditional Berger–Sanai and Yasargil systems in prognosticating key surgical outcomes in insular glioma resection. Incorporation of IIP into clinical practice may enhance decision-making and improve patient management.

References

1. Article Source 2025 -- Comparative Prognostic Assessment of Integrated Insular Phenotype (IIP) Against Berger–Sanai and Yasargil Classifications in Insular Glioma Surgery