Clinical Scorecard: Comparative Prognostic Assessment of Integrated Insular Phenotype (IIP) Against Berger–Sanai and Yasargil Classifications in Insular Glioma Surgery

At a Glance

Key Highlights

• IIP classification integrates tumor topography and surgical complexity better than Berger–Sanai and Yasargil systems
• IIP stratifies tumors into Local (IIP-L), Hybrid (IIP-H), and Multizonal (IIP-M) phenotypes correlating with surgical outcomes
• Surgical outcomes assessed include extent of resection, seizure control, and persistent neurological deficits at 90 days

Guideline-Based Recommendations

Diagnosis

• Use preoperative neuroimaging including MRI and consider DTI-tractography and functional MRI to assess tumor relation to critical pathways
• Apply Integrated Insular Phenotype (IIP) classification alongside Berger–Sanai and Yasargil systems for comprehensive topographic assessment

Management

• Plan microsurgical resection aiming for maximal safe tumor removal guided by IIP classification to balance oncological and functional outcomes
• Employ intraoperative techniques such as motor monitoring, direct cortical/subcortical stimulation, awake mapping, and neuronavigation selectively based on risk profile

Monitoring & Follow-up

• Conduct clinical and radiological follow-up for at least 12 months postoperatively to assess seizure control and neurological status
• Monitor for persistent neurological deficits at 90 days as a key outcome measure

Risks

• Recognize higher surgical complexity and risk of neurological deficits with IIP-M (Multizonal) tumors involving multiple insular zones and critical adjacent areas
• Consider increased risk of postoperative seizures and complications related to tumor spread and surgical approach

Patient & Prescribing Data

167 patients with insular gliomas undergoing microsurgical resection

IIP classification provides reproducible prognostic associations that can guide surgical planning and predict extent of resection, seizure control, and neurological outcomes

Clinical Best Practices

• Integrate IIP classification into preoperative planning to better stratify surgical complexity and expected outcomes
• Use multimodal neuroimaging and selective intraoperative monitoring to maximize safe resection
• Focus on balancing maximal tumor removal with preservation of neurological function and seizure control
• Maintain prospective data collection and follow-up to refine prognostic models and surgical strategies

References

• Berger MS, Sanai N. Insular glioma surgery: anatomical and surgical considerations.
• Yasargil MG. Microsurgical anatomy and technique of insular glioma resection.
• Recent meta-analyses and multicenter studies on insular glioma surgical outcomes.