Objective:

To compare the prognostic performance of the Integrated Insular Phenotype (IIP) with traditional Berger–Sanai and Yasargil classifications regarding surgical outcomes, specifically extent of resection, seizure control, and neurological deficits in insular gliomas.

Key Findings:

• IIP provides more reproducible prognostic associations with surgical outcomes compared to Berger–Sanai and Yasargil classifications, with a statistically significant improvement in predictive accuracy.
• Surgical outcomes are influenced by the complexity of anatomical and functional barriers, not just the extent of resection, highlighting the need for tailored surgical strategies.
• Seizure control and risk of neurological deficits vary significantly based on tumor spread and surgical strategies, emphasizing the importance of individualized treatment plans.

Interpretation:

The Integrated Insular Phenotype (IIP) offers a more nuanced understanding of insular gliomas, potentially improving surgical planning and outcomes by allowing for a more tailored approach to treatment.

Limitations:

• The study did not address biological, surgical-technical, or epileptological parameters, which may limit the generalizability of the findings.
• Retrospective design may introduce biases in data interpretation, necessitating caution in drawing definitive conclusions.

Conclusion:

The IIP classification may enhance prognostic accuracy in insular glioma surgery, supporting better surgical decision-making and potentially leading to improved patient outcomes.