10046- STMO-4 AWAKE SURGERY WITH INTRAOPERATIVE MRI FOR INSULAR GLIOMA

Abstract BACKGROUND Surgical resection of insular glioma remains challenging due to the complex functional involvement and the intricate vascularization of the insular lobe. We perform awake surgery with intraoperative MRI for insular glioma. We report the outcome of the surgical treatment for insular gliomas at our hospital. METHODS We retrospectively reviewed the records of 27 consecutive patients with insular gliomas who underwent surgical treatment between 2014 and 2024. The extent of resection (EOR), ischemic complication and Karnofsky Performance Status (KPS) at postoperative discharge were analyzed in the awake surgery (AS) group compared to the non-awake surgery (NAS) group. RESULTS In 12 cases, basal ganglion was involved (basal ganglionic involvement). Berger-Sanai zone III&IV was the most common site within the insula (10 cases), followed by I, II, III&IV (6 cases). Surgical resection was performed in 24 cases (biopsy in 3 cases). Elective awake surgery: 18 cases (of which 5 were abandoned due to poor arousal); intraoperative MRI: 24 cases. Additional resection after intraoperative MRI review was performed in 10 cases. The followings were studied in 24 cases where surgical resection was performed. In characteristics, basal ganglionic involvement was significantly different (3 patients in AS group and 7 patients in NAS group, p=0.04). The mean EOR was 81.4% in AS group vs. 53.4% in NAS group (p=0.008). Ischemic complication rate on postoperative MRI was 15.4% (2 cases) in AS group and 9.1% (1 case) in NAS group; all of them had no permanent neurological symptoms. The deterioration of KPS at discharge was not found in both groups. DISCUSSION The EOR of insular glioma in awake surgery with intraoperative MRI in this study was comparable to previous reports. It was indicated that awake surgery with intraoperative MRI contributes greatly to maximum safe resection for insular glioma.