Feasibility of intraoperative neurophysiological monitoring during insular glioma surgery: A single-center experience in a developing country

• Insular glioma surgery with multimodal IONM is feasible in resource-limited settings. • Multimodal IONM allows safe resection with preserved neurological function, even in eloquent brain regions. • Functional neurosurgery can be successfully implemented in resource-limited environments through structured workflows and outsourced monitoring services. Insular gliomas are among the most complex brain tumors to manage surgically due to their deep anatomical location and proximity to eloquent cortical and subcortical areas. This study aimed to evaluate the feasibility and early outcomes of insular glioma resections using intraoperative neurophysiological monitoring (IONM) in a Mexican public neurosurgical center. A retrospective review was performed of eight adult patients with insular gliomas who underwent surgery with the use of multimodal IONM between 2019 and 2022. Monitoring techniques included iECoG, SSEPs, MEPs, EEG, EMG, and cortical and subcortical stimulation. Data collected included tumor characteristics, extent of resection, neurological outcomes, and IONM modalities used. Gross total resection was achieved in three cases (37.5%) and subtotal resection in five cases (62.5%). No intraoperative complications or perioperative mortality were observed. One patient developed a transient expressive aphasia, while the remaining patients preserved their preoperative neurological status. Multimodal IONM in insular glioma surgery is feasible and safe in a Mexican public hospital setting. This represents one of the first reports from Mexico to document the successful use of IONM in this context, emphasizing its potential to improve surgical outcomes in resource-constrained environments.