What question did this study set out to answer?

This research aims to compare the transcortical and transsylvian surgical approaches for resecting insular gliomas.

February 5, 2026

Transcortical versus Transsylvian Approach for Insular Gliomas: A Systematic Review and Meta-Analysis

Key Points

This research aims to compare the transcortical and transsylvian surgical approaches for resecting insular gliomas.
Conducted a systematic review of literature from various databases up to November 2022.
Followed PRISMA guidelines for reporting systematic reviews and meta-analyses.
Analyzed primary outcomes: extent of resection, postoperative deficits, and complications.
Included data from 16 studies comprising 1,517 patients.
Transcortical approach achieved a higher gross total resection rate (44%) compared to the transsylvian approach (19%).
Transsylvian approach resulted in a higher rate of subtotal resection (47%) than transcortical (41%).
Postoperative speech deficits were more common in the transsylvian group (4%) compared to transcortical (negligible).
Motor deficits were also more frequent in the transsylvian approach (10%).

Abstract

Abstract Insular gliomas can be resected via a transcortical (TC) or transsylvian (TS) approach. The TC approach avoids injury to the middle cerebral artery (MCA) and is considered suitable for gliomas with opercular spread. The TS approach is limited by bridging veins and a surgical “blind spot” for larger gliomas. We aimed to compare the TC and TS approaches for the resection of insular gliomas. A systematic review of the literature was performed using PubMed, Scopus, and Web of Science databases from inception to November 20, 2022, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Primary outcomes included the extent of resection (EOR), postoperative deficits, and immediate and delayed complications of both approaches. Summary estimate of proportion, random effects, and confidence intervals (CIs) were calculated using R (statistical package). Sixteen studies with 1,517 patients (56.5% male) were included. The mean age ± standard deviation (SD) of patients was 43.6 ± 6.8 years. The predominant presenting symptom was first-onset seizure (62.8%), followed by headache (∼10%). There was a slight predominance of right-sided gliomas (52.5%). Pathology revealed a slight abundance of low-grade (WHO grade I or II) histology (51.5%) compared with 48.5% high-grade (WHO grade III or IV). A greater pool proportion of 0.44 (CI: 0.28–0.61) for gross total resection and 0.19 (CI: 0.10–0.34) for partial resection was found for the TC approach compared with the TS approach. For subtotal resection, the TS approach had a higher pooled proportion (0.47 CI: 0.40–0.54) than the TC approach (0.41 CI: 0.24–0.60). Postoperative speech deficits (0.04 95% CI: 0.02–0.11) and motor deficits (0.10 95% CI: 0.07–0.15) were more frequent with the TS approach compared with the TC approach. Our study confirms that the TC approach results in a higher proportion of gross total resection of insular gliomas compared with the TS approach, with fewer postoperative speech and motor deficits.

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