: Aim Insular gliomas were classified based on their fiber tract origin and extension. The presenting clinical features and surgical decisions were based on such anatomic extensions. Material and methods During the period June 2016 to January 2025, 69 cases of insular low-grade gliomas were surgically treated. The tumors were classified into localized type when they arose from short association fibers and of diffuse type when they arose from long association, commissural and projection fibers. The clinical features were stratified according to the classification. The surgical trans-sylvian or transcortical access was based on the fiber tract origin. Our previously described surgical strategy of en-masse tumor resection was modified according to location and extension and critical brain areas and vital blood vessels in the neighborhood. The aim of surgical treatment was radical tumor resection using standard techniques. Results The follow up period ranged from 6 to 86 months (mean 26 months). A gross total resection was possible in 24 out of 32 patients in the localized group and in 10 out of 37 patients in the diffuse group of patients. Conclusions Gliomas involving the insula have defined pattern of origin and extension. The classification of these tumors according to the presumed white fiber tract origin can facilitate understanding of clinical presenting features, designing surgical strategy, predicting extent of possible resection and prognosticating the ultimate outcome.
Shah et al. (Mon,) studied this question.