Background/Objectives: Insular gliomas are rare entities whose surgical resection presents a significant challenge due to their close relationship with crucial white matter bundles and deep perforating arteries. The Berger–Sanai classification is a well-established system based on dividing the insula into four quadrants. In contrast, the Kawaguchi grading system focuses on the tumor’s behavior and vascular infiltration. In this study, we compared these two systems in terms of surgical and clinical outcomes.Methods: A retrospective single-center consecutive series of patients treated for insular gliomas was analyzed.Results: A total of 43 patients were analyzed, with a mean age of 47 years. The average preoperative KPS was 92.6, and seizures were the most common presenting symptom. The mean extent of resection (EOR) was 92.2%. Both the Berger–Sanai and Kawaguchi classifications influenced the EOR, but the former showed a moderate-to-strong correlation with expected resection rates. Postoperative clinical outcomes were related to both classification systems, but this association was lost at the 6-month follow-up. Additionally, lower Kawaguchi grades were associated with significant postoperative MRI hyperintensities on DWI sequences and higher rates of intraoperative neuromonitoring (IONM) alterations, which translated into worse postoperative clinical conditions.Conclusions: The Berger–Sanai and Kawaguchi classification systems are both significantly related to the EOR in insular gliomas; however, only the Berger–Sanai system shows strong predictive value regarding resection rates. Both systems serve as good prognostic tools for determining short-term postoperative clinical outcomes, but significant DWI hyperintensities and IONM alterations are specifically associated with the Kawaguchi system.
背景/目的：岛叶胶质瘤较为罕见，因其与关键白质纤维束及深部穿支动脉关系密切，手术切除面临重大挑战。Berger-Sanai分级系统基于将岛叶划分为四个象限，是公认的分级体系；而Kawaguchi分级系统则侧重于肿瘤行为特征及血管浸润程度。本研究旨在比较这两种分级系统对手术及临床结局的预测价值。方法：对单中心连续收治的岛叶胶质瘤患者进行回顾性分析。结果：共纳入43例患者，平均年龄47岁。术前平均KPS评分为92.6，癫痫为最常见首发症状。平均切除范围达92.2%。Berger-Sanai与Kawaguchi分级均影响切除范围，但前者与预期切除率呈中至强相关性。术后临床结局与两种分级系统均相关，但在6个月随访时该关联消失。此外，较低的Kawaguchi分级与术后DWI序列显著高信号及术中神经电生理监测改变率升高相关，并导致更差的术后临床状况。结论：Berger-Sanai与Kawaguchi分级系统均与岛叶胶质瘤切除范围显著相关，但仅Berger-Sanai系统对切除率具有强预测价值。两种系统均为评估术后短期临床结局的良好预后工具，但显著的DWI高信号及术中神经监测改变特异性地与Kawaguchi分级系统相关。
肿瘤(癌症)患者之家