| Objective:In this research,we investigated the clinical characteristics of insula glioma as well as comparing the clinical efficacy and the indication of the transsylvian approach(TS)and the transcortical approach(TC)for the microsurgical treatment of insula glioma.Methods:A collection of a population of 57 patients with insula glioma treated by microsurgery at the Division of Neurosurgery,Our hospital from January 2016 to December 2022,who were collected to obtain basic clinical data: gender,age,existence of primary diseases,pre-operative physical capacity status score(Karnofsky,KPS),pre-operative clinical behavior of patients,pre-operative seizures,etc.;imaging data.tumor volume,localization,extent of Resection(EOR),etc.;surgical data:surgical approach,surgical time,intraoperative amount of bleeding,etc.;pathological data: pathological grading;postoperative complications and recovery,postoperative KPS score,postoperative seizure situation,etc.The groups were divided into TS and TC groups according to the surgical access mode.The above data were studied and analyzed,in which the measurement data satisfying the regular distribution were expressed as mean ± standard error(s±x),and the t-test was used for comparison between groups,and the measurement data not satisfying the regular distribution were displayed as median and quartile M(P25,P75),and the Wilcoxon rank square test was used for discussion between groups;the counted data were stated as percentages of total or constitution ratio,and the chi-square was used for interaction between groups If the chi-square did not satisfy the test,Fisher’s exact odds ratio method was used for making comparisons.Survival analysis was performed using the Kaplan-Meier method test.Variation was considered Statistical meaningful at P<0.05.The above data were processed for their statistical analysis using SPSS Statistics 27.0.Results:1.The volume of tumor in TS group was 47.21(27.33,60.86)cm3,in TC tumor size was 64.28(39.73,86.57)cm3,the volume of TS group was remarkably lower than that of TC group,between the two groups was found to be significant level of the discrepancy(P=0.011<0.05),the foci of TS were located on the left side in 31.58%,the lesions of TC were located on the left side in 47.37%,there was never a single variance between the two groups(P=0.255>0.05).For tumor in the anterior part of the insula,there were 14 cases(73.68%)in the TS group and 13 cases(34.21%)in the TC group;For other types of tumors,there were 3 samples(15.79%)in the TS group and17 samples(44.74%)in the TC group,with statutory distinctions between the two groups(P=0.005,P=0.031<0.05).For posterior part of the insula tumors,2 subjects in the TS group(10.53%)and 8 subjects in the TC group(21.05%),the difference was not relevant(P=0.325>0.05).2.The duration of surgery was 5.33(4.42,7)hours in the TS group and 6(5,8)hours in the TC group,with the TS group being shorter than the TC group.The difference was not really statistically valid(P=0.068>0.05).There was 600(400,900)ml of intra-operative bleeding in the TS group and 925(500,1200)ml of intra-operative bleeding in the TC group,which was noticeably less to that in the TC group,statistically significant between the two groups(P=0.047<0.05).3.Tumor in the anterior part of the insula(areas I,IV,I+IV): the removal extent >90% the overall resection rate in the TS group was 85.71%,which was similar with the total partial resection rate in the TC group(76.92%),and the gap was considered statistically important(P=0.648>0.05).Some tumors in the post-insular portion of the insula(areas II,III,II+III),others: the resection range >90% total resection rate in the TS group was 0% and 0%,respectively,which was smaller than the total resection rate in the TC group(62.50% and 29.41%),however,the change between the two groups was not significant(P=0.444,P=539>0.05).4.The incidence of speech impairment was 10.53% and activity impairment was15.79% in the TS group and 10.53% and 36.84% in the TC group,respectively,which were not of statistic relevance;the incidence of long-term consequences was 5.26% in the TS group and 10.53% in the TC group.In both groups,there was postoperative hemorrhage from the tumor cavity,intracranial infection,cerebrospinal fluid leakage and infection in other extracranial sites,etc.The number of accumulated complications in the TS group was 36.84%,which was much fewer than the cumulative complication rate in the TC(65.79%)group,and the difference was of some importance(P=0.038<0.05).5.The time to stay in hospital after surgery was 15(12,18)d in the TS group and 18(15,25.5)d in the TC group,which was dramatically decreased in the TS group versus the TC group,with a measurable variation(P=0.025<0.05).The preoperative and postoperative KPS score difference ≥0 accounted for 78.95% in the TS group,which was greater than that in the TC group(67.32%).3 months postoperative epilepsy in the TS group.The improvement rate was greater in the TS group(83.33%)than in the TC group(44.44%),all of which were not statistically different.6.The mean survival time in the TS group was 51 months,with 1,2,and 3 survival rates of 82.35 %,67.57 %,and 67.57 %,respectively;the mean survival time in the TC group was 47 months,with 1,2,and 3-year survival rates of 89.18 %,66.89 %,and 46.33 %,respectively,whose survival analysis showed no statistical difference in the effect of surgical access on patient survival(P=0.820 > 0.05).7.The mean survival time for WHO grade 2 insula glioma was 68 months,with 1-,2-,and 3-year survival rates of 95.00%,87.69%,and 79.72%,respectively;the mean survival time for WHO grade 3 insula glioma was 35 months,with 1-,2-,and 3-year survival rates of 92.86%,81.25%,and 41.79%,respectively;and the mean survival time for WHO grade 4 insula glioma was The survival analysis showed that there was a statistical difference in the effect of pathological grade on patient survival(P=0.001<0.05).Conclusion(s):1.TS is suitable for tumors of small size and anterior part of the insula(regions I,IV,I+IV),and can obtain good resection rate,as well as the advantages of less surgical trauma,lower incidence of cumulative postoperative complications,faster postoperative recovery of patients,shorter hospital stay,and less economic pressure.2.TC can provide the best exposure for the posterior part of the insula,or the extensive area involving the anterior and posterior interventricular foramina,and is suitable for large tumors and other tumors(extensive tumors involving the anterior and posterior interventricular foramina),which can achieve a better resection rate. |
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