• Joshua Pepper, Hadleigh Cuthbert, Teresa Scott, Ismail Ughratdar, Victoria Wykes, Colin Watts, Pietro D'Urso, Konstantina Karabatsou, Carl-Christian Moor, and Erminia Albanese.
• Department of Neurosurgery, University Hospital of North Midlands, Stoke on Trent, United Kingdom. Electronic address: joshua.pepper1@nhs.net.
• World Neurosurg. 2021 Oct 1; 154: e718-e723.

BackgroundThe insular cortex is an eloquent island of mesocortex surrounded by vital structures making this region relatively challenging to neurosurgeons. Historically, lesions in this region were considered too high risk to approach given the strong chance of poor surgical outcome. Advances in recent decades have meant that surgeons can more safely access this eloquent region. Seizure outcome after excision of insular low-grade gliomas is well reported, but little is known about seizure outcomes after excision of insular high-grade gliomas.MethodsA retrospective analysis was performed of all patients presenting with new-onset seizures during 2015-2019 who underwent excision of an insular high-grade glioma at 3 regional neurosurgical centers in the United Kingdom.ResultsWe identified 38 patients with a mean (SD) age of 45.7 (15.3) years with median follow-up of 21 months. At long-term follow-up, of 38 patients, 23 were seizure-free (Engel class I), 2 had improved seizures (Engel class II), 6 had poor seizure control (Engel class III/IV), and 7 died.ConclusionsExcision of insular high-grade gliomas is safe and results in excellent postoperative seizure control.Copyright © 2021 Elsevier Inc. All rights reserved.

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