Neurosurgery最新文献

{"title":"Genomic Alterations in Molecularly Defined Oligodendrogliomas.","authors":"Carly Weber-Levine, Maureen Rakovec, Kelly Jiang, Anita Kalluri, Divyaansh Raj, Megan Parker, Joshua Materi, Sadra Sepehri, Abel Ferrés, Karisa C Schreck, Iban Aldecoa, Calixto-Hope G Lucas, Kristin J Redmond, Matthias Holdhoff, Haris I Sair, Jon D Weingart, Henry Brem, Josep González Sánchez, Xiaobu Ye, Chetan Bettegowda, Jordina Rincon-Torroella","doi":"10.1227/neu.0000000000003078","DOIUrl":"10.1227/neu.0000000000003078","url":null,"abstract":"<p><strong>Background and objectives: </strong>Oligodendrogliomas are defined by IDH1/2 mutation and codeletion of chromosome arms 1p/19q. Although previous studies identified CIC , FUBP1 , and TERTp as frequently altered in oligodendrogliomas, the clinical relevance of these molecular signatures is unclear. Moreover, previous studies predominantly used research panels that are not readily available to providers and patients. Accordingly, we explore genomic alterations in molecularly defined oligodendrogliomas using clinically standardized next-generation sequencing (NGS) panels.</p><p><strong>Methods: </strong>A retrospective single-center study evaluated adults with pathologically confirmed IDH -mutant, 1p/19q-codeleted oligodendrogliomas diagnosed between 2005 and 2021. Genetic data from formalin-fixed, paraffin-embedded specimens were analyzed with the NGS Solid Tumor Panel at the Johns Hopkins Medical Laboratories, which tests more than 400 cancer-related genes. Kaplan-Meier plots and log-rank tests compared progression-free survival (PFS) and overall survival by variant status. χ 2 tests, t -tests, and Wilcoxon rank-sum tests were used to compare clinical characteristics between genomic variant status in the 10 most frequently altered genes.</p><p><strong>Results: </strong>Two hundred and seventy-seven patients with molecularly defined oligodendrogliomas were identified, of which 95 patients had available NGS reports. Ten genes had 9 or more patients with a genomic alteration, with CIC , FUBP1 , and TERTp being the most frequently altered genes (n = 60, 23, and 22, respectively). Kaplan-Meier curves showed that most genes were not associated with differences in PFS or overall survival. At earlier time points (PFS <100 months), CIC alterations conferred a reduction in PFS in patients ( P = .038).</p><p><strong>Conclusion: </strong>Our study confirms the elevated frequency of CIC , FUBP1 , and TERTp alterations in molecularly defined oligodendrogliomas and suggests a potential relationship of CIC alteration to PFS at earlier time points. Understanding these genomic variants may inform prognosis or therapeutic recommendations as NGS becomes routine.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"328-337"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Application and Safety of Externally Controlled Metronomic Drug Delivery to the Brain by an Implantable Smart Pump in a Sheep Model.","authors":"Mingsheng Huang, Yiheng Liu","doi":"10.1227/neu.0000000000003285","DOIUrl":"10.1227/neu.0000000000003285","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e33"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-Up Care for Brain Tumors in Low- and Middle-Income Countries: A Systematic Review of Existing Challenges and Strategies for the Future.","authors":"Muhammad Shakir, Izza Tahir, Syeda Fatima Shariq, Aly Hamza Khowaja, Hammad Atif Irshad, Ali I Rae, Radzi Hamzah, Saksham Gupta, Kee B Park, Syed Ather Enam","doi":"10.1227/neu.0000000000003082","DOIUrl":"10.1227/neu.0000000000003082","url":null,"abstract":"<p><strong>Background and objectives: </strong>Brain tumors have a poor prognosis and a high death rate. Sufficient aftercare is necessary to enhance patient results. But follow-up care provision is fraught with difficulties in low- and middle-income countries (LMICs), where a variety of variables can impede access to care. Therefore, our systematic review aimed to identify challenges to follow-up care for brain tumors and possible solutions in LMICs.</p><p><strong>Methods: </strong>A thorough search of the literature was performed from the beginning until October 20, 2022, using Google Scholar, PubMed, Scopus, and CINAHL. Studies focusing on the aftercare of brain tumors in LMICs met the inclusion criteria. Two reviewers used the National Surgical, Obstetric, and Anesthesia Plan categories to identify themes, extract relevant data, and evaluate individual articles. After being discovered, these themes were arranged in Microsoft Excel to make reporting and comprehension simpler.</p><p><strong>Results: </strong>A total of 27 studies were included in the review. Among the studies included, the most frequently cited barriers to follow-up care were financial constraints (54%), long-distance travel (42%), and a lack of awareness about the importance of follow-up care (25%). Other challenges included preference for traditional or alternative medications (4%) and high treatment costs (8%). Proposed strategies included implementing mobile clinics (20%), establishing a documentation system (13%), and educating patients about the importance of follow-up care (7%).</p><p><strong>Conclusion: </strong>In LMICs, several issues pertaining to personnel, infrastructure, service delivery, financing, information management, and governance impede the provision of follow-up treatment for patients with brain tumors. As established by the suggested techniques found in the literature, addressing these issues will necessitate concurrent action by stakeholders, legislators, health ministries, and government agencies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"276-288"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical Feasibility of Delineating the Thalamic Gustatory Tract Using Tractography.","authors":"Kazuki Sakakura, Nathan Pertsch, Julia Mueller, Alireza Borghei, Nicholas Rubert, Sepehr Sani","doi":"10.1227/neu.0000000000003227","DOIUrl":"10.1227/neu.0000000000003227","url":null,"abstract":"<p><strong>Background and objectives: </strong>Magnetic resonance-guided focused ultrasound (MRgFUS) has been increasingly performed in recent years as a minimally invasive treatment of essential tremor and tremor-dominant Parkinson disease. One of the side effects after treatment is dysgeusia. Some centers use tractography to facilitate the treatment planning. However, there have been no reports of identifying gustatory tracts so far. Our aim was to investigate the technical feasibility of isolating and visualizing the gustatory tracts, as well as to explore the relationship between the gustatory tract and the MRgFUS lesion using actual patient data.</p><p><strong>Methods: </strong>We used 20 randomly selected individuals from the Human Connectome Project database to perform tractography of the gustatory tracts. We defined region of interest as the dorsal region of the brainstem, Brodmann area 43 associated with taste perception, and a sphere with a 3-mm radius centered around the ventral intermediate nucleus in the anterior commissure-posterior commissure plane. We also examined the position of the gustatory tract in relation with other tracts, including the medial lemniscus, the pyramidal tract, and the dentatorubrothalamic tract. In addition, using the data of real patients with essential tremor, we investigated the distance between MRgFUS lesions and the gustatory tract and its association with the development of dysgeusia.</p><p><strong>Results: </strong>We delineated a mean of 15 streamlines of the gustatory tracts per subject in each hemisphere. There was no statistical difference in the localization of the gustatory tracts between the left and right cerebral hemispheres. The gustatory tract was located anteromedial to the medial lemniscus and posteromedial to the dentatorubrothalamic tract in the anterior commissure-posterior commissure plane. The distance from the MRgFUS lesion to the gustatory tract was significantly shorter in the case where dysgeusia occurred compared with nondysgeusia cases ( P -value: .0068).</p><p><strong>Conclusion: </strong>The thalamic gustatory tracts can be reliably visualized using tractography.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"454-462"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Angiographic Features of Meningiomas Predicting Extent of Preoperative Embolization.","authors":"M Marzia Noor, Md Moshiur Rahman","doi":"10.1227/neu.0000000000003306","DOIUrl":"10.1227/neu.0000000000003306","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e35-e36"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial Arteriovenous Malformations During Pregnancy and Puerperium-A Retrospective Nationwide Population-Based Cohort Study.","authors":"Anni Pohjola, Teresa Vest, Liisa Verho, Karoliina Aarnio, Kirsi Rantanen, Hannele Laivuori, Mika Gissler, Aki Laakso, Mika Niemelä, Petra Ijäs","doi":"10.1227/neu.0000000000003067","DOIUrl":"10.1227/neu.0000000000003067","url":null,"abstract":"<p><strong>Background and objectives: </strong>The knowledge about the management of patients with brain arteriovenous malformations (AVM) during pregnancy is limited, owing partly to insufficient evidence about the outcomes of newborns. This study aims to explore symptomatic AVMs and their outcomes during pregnancy, delivery, and the postpartum period.</p><p><strong>Methods: </strong>We conducted a retrospective analysis by combining patients with symptomatic AVM from a nationwide population-based cohort of all women with a pregnancy resulting in delivery during 1987 to 2016 (n = 1 773 728 deliveries) and our AVM database (n = 805, 1942-2014). Cerebrovascular events during pregnancy were identified through International Classification of Diseases-9, International Classification of Diseases-10, or surgical procedure codes from the Hospital Discharge and Medical Birth Registers. Our analysis focused on treatment characteristics and outcomes of patients with AVM hemorrhage or symptomatic AVM during pregnancy, delivery, or puerperium.</p><p><strong>Results: </strong>A total of 28 women with symptomatic AVMs during pregnancy, delivery, or postpartum period were followed for an average of 12.8 years (SD = 15.5) after admission. Among them, 21 (75%) experienced AVM hemorrhages during pregnancy, puerperium, or delivery. The mean age of patients was 28.9 years (SD = 5.5). Hemorrhages occurred predominantly during the second (n = 9, 43% of all ruptures) or the third trimester (n = 5, 24%). Two AVM ruptures occurred during labor. Treatment for AVM took place during pregnancy (n = 7, 25%) or puerperium (n = 3, 14%) in 10 patients (35.7%). Only 5 mothers (17.8%) had not been previously pregnant. There was no significant difference in mean Apgar scores between those with AVM hemorrhage (8.3) and those without (8.4).</p><p><strong>Conclusion: </strong>Most mothers in the study had prior pregnancies, suggesting a potentially weaker association between AVM rupture and pregnancy compared to previous reports. Notably, 2 AVM ruptures occurred during spontaneous vaginal deliveries. Outcomes were generally favorable in both mothers and infants. More research is needed to refine our understanding of the optimal timing for invasive treatment during pregnancy.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"346-355"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11698266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141458343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Corpus Callosotomy Brings Worthwhile Seizure Reduction in Both Pediatric and Adult Patients.","authors":"Kazushi Ukishiro, Shin-Ichiro Osawa, Masaki Iwasaki, Yosuke Kakisaka, Kazutaka Jin, Mitsugu Uematsu, Tetsuya Yamamoto, Teiji Tominaga, Hidenori Endo, Nobukazu Nakasato","doi":"10.1227/neu.0000000000003092","DOIUrl":"10.1227/neu.0000000000003092","url":null,"abstract":"<p><strong>Background and objectives: </strong>The influence of the age at which complete corpus callosotomy (CC) surgery is performed on seizure outcomes remains unclear. This study aimed to evaluate the age-dependent aspects of long-term seizure outcomes after complete CC.</p><p><strong>Methods: </strong>We reviewed 41 patients who underwent one-stage complete CC. Seizure outcomes were analyzed for age at epilepsy onset and at complete CC, focal MRI abnormality, and etiology.</p><p><strong>Results: </strong>The median age was 7 months at epilepsy onset and 93 months at complete CC. The median follow-up duration was 67 months. Sixteen patients had focal MRI lesions and 4 had only general atrophy. Etiology was identified in 20 patients. For overall seizure outcomes (N = 41), complete seizure freedom was achieved in 5 patients, excellent seizure reduction (>80%) in 11, good (50%-80%) in 5, and poor (<50%) in 20. Freedom was correlated with younger age at complete CC and unknown etiology ( P ≤ .05). Freedom was only achieved in patients aged younger than 7 years. Worthwhile (≥50%, freedom, excellent, and good) and not worthwhile (<50%, poor) overall seizure reduction showed no statistical difference in age at complete CC. No related factor was found for worthwhile overall seizure reduction. For drop attack outcomes (N = 31), freedom was achieved in 22 cases, excellent in 5, and poor in 4. Freedom was correlated with younger age at complete CC ( P < .05) although freedom was achieved in 4 of 7 patients older than 20 years. Age at complete CC showed no statistical difference between worthwhile (≥50%) and not worthwhile (<50%) drop attack reduction. Worthwhile drop attack reduction was correlated with unknown etiology ( P < .05). Complications were mild and transient.</p><p><strong>Conclusion: </strong>Complete CC is an excellent surgical option based on favorable seizure outcomes and acceptable complications in our present study.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"410-415"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11698267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Fixation of Thoracolumbar Fractures in Patients Older than 80 Years.","authors":"Shane Zaw, Lin Sen, Joshua Zhi En Koh, Lilian Ow, Dinesh Shree Kumar, Hong Lee Terry Teo, Zhihong Chew, Ree Yi Koh, Zhen Yang, Andy Kuei Siong Yeo, Lester Lee","doi":"10.1227/neu.0000000000003358","DOIUrl":"https://doi.org/10.1227/neu.0000000000003358","url":null,"abstract":"<p><strong>Background and objective: </strong>The global average life expectancy has been increasing steadily as the quality of healthcare continues to improve. However, there is a paucity of data looking at surgical fixation of thoracolumbar spine fractures in patients ≥80 years (super-elderly). Aim of this study is to look at whether there is higher rate of complications from surgical fixation of thoracolumbar fractures in this group of patients.</p><p><strong>Methods: </strong>We performed a retrospective study of patients who underwent surgical fixation of thoracolumbar spine fractures from 2019 to 2023. Patients were dichotomized into those who were 80 years old and above (super-elderly) and those younger than 80 years (control). Variables include sex, age, Charleston comorbidity index, presence of osteoporosis, length of hospital stay, complications, 6- and 12-months' implant status, and mortality. Incidence of revision surgery, rate of implant loosening, and mortality between the 2 groups were analyzed.</p><p><strong>Results: </strong>Total of 108 patients were included, 43 patients in the super-elderly group and 65 in the control group. Despite the super-elderly having a higher rate of osteoporosis and higher proportion of patients with severe comorbidities (P < .0001), there was no significant difference in the rate of implant loosening at 12 months' follow-up (P = .467) or all-cause mortality (P = .158). There were no significant differences between the 2 groups regarding revision surgery (P = .923) needed either.</p><p><strong>Conclusion: </strong>The super-elderly had a higher incidence of osteoporosis and worse comorbidities, but there was no significant difference regarding implant complications, revision surgery required, or all-cause mortality. Hence, surgical fixation of thoracolumbar spine fractures in people older than 80 years should be considered despite their advanced age.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Diffusion Tensor Imaging and Neurite Dispersion and Density Imaging in Isocitrate Dehydrogenase-Mutant Grade 2 and 3 Gliomas: Definition of Tumor-Related Epilepsy and Predictive Factors of Seizure Outcomes Based on a Single-Center Retrospective Case Series.","authors":"Beatrice C Bono, Alessandro Grimi, Artem Emanuele Di Toro, Gaia Ninatti, Andrea Franzini, Zefferino Rossini, Maria Pia Tropeano, Pierina Navarria, Luisa Bellu, Matteo Simonelli, Angelo Dipasquale, Giovanni Savini, Riccardo Levi, Letterio S Politi, Federico Pessina, Marco Riva","doi":"10.1227/neu.0000000000003365","DOIUrl":"https://doi.org/10.1227/neu.0000000000003365","url":null,"abstract":"<p><strong>Background and objectives: </strong>Understanding and managing seizure activity is crucial in neuro-oncology, especially for highly epileptogenic lesions like isocitrate dehydrogenase (IDH)-mutant gliomas. Advanced MRI techniques such as diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) have been used to describe microstructural changes associated with epilepsy. However, their role in tumor-related epilepsy (TRE) remains unclear. This study aims to investigate the role of DTI and NODDI tumor-derived metrics in defining TRE and predicting postoperative seizure outcomes in patients undergoing surgical resection for IDH-mutant grade 2 and 3 gliomas.</p><p><strong>Methods: </strong>This was a single-center retrospective study. Preoperative DTI parameters included fractional anisotropy and mean diffusivity. NODDI parameters included neurite density index (NDI), orientation dispersion index, and free-water fraction (FWF). These metrics were calculated within three volumes of interest (fluid-attenuated inversion recovery [FLAIR] tumor volume, FLAIR peripheral zone, and FLAIR central zone [Fcz]) and correlated with seizure presentation, type, and postoperative control, which was reported according to the Engel classification system.</p><p><strong>Results: </strong>Fifty-seven patients were included in this study. Increased NODDI-derived FWF-Fcz (P = .031) and NDI-Fcz (P = .046) values correlated with preoperative generalized seizure presentation, although only the FWF-Fcz confirmed its statistical significance (P = .047) in the multivariate analysis. Lower mean diffusivity-FLAIR tumor volume correlated with poor postoperative seizure control both in the univariate (P = .015, P = .026) and multivariate analyses (P = .024, P = .036), while a trend toward significance was found between higher NDI-FLAIR peripheral zone and worse seizure control (P = .055).</p><p><strong>Conclusion: </strong>DTI and NODDI tumor-derived quantitative parameters may define TRE and predict postoperative seizure outcomes in patients with IDH-mutant gliomas. Notably, DTI metrics were found to be independent predictors of postoperative seizure outcomes, while preoperative NODDI parameters correlated with seizure presentation. Further research is warranted to validate our findings and to better understand the underlying mechanisms driving TRE.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility, Safety, and Impact of Awake Resection for Recurrent Insular Diffuse Gliomas in Adults.","authors":"Marco Demasi, Angela Elia, Giorgia Antonia Simboli, Alessandro Moiraghi, Luca Paun, Benoit Hudelist, Meissa Hamza, Xavier Schumacher, Bénédicte Trancart, Maimiti Seneca, Edouard Dezamis, Jun Muto, Fabrice Chretien, Catherine Oppenheim, Alexandre Roux, Marc Zanello, Johan Pallud","doi":"10.1227/neu.0000000000003366","DOIUrl":"https://doi.org/10.1227/neu.0000000000003366","url":null,"abstract":"<p><strong>Background and objectives: </strong>The risk-to-benefit ratio of transopercular awake resection for recurrent insular diffuse gliomas is poorly studied. We assessed feasibility, safety, and efficacy of awake surgical resection of recurrent insular diffuse gliomas in patients with previous treatments (resection and/or radiotherapy and/or chemotherapy and/or combination).</p><p><strong>Methods: </strong>Observational, retrospective, single-institution cohort analysis (2010-2023) of 123 consecutive adult patients operated on for an insular diffuse glioma (2021 World Health Organization classification) under awake conditions. Comparison between awake resection for an insular diffuse glioma as first-line treatment (n = 87) and after previous treatments (n = 36).</p><p><strong>Results: </strong>Function-based transopercular awake resection for a recurrent insular diffuse glioma (1) did not increase intraoperative adverse events compared with first-line resection; (2) was associated with a higher rate of intraoperative insufficient cooperation in patients with a previous combined oncological treatment (33.3%), compared with patients with a previous monotherapeutic modality (7.4%), and compared with patients with a first-line surgery (8.1%, P = .046); (3) resulted in resection rates similar to those of awake resection at first-line surgery (median 91.9%, vs 90.1%); (4) did not increase surgery-related complications or duration of hospital stay; (5) did not worsen the 6-month Karnofsky Performance Status score, seizure control, and sick leave; (6) did not influence the 6-month sick leave from work, but was associated with longer sick leave in patients with high-grade gliomas (38.0% vs 7.7%, P < .001).</p><p><strong>Conclusion: </strong>Function-based transopercular awake resection seems feasible and safe at recurrence of a previously treated insular diffuse glioma, with similar resection rates and outcomes than first-time surgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}