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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0046-1815955
Review Article

Transcortical versus Transsylvian Approach for Insular Gliomas: A Systematic Review and Meta-Analysis

Authors

  • Hammad Atif Irshad 

    1   Medical College, Aga Khan University, Karachi, Pakistan

  • Ahmed Altaf 

    2   Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan

  • Muhammad Shakir 

    2   Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan

  • Zuhaib Ali

    1   Medical College, Aga Khan University, Karachi, Pakistan

  • Haseeb Mehmood Qadri

    3   Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore General Hospital, Lahore, Pakistan

  • Illiyun Banani 

    1   Medical College, Aga Khan University, Karachi, Pakistan

  • Altamash Shahriyar Ghazanfar

    1   Medical College, Aga Khan University, Karachi, Pakistan

  • Roua Nasir

    2   Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan

  • Saad Akhtar Khan

    4   Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan

  • Muhammad Riaz

    5   Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, United States

  • Muhammad Omar Chohan

    6   Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, United States

  • Syed Ather Enam

    2   Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
    7   Centre of Oncological Research in Surgery, Juma Research Laboratories, Aga Khan University, Karachi, Pakistan
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Abstract

Insular gliomas can be resected via a transcortical (TC) or transsylvian (TS) approach. The TC approach avoids injury to the middle cerebral artery (MCA) and is considered suitable for gliomas with opercular spread. The TS approach is limited by bridging veins and a surgical “blind spot” for larger gliomas. We aimed to compare the TC and TS approaches for the resection of insular gliomas. A systematic review of the literature was performed using PubMed, Scopus, and Web of Science databases from inception to November 20, 2022, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Primary outcomes included the extent of resection (EOR), postoperative deficits, and immediate and delayed complications of both approaches. Summary estimate of proportion, random effects, and confidence intervals (CIs) were calculated using R (statistical package). Sixteen studies with 1,517 patients (56.5% male) were included. The mean age ± standard deviation (SD) of patients was 43.6 ± 6.8 years. The predominant presenting symptom was first-onset seizure (62.8%), followed by headache (∼10%). There was a slight predominance of right-sided gliomas (52.5%). Pathology revealed a slight abundance of low-grade (WHO grade I or II) histology (51.5%) compared with 48.5% high-grade (WHO grade III or IV). A greater pool proportion of 0.44 (CI: 0.28–0.61) for gross total resection and 0.19 (CI: 0.10–0.34) for partial resection was found for the TC approach compared with the TS approach. For subtotal resection, the TS approach had a higher pooled proportion (0.47 [CI: 0.40–0.54]) than the TC approach (0.41 [CI: 0.24–0.60]). Postoperative speech deficits (0.04 [95% CI: 0.02–0.11]) and motor deficits (0.10 [95% CI: 0.07–0.15]) were more frequent with the TS approach compared with the TC approach. Our study confirms that the TC approach results in a higher proportion of gross total resection of insular gliomas compared with the TS approach, with fewer postoperative speech and motor deficits.

Keywords

insular glioma - transsylvian - transcortical

Authors' Contributions

A.A. contributed to writing the original draft, reviewing and editing the manuscript, and visualization. M.S. was responsible for methodology, supervision, writing, reviewing and editing, project administration, and validation. H.A.I. contributed to conceptualization and to writing the original draft as well as reviewing and editing. H.M.Q. contributed to writing the original draft, reviewing and editing, and visualization. Z.A. and I.B. were involved in investigation, data curation, writing the original draft, and visualization. A.S.G. contributed to investigation, data curation, and writing the original draft. R.N. contributed to writing the original draft, investigation, and data curation. S.A.K., M.R., and S.A.E. contributed to conceptualization, supervision, project administration, and review. M.O.C. contributed to writing, reviewing, and editing the manuscript.


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Publication History

Article published online:
03 February 2026

© 2026. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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