Insular glioblastoma: surgical challenges, survival outcomes and prognostic factors

Singh, Amanjot; Das, Kuntal Kanti; Khatri, Deepak; Singh, Shanker K.; Gosal, Jaskaran Singh; Jaiswal, Sushila; Mishra, Prabhakar; Mehrotra, Anant; Bhaisora, Kamlesh Singh; Sardhara, Jayesh; Srivastava, Arun Kumar; Jaiswal, Awadhesh Kumar; Behari, Sanjay

doi:10.1080/02688697.2020.1859089

Cited by 8 publications

(15 citation statements)

References 39 publications

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“…Although uncommon, histone-mutant high-grade gliomas can lead to leptomeningeal dissemination early in the course of disease, representing a diagnostic challenge and precluding gross total tumor resection [15][16][17]32]. Primary CNS malignancies should be considered in the setting of radiographic leptomeningeal enhancement, even without a mass lesion.…”

Section: Discussionmentioning

confidence: 99%

Histone-mutant glioma presenting as diffuse leptomeningeal disease

et al. 2021

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Glioblastoma multiforme is the most common malignant primary brain tumor in adults. Histone H3 mutations have been identified in pediatric and adult gliomas, with H3K27M mutations typically associated with a posterior fossa midline tumor location and poor prognosis. Leptomeningeal disease is a known complication of histone-mutant glioma, but uncommon at the time of initial diagnosis. We describe a case of glioblastoma with H3K27M mutation that initially presented with progressive vision loss due to diffuse leptomeningeal disease in the absence of a mass lesion other than a small cerebellar area of enhancement and with cerebrospinal fluid cytology negative for malignant cells on two occasions, highlighting the importance of including primary CNS malignancies in the differential of diffuse radiographic leptomeningeal enhancement.

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Section: Discussionmentioning

confidence: 99%

Histone-mutant glioma presenting as diffuse leptomeningeal disease

et al. 2021

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“… 1 While earlier studies associated insular location predominantly with LGGs, recent reports suggest up to 40% of ING lesions are high-grade gliomas (HGGs). 3 Additionally, contradictory survival outcomes have been reported, with earlier studies describing insular lesions as indolent, 3 4 while Singh et al 5 noted shorter median overall survival (OS) in insular glioblastoma compared with superficial tumors. The latter would be consistent with a higher frequency of molecular phenotypes with dismal prognosis such as absence of isocitrate dehydrogenase (IDH) mutations, p53 expression, and 1p19q codeletion.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors and Resectability Predictors in Insular Gliomas: A Systematic Review

Papadopoulou,

Kumar

2023

J Neurol Surg A Cent Eur Neurosurg

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Background Insular gliomas (INGs) remain a surgically intimidating glioma subgroup encased by eloquent cortical parcels and white matter language tracts, and traversed by multiple middle cerebral artery branches. The predictive power of prognostic factors affecting overall survival (OS), progression-free survival (PFS), and resectability of INGs remain disputed. This comprehensive systematic review analyses prognostic factors and resectability predictors of INGs substantiating pragmatic management options. Material and Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Cochrane Handbook of Systematic Reviews of Interventions guidelines. The PubMed, MEDLINE, and Embase databases were searched in April 2022. All clinical studies with ≥10 patients harboring INGs with any intervention and reporting predictors of OS, PFS, and tumor resectability in INGs were included. Molecular ING prognosticators were also included. Studies combining insular and other gliomas analysis, case studies, experimental and animal studies, conference abstracts, letters to the editor, and articles in other languages were excluded. Results Of the 2,384 articles returned, 27 fulfilled the inclusion criteria totaling 1,985 patients. The review yielded 18 OS and 17 PFS prognosticators. These were classified as preoperative (radiologic; clinical), intraoperative, and postoperative (molecular; histopathologic; clinical) prognosticators. In addition, 21 resectability predictors were categorized as preoperative (radiologic; clinical), intraoperative (surgical approach and assistive technology), and postoperative (histopathologic; clinical). The quality assessment revealed 24/27 studies had low risk of bias. One study with moderate and two studies with high risk of bias were included. Conclusion Negative prognosticators reported in ≥2 studies included putaminal or paralimbic involvement and higher tumor grade, while seizures at presentation, isocitrate dehydrogenase (IDH) mutation, increased extent of resection, and higher Karnofsky Performance Status preoperatively and at 3 months postoperation were positive prognosticators. Resectability predictors reported in ≥2 studies included the positive predictors of zone I/zone IV tumor location and intraoperative imaging use and the negative predictor of encased lenticulostriate arteries. Paralimbic INGs are not a single entity with homogeneous prognosis. Integration of identified prognosticators in a prospective trial to devise a grading system for INGs can improve clinical decision-making.

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“…Our understanding of these tumors has improved immensely, both on a conceptual and technological front. [ 1 2 3 4 ] Multifocality and possible tumor metastasis from insular glioma are extremely rare and less explored. [ 5 ] Therefore, very little is known regarding the predictability of such growth patterns and their management implications.…”

Section: Introductionmentioning

confidence: 99%

The dilemma of multifocality in insular tumors: Multicentricity versus metastasis

et al. 2021

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Background and Purpose: Multifocality and metastasis from insular glioma are extremely rare. Pathological insights and elaboration of the clinical course of this condition will contribute to their better understanding. Materials and Methods: Among 123 consecutively operated insular gliomas, 5 patients (4.2%) presented with a multifocal tumor. The clinico-radiological, histo-molecular, and treatment outcomes were noted and compared with the unifocal insular glioma cohort. Results: Among the five patients, all were males and involved the right insular lobe. Three patients presented with synchronous tumors, while two patients developed metachronous multifocal tumors. The histology of the insular tumor was Grade I glioma in 1, Grade II astrocytoma with p53 mutation in 2, and anaplastic astrocytoma and glioblastoma in one patient each. Histological confirmation of the second lesion was performed in two patients, showing the same histology of the insular tumor. Interconnection between the tumors was apparent through cerebrospinal fluid pathways in four patients, while no such connection could be established in one patient. Barring the patient of Grade I glioma, the rest of the patients died within months of the diagnosis. Conclusion: Multifocal insular glioma is rare and probably represents a biologically more aggressive tumor. Insular glioma that touches the ventricle appears a common denominator for multifocality. True multicentricity is rare. The prognosis in insular glioma with multifocality is poor in non-Grade I gliomas.

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Insular glioblastoma: surgical challenges, survival outcomes and prognostic factors

Cited by 8 publications

References 39 publications

Histone-mutant glioma presenting as diffuse leptomeningeal disease

Histone-mutant glioma presenting as diffuse leptomeningeal disease

Prognostic Factors and Resectability Predictors in Insular Gliomas: A Systematic Review

The dilemma of multifocality in insular tumors: Multicentricity versus metastasis

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