Given the importance of maximizing resection for prognosis in patients with HGG and the potential risks associated with ventricle opening, this study aimed to assess the actual increase in post-surgical complications related to lateral ventricle opening and its influence on OS and PFS. A retrospective study was conducted on newly diagnosed HGG, dividing the patients into two groups according to whether the lateral ventricle was opened (69 patients) or not opened (311 patients). PFS, OS, subependymal dissemination, distant parenchymal recurrences, the development of hydrocephalus and CSF leak were considered outcome measures. A cohort of 380 patients (154 females (40.5%) and 226 males (59.5%)) was involved in the study (median age 61 years). The PFS averaged 10.9 months (±13.3 SD), and OS averaged 16.6 months (± 16.3 SD). Among complications, subependymal dissemination was registered in 15 cases (3.9%), multifocal and multicentric progression in 56 cases (14.7%), leptomeningeal dissemination in 12 (3.2%) and hydrocephalus in 8 (2.1%). These occurrences could not be clearly justified by ventricular opening. The act of opening the lateral ventricles itself does not carry an elevated risk of dissemination, hydrocephalus or cerebrospinal fluid (CSF) leak. Therefore, if necessary, it should be pursued to achieve radical removal of the disease.

Gliomas within the insular region represent one of the most challenging problems in neurosurgical oncology. There are two main surgical approaches to address the complex vascular network and functional areas around the insula: the transsylvian approach and the transcortical approach. In the literature, there is not a clear consensus on the best approach in terms of safety and efficacy. The purpose of this study is to evaluate the effectiveness of these approaches and to analyze prognostic factors on the natural history of insular gliomas. Patients with newly diagnosed high-grade insular gliomas who underwent surgery between January 2019 and June 2024 were analyzed. The series was analyzed according to the classification of Berger–Sanai and Yaşargil. The Karnofsky performance score (KPS), extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were considered the outcome measures. A total of 58 primary high-grade insular glioma patients were enrolled in this study. The IDH mutation was found in 13/58 (22.4%); specifically, 3/13 (23.1%) were grade 4, and 10/13 (76.9%) were grade 3. Furthermore, 40/58 patients (69%) underwent gross total resection (GTR), 15 patients (26%) subtotal resection, and 3 patients (5%) partial resection. Middle cerebral artery encasement negatively affected the OS. GTR, radiotherapy, KPS, and autonomous deambulation at a month after surgery positively affected the OS. The surgical approach used was transsylvian and transcortical in 11 and 47 cases, respectively. The comparison between the two different approaches did not display differences in terms of neurological deficits and OS (p > 0.05). The transcortical approach was related to the greater achievement of GTR (p = 0.031). According to the Berger–Sanai classification, the transcortical approach has higher EOR and postoperative KPS when the lesion is in zone III-IV (p = 0.029). Greater resection of insular gliomas can be achieved with an acceptable morbidity profile and is predictive of improved OS. Both the transsylvian and transcortical corridors to the insula are associated with low morbidity profiles. The transcortical approach with intraoperative mapping is more favorable for achieving greater EOR, particularly in gliomas within the inferior border of the Sylvian fissure.

BACKGROUND AND OBJECTIVES: Spontaneous intracerebral hemorrhage (ICH) has the highest short-term mortality among stroke subtypes, and progress in treatment has been hindered by the limited accuracy of current prognostic tools. We investigated whether white matter functional disconnection severity, estimated using a normative lesion network mapping framework integrating direct electrical stimulation and resting-state functional MRI data from previously published independent Data sets, improves prediction of 6-month functional outcome measured with the modified Rankin Scale (mRS). METHODS: We analyzed 97 patients with spontaneous ICH. Ordinal logistic regression models were used to evaluate the association between domain-specific disconnection severity and 6-month mRS, and to compare traditional functional outcome in patients with primary intracerebral hemorrhage and ICH scores with connectivity-enriched models incorporating disconnection measures. RESULTS: White matter functional disconnectivity was significantly associated with 6-month functional outcome (mRS; P < .001; Nagelkerke's R ² = 0.507). Integrating disconnection severity into the functional outcome in patients with primary intracerebral hemorrhage and ICH scores improved predictive performance in both cases (Nagelkerke's R ² = 0.615 vs 0.389 and 0.651 vs 0.434, respectively), with the connectivity-enriched ICH score achieving the strongest overall fit across all models tested. Exploratory analyses showed associations between domain-specific disconnection severity, residual functional deficits, and early mortality. CONCLUSION: Assessment of white matter functional disconnection severity seems to be a promising approach for predicting long-term disability after ICH, although prospective validation in larger multicenter cohorts is required before clinical implementation. The findings suggest that different brain networks exhibit variable vulnerability to injury and differential potential for functional recovery.