Berger-Sanai Topography and Achievable Extent of Resection in Insular Gliomas: A Single-Center Experience from Ukraine.

Abstract

To evaluate the association between Berger-Sanai topography and achievable extent of resection in patients with insular gliomas. This retrospective single-center study from Ukraine included 167 consecutive patients with insular gliomas treated surgically between 2017 and 2024. Tumors were classified according to the Berger-Sanai system. Extent of resection (EOR) was categorized as total/subtotal or partial. Persistent postoperative neurological deficits were assessed at 90 days. Univariable and multivariable logistic regression analyses were performed to identify factors associated with partial resection. Significant differences in EOR were observed among Berger-Sanai zones (p<0.001). Total or subtotal resection was achieved in 76% of zone I tumors compared with 39% in zone II, 51% in zone III, and 28% in zone IV. Persistent neurological deficits occurred in 13% of patients and were more frequent in zones II-IV. Tumor size and World Health Organization (WHO) grade differed significantly among topographic groups (both p<0.001). In univariable analysis, zones II, III, and IV were associated with partial resection. After adjustment for tumor size and WHO grade, zone II (odds ratio 2.88, 95% confidence interval 1.06-7.84; p=0.037) and zone IV (odds ratio 4.42, 95% confidence interval 1.30-15.10; p=0.017) remained independently associated with partial resection. Because only 22 patients experienced persistent neurological deficits, multivariable analysis was not performed. Berger-Sanai topography was associated with achievable EOR in insular glioma surgery. Zones II and IV demonstrated lower resectability independent of tumor size and WHO grade. These findings should be interpreted within the context of local surgical strategy and available technologies.