Systematic Review: Transylvian Approach for Insular Cortex Tumour Resection Using a Selective Strategy for Four Zones of the Insula

https://doi.org/10.66715/ijcar/2026v2.i1.3745 | Review Paper | 2026 | Volume 2 | Issue 1 | Page 37-45

Systematic Review Transylvian Approach for Insular Cortex Tumour Resection Using a Selecti.

Download • 239KB

1. Dr Jaya Deshmukh, Demonstrator, Department of Anatomy Gandhi medical College Bhopal, Assistant State Nodal MEU DME Madhya Pradesh Bhopal

2. Dr Vandana Sharma, Professor Head of the Department Anatomy, Gandhi medical College Bhopal

3. Dr. Deepak Sharma, Assistant Professor, Department of Anatomy, Gandhi Medical College Hamidia Hospital, Bhopal

4. Dr Vidhatri TiwariAssociate Professor  Department of Public Health Dentistry Government Dental College Indore . Joint Director DME Madhya Pradesh Bhopal.

5. Dr Abhimanu Kumar, Associate Professor, Department of Anatomy, JHMCRI, Raghunathgunj, WB

Corresponding Author 

Dr Jaya Deshmukh,

Demonstrator, Department of Anatomy

Gandhi medical College Bhopal,

Assistant State Nodal MEU DME Madhya Pradesh Bhopal

Abstract

The insular cortex remains one of the most neurosurgicaly challenging regions due to its deep location, proximity to the M1 and M2 segments of the middle cerebral artery (MCA), and its intimate relationship with the internal capsule and basal ganglia. While various approaches exist, the transylvian approach offers a direct corridor, though it requires meticulous dissection to avoid vascular and functional morbidity.

Objective:

To systematically review the efficacy and safety of the transylvian approach for insular tumor resection, specifically focusing on the "Selective Strategy" based on the four-zone classification of the insula.

Methods:

A systematic search was conducted across PubMed, Embase, and Scopus for studies published through 2025. Inclusion criteria focused on adult patients with insular gliomas where a transylvian approach was employed using a zone-based strategy (Zones I–IV). Primary outcomes included extent of resection (EOR) and postoperative neurological deficits. Secondary outcomes included vascular complications and overall survival.

Results: Analysis of the pooled data reveals that a selective transylvian strategy—tailoring the sylvian fissure opening to the specific zone involved—significantly optimizes EOR while preserving the opercular cortex.

●     Zone I (Anterocranial) and Zone IV (Posterocranial): Higher rates of gross total resection (GTR) were observed when utilizing the selective transylvian corridor.

●     Zones II and III: Showed a higher risk of transient motor deficits due to the density of lenticulostriate arteries and proximity to the corticospinal tract.

●     The review indicates that the use of intraoperative neuromonitoring (IONM) and subcortical stimulation in conjunction with the selective transylvian approach reduced permanent morbidity to less than 5% across the studied cohorts.

Conclusion: The selective transylvian approach, guided by the four-zone anatomical classification, provides a safe and effective framework for maximizing resection in insular tumors. By limiting the dissection to the specific zone of involvement, surgeons can achieve high EOR while minimizing the "surgical footprint" and protecting critical vascular and white matter structures.