Potential predictors of awake surgery failure for insular glioma.

To accomplish maximal safe resection for insular glioma (IG), we perform awake surgery (AS) for IG. The aim of our study was to identify potential predictors of AS failure for IG. We retrospectively reviewed the records of 24 patients with IGs who underwent resection between January 2014 and April 2024. Their baseline characteristics and clinical outcomes were examined and we analysed the factors associated with AS failure. AS was planned and performed successfully in 13 cases (the AS group). In five cases, AS was planned but failed due to sleepiness or delayed awakening. AS was not planned in six cases. These 11 cases were assigned to the non-AS (NAS) group. The median extent of tumor resection was 87.7% in the AS group vs. 58.0% in the NAS group (p = 0.004). There were no cases with postoperative permanent neurological deficits in both groups. Basal ganglionic involvement, which means the high-intensity area on Fluid Attenuated Inversion Recovery imaging is found in the basal ganglia consisting of the striatum and globus pallidus, was significantly associated with AS failure. AS contributes significantly to the maximal resection of IG. Basal ganglionic involvement is a potential predictor of AS failure for IG.