title: Second Surgery in Insular Low-Grade Gliomas.
abstract: BACKGROUND
  Given the technical difficulties, a limited number of works have been published on insular gliomas surgery and risk factors for tumor recurrence (TR) are poorly documented.
  
  
  OBJECTIVE
  The aim of the study was to determine TR in adult patients with initial diagnosis of insular Low-Grade Gliomas (LGGs) that subsequently underwent second surgery.
  
  
  METHODS
  A consecutive series of 53 patients with insular LGGs was retrospectively reviewed; 23 patients had two operations for TR.
  
  
  RESULTS
  At the time of second surgery, almost half of the patients had experienced progression into high-grade gliomas (HGGs). Univariate analysis showed that TR is influenced by the following: extent of resection (EOR) (P < 0.002), ΔVT2T1 value (P < 0.001), histological diagnosis of oligodendroglioma (P = 0.017), and mutation of IDH1 (P = 0.022). The multivariate analysis showed that EOR at first surgery was the independent predictor for TR (P < 0.001).
  
  
  CONCLUSIONS
  In patients with insular LGG the EOR at first surgery represents the major predictive factor for TR. At time of TR, more than 50% of cases had progressed in HGG, raising the question of the oncological management after the first surgery.
authors.affiliation: Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Tamara
authors.initials: T
authors.lastname: Ius
authors.affiliation: Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Pauletto
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Cesselli
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Isola
authors.affiliation: Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Turella
authors.affiliation: Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Budai
authors.affiliation: Surgical Pathology Department, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: DeMaglio
authors.affiliation: Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Eleopra
authors.affiliation: Robotics, Brain and Cognitive Sciences Department, Italian Institute of Technology, Genoa, Italy ; Section of Human Physiology, University of Ferrara, Ferrara, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Fadiga
authors.affiliation: Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Lettieri
authors.affiliation: Surgical Pathology Department, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pizzolitto
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Beltrami
authors.affiliation: Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
authors.forename: Miran
authors.initials: M
authors.lastname: Skrap
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography