由于复杂的周围功能和血管解剖结构，岛状胶质瘤带来了重大的手术挑战。作者报告了他们使用激光间质热疗法 (LITT) 治疗岛状神经胶质瘤的新框架的经验，并提供了代表性案例，强调了适应症、基本原理和技术要点。前瞻性收集的机构数据库用于识别新诊断的患者2015 年至 2023 年间接受 LITT 的岛状胶质瘤。拟议的岛状胶质瘤治疗框架以肿瘤大小和岛外肿瘤受累程度为指导。肿瘤局限于岛叶（仅岛叶）的患者接受单次或分期 LITT 治疗。患有额颞叶受累的岛叶肿瘤（岛叶）患者接受岛叶 LITT 和标准额颞叶岛外肿瘤切除术治疗。分析了临床和体积病变特征，特别强调细胞减灭治疗的程度和安全性。在 2015 年至 2023 年间在作者所在机构接受 LITT 治疗的 261 名患者中，确定了 33 例 LITT 手术，涉及 22 名未经治疗的岛叶状肿瘤患者。神经胶质瘤。在 22 名患者中，12 名仅患有岛叶肿瘤，仅接受 LITT 治疗，而 10 名患者患有岛叶病变，接受 LITT 和切除术治疗。仅岛叶肿瘤的中位肿瘤体积为 13.4 cm3（IQR 10.6、26.3 cm3），中位治疗范围为 100%（IQR 92.1%、100%）。岛叶病变明显更大，中位体积为 81.2 cm3（IQR 51.9，97 cm3），中位治疗范围为 96.6%（IQR 93.7%，100%）。所有仅有岛叶肿瘤的患者在消融后第二天就出院了，而岛叶患者的住院时间明显更长，50% 的住院时间超过 3 天。总体而言，8% 的仅岛状患者患有永久性神经功能缺损，而岛状患者的这一比例为 33%。两名患者的肿瘤在随访期间出现进展：一名患者患有 WHO 4 级星形细胞瘤，另一名患者患有未另行说明的弥漫性神经胶质瘤。 4 级肿瘤患者的永久性神经功能缺损率最高 (43%)，术后卡诺夫斯基表现状态评分下降幅度较大 (p = 0.046)。作者介绍了他们使用新型岛状胶质瘤治疗范例的经验，该范例将 LITT 纳入岛状胶质瘤手术的更广泛框架。他们的研究结果表明，岛叶 LITT 是可行的，并且可以实现高细胞减灭率，同时可能降低传统岛叶神经胶质瘤手术的风险。

Insular gliomas pose a significant surgical challenge due to the complex surrounding functional and vascular anatomy. The authors report their experience using a novel framework for the treatment of insular gliomas with laser interstitial thermal therapy (LITT) and provide representative case examples emphasizing indications, rationale, and technical pearls.A prospectively gathered institutional database was used to identify patients with newly diagnosed insular gliomas who underwent LITT between 2015 and 2023. The proposed framework of insular glioma management is guided by tumor size and extent of extra-insular tumor involvement. Patients with tumors localized to the insula (insula-only) were treated with single-session or staged LITT. Patients with insular tumors with frontotemporal involvement (insular+) were treated with insular LITT and standard frontotemporal resection of extra-insular tumor. Clinical and volumetric lesional characteristics were analyzed, with particular emphasis on extent of cytoreductive treatment and safety.Of the 261 patients treated at the authors' institution with LITT between 2015 and 2023, 33 LITT procedures were identified involving 22 unique patients with treatment-naive insular gliomas. Of the 22 patients, 12 had insular-only tumors and were treated with LITT alone, while 10 patients had insular+ lesions and were treated with LITT and resection. The median tumor volume for insular-only tumors was 13.4 cm3 (IQR 10.6, 26.3 cm3), with a median extent of treatment of 100% (IQR 92.1%, 100%). Insular+ lesions were significantly larger, with a median volume of 81.2 cm3 (IQR 51.9, 97 cm3) and median extent of treatment of 96.6% (IQR 93.7%, 100%). All patients with insular-only tumors were discharged the day after ablation, while insular+ patients had significantly longer hospital stays, with 50% staying more than 3 days. Overall, 8% of insular-only patients had permanent neurological deficits compared with 33% of insular+ patients. Two patients' tumors progressed during follow-up: one patient with WHO grade 4 astrocytoma and the other with diffuse glioma not otherwise specified. Patients with grade 4 tumors had the highest rate of permanent neurological deficit (43%) and a larger decline in postoperative Karnofsky Performance Status score (p = 0.046).The authors present their experience using a novel insular glioma treatment paradigm that incorporates LITT into the broader framework of insular glioma surgery. Their findings suggest that insular LITT is feasible and may allow for high rates of cytoreduction while potentially ameliorating the risks of conventional insular glioma surgery.