Silent aspiration and swallowing safety impairment after insular glioma surgery: a prospective FEES-based study.

BACKGROUND

Postoperative swallowing safety disturbances after insular glioma surgery remain insufficiently characterized, despite the insula's important role in laryngopharyngeal sensorimotor integration, swallowing modulation, and airway-protective responses.

OBJECTIVE

To characterize FEES-based swallowing safety impairment after insular glioma resection.

METHODS

This prospective single-center observational study included 48 consecutive patients who underwent resection of insular gliomas. FEES was performed preoperatively and on postoperative days 3 and 7 in all patients, and additionally at 4 weeks, 3 months, and 6 months in patients with postoperative abnormalities. Silent aspiration was assessed using the Penetration-Aspiration Scale (PAS), pharyngeal residue using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), and secretion management using the Murray Secretion Scale.

RESULTS

Postoperative FEES abnormalities were most pronounced on postoperative day 3 and included penetration, aspiration, silent aspiration, pharyngeal residue, and impaired secretion management. In exploratory subgroup analyses, swallowing safety disturbances appeared more frequent in patients with motor deficits, aphasia, dominant-hemisphere tumors, medial or multilobar extension, and transcortical/combined approaches. Respiratory complications occurred in 8 patients (16.7%) and were associated with silent aspiration and impaired secretion management.

CONCLUSIONS

Silent aspiration and swallowing safety impairment are clinically relevant and underrecognized postoperative abnormalities after insular glioma surgery. These disturbances are most pronounced in the early postoperative period, usually regress during follow-up, but may persist in selected high-risk patients. The findings support consideration of early, structured FEES-based postoperative assessment to detect clinically occult swallowing safety abnormalities; because this observational design cannot establish that routine FEES improves clinical outcomes, prospective outcome-based studies are warranted.