====== Berger-Sanai classification ======

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Divides the insula into four quadrants using:
  * **Horizontal axis**: The Sylvian fissure
  * **Vertical axis**: The foramen of Monro

  * **Zone I**: Anterior-superior quadrant
  * **Zone II**: Posterior-superior quadrant
  * **Zone III**: Posterior-inferior quadrant
  * **Zone IV**: Anterior-inferior quadrant

**Advantages**:
  * Simple and reproducible using preoperative MRI
  * Correlates well with surgical corridors
  * Helps anticipate surgical risks (e.g., Zone II → higher risk of injury to lenticulostriate arteries)
Based on resectability and functional outcomes for [[insular glioma]]s, and it may be used to predict
PFS and OS
((Sanai N, Polley M-Y, Berger MS: Insular glioma resection:
assessment of patient morbidity, survival, and tumor progression.
Clinical article. J Neurosurg 112:1–9, 2010)).

The Berger-Sanai insular glioma classification system
((Sanai N, Polley M-Y, Berger MS: Insular glioma resection: Assessment of patient morbidity, survival, and tumor progression. J Neurosurg 112(1): 1–9, 2010. Reprinted by permission.)).

A. Zones I to IV are divided along the line of the sylvian fissure and a perpendicular plane crossing the foramen of Monro. 

{{::bergersanaia.png?500|}} 

B. The tumor′s location is determined according to the location of the majority of the tumor mass. 

{{::bergersanaib.png?500|}} 

C. Axial illustrations of zones I and IV, located anterior to the foramen of Monro, and zones II and III, located behind the foramen of Monro

{{::bergersanaic.png|}} 



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Orientation lines

Horizontal plane in sagittal view, bisection line along the sylvian fissure
    
Perpendicular plane intersected at the level of the foramen of Monro

Zones
(existing of the resulting quadrants)

Zone I: anterior-superior
    
Zone II: posterior-superior
    
Zone III: posterior-inferior
    
Zone IV: anterior-inferior

Combinations

for tumors occupying > 1 zone, write e.g. "Zone I + II"
    
tumors occupying all 4 zones are defined as "giant"
((Sanai N, Polley M-Y, Berger MS. Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. J Neurosurg 2010; 112:1-9.)).