In summary, lesions located in the insular region occur more commonly in young patients. Epilepsy is the primary symptom and may be cured after tumor resection. The majority of the lesions are low-grade gliomas and other benign tumors. Surgical treatment of these lesions has prominent clinical significance. In order to decrease the rate of complications, we prefer a standard pterional approach, splitting the sylvian fissure along its full length. The key points to remember during this operative procedure include identifying carefully the periinsular sulci and the LLAs, carefully protecting the middle cerebral artery, and minimizing retraction of the frontal and temporal opercula. How exactly to determine the depth of tumor resection remains to be studied.