Abstract: Objective To indentify the effect and prognosis of patients with high-grade insular glioma by neuro-navigation assisted treatment or iMRi assisted treatment. Methods Clinical data about 56 patients with high-grade gliomas admitted to our hospital from January 2013 to December 2016 were reviewed and analyzed. Then they were classified into neuro-navigation assisted group (n=16)and iMRI assisted group (n=40) according to different surgical treatments. In neuro-navigation assisted group, there were 9 males(56.3%) and 7 females (43.7%), with mean age of (47.0±5.3) years old. In iMRI assisted group, there were 29 males (72.5%) and 11 females (27.5%), with mean age of (51.0±7.1) years old. Extent of resection (EOR), histological pathology, preoperative KPS score and postoperative chemoradiotherapy were compared between two groups, and survival rates including PFS and OS were collected by outpatients follow-up. There was no statistically significant difference in gender, age, tumor side, KPS score, tumor volume and pathology between the two groups. Results Of the 56 cases, 10 (62.5%) cases had complete resection in neuro navigation assisted group, and 37 (92.5%) cases in iMRI assisted group. All patients were followed up for 12-54 months, with mean follow-up of 28 months. iMRI assisted group displayed longer PFS (39.4 months vs 28.5 months, P=0.049) and OS (43.0 months vs 31.0 months, P=0.026). Cox regression analysis revealed surgical method (HR=0.393, P=0.024), extent of resection (HR=0.470, P=0.014), and long term TMZ (HR=0.410, P=0.030) were independent prognostic factors for high-grade insular glioma. Conclusion With the clinical application of new devices such as iMRI, the intraoperative MRI assisted treatment is more effective for patients with highgrade insular glioma with better prognosis.