Objective To investigate the clinical efficacy of neurophysiological monitoring and intraoperative color Doppler ultrasound-assisted microsurgery via lateral fissure approach in the treatment of insular glioma.Methods A total of 21 patients with insular glioma who underwent neurophysiological monitoring and intraoperative color Doppler ultrasound-assisted microsurgery via lateral fissure approach from January 2015 to January 2018 were included in the study as observation group. And 19 patients with insular glioma who underwent microsurgery via cortical approach without neurophysiological monitoring and intraoperative color Doppler ultrasound from January 2013 to December 2014 were selected as control group. For the observation group, intraoperative neuroelectrophysiology was used to monitor the integrity of motor and sensory pathways in real time, and intraoperative color Doppler ultrasound was used to locate tumors in real time and to confirm tumor resection. Microsurgery via lateral fissure approach using modified or extended pterional approach was used to remove tumors.Results According to imaging analysis before and after surgery, the observation group had a significantly higher total resection rate than the control group (66.66% vs 15.79%). In the observation group, four patients had contralateral motor dysfunction after surgery; at one month after surgery, three patients recovered completely and one patient had long-term motor dysfunction. Three patients had language dysfunction after surgery; at one month after surgery, two patients recovered to the preoperative level and one patient improved significantly. The patients with sensorimotor impairment and language dysfunction before surgery had different degrees of improvement after surgery.Conclusions Neurophysiological monitoring and intraoperative color Doppler ultrasound-assisted microsurgery via lateral fissure approach can increase the safety factor and total resection rate in the treatment of insular glioma and has satisfactory efficacy. And it can effectively protect the surrounding important structures and blood vessels while completely removing tumors and reduce the incidence of postoperative complications.