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Marino S, Dannhoff G, Destrieux C, Maldonado IL. Frontal trans opercular approaches to the insula: building the mental picture from procedure-guided anatomical dissection. Surg Radiol Anat 2024; 46:1331-1344. [PMID: 38871860 DOI: 10.1007/s00276-024-03409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Performing transopercular frontal approaches to the insula, widely used in glioma surgeries, necessitates a meticulous understanding of both cortical and subcortical neuroanatomy. This precision is vital for preserving essential structures and accurately interpreting the results of direct electrical stimulation. Nevertheless, acquiring a compelling mental image of the anatomy of this region can be challenging due to several factors, among which stand out its complexity and the fact that white matter fasciculi are imperceptible to the naked eye in the living brain. AIM In an effort to optimize the study of the anatomy relevant to this topic, we performed a procedure-guided laboratory study using subpial dissection, fiber dissection, vascular coloration, and stereoscopic photography in a "real-life" surgical perspective. METHODS Nine cerebral specimens obtained from body donation were extracted and fixed in formalin. Colored silicone injection and a variant of Klinglers's technique were used to demonstrate vascular and white matter structures, respectively. We dissected and photographed the specimens in a supero-antero-lateral view to reproduce the surgeon's viewpoint. The anatomy related to the development of the surgical corridor and resection cavity was documented using both standard photography and the red-cyan anaglyph technique. RESULTS The anatomy of frontal transopercular approaches to the insula involved elements of different natures-leptomeningeal, cortical, vascular, and fascicular-combining in the surgical field in a complex disposition. The disposition of these structures was successfully demonstrated through the aforementioned anatomical techniques. Among the main structures in or around the surgical corridor, the orbital, triangular, and opercular portions of the inferior frontal gyrus are critical landmarks in the cortical stage, as well as the leptomeninges of the Sylvian fissure and the M2-M4 branches of the middle cerebral artery in the subpial dissection stage, and the inferior fronto-occipital, uncinate and arcuate fasciculi, and the corona radiata in establishing the deep limits of resection. CONCLUSIONS Procedure-guided study of cerebral hemispheres associating subpial, vascular, and fiber dissection from a surgical standpoint is a powerful tool for the realistic study of the surgical anatomy relevant to frontal transopercular approaches to the insula.
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Affiliation(s)
- Salvatore Marino
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
- INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Université de Tours, Tours, France
| | - Guillaume Dannhoff
- INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Université de Tours, Tours, France
- CHRU de Strasbourg, Strasbourg, France
| | - Christophe Destrieux
- INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Université de Tours, Tours, France
- CHRU de Tours, Tours, France
| | - Igor Lima Maldonado
- INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Université de Tours, Tours, France.
- CHRU de Tours, Tours, France.
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Xue B, Hou Z, Deng Z, Sun S, Zhang C, Pan Y, Zhang Y, Li Z, Xie J. Survival outcome and predictors of WHO grade 2 and 3 insular gliomas: A classification based on the tumor spread. Cancer Med 2024; 13:e7377. [PMID: 38850123 PMCID: PMC11161818 DOI: 10.1002/cam4.7377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/06/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE The study aimed to identify if clinical features and survival outcomes of insular glioma patients are associated with our classification based on the tumor spread. METHODS Our study included 283 consecutive patients diagnosed with histological grade 2 and 3 insular gliomas. A new classification was proposed, and tumors restricted to the paralimbic system were defined as type 1. When tumors invaded the limbic system (referred to as the hippocampus and its surrounding structures in this study) simultaneously, they were defined as type 2. Tumors with additional internal capsule involvement were defined as type 3. RESULTS Tumors defined as type 3 had a higher age at diagnosis (p = 0.002) and a higher preoperative volume (p < 0.001). Furthermore, type 3 was more likely to be diagnosed as IDH wild type (p < 0.001), with a higher rate of Ki-67 index (p = 0.015) and a lower rate of gross total resection (p < 0.001). Type 1 had a slower tumor growth rate than type 2 (mean 3.3%/month vs. 19.8%/month; p < 0.001). Multivariate Cox regression analysis revealed the extent of resection (HR 0.259, p = 0.004), IDH status (HR 3.694, p = 0.012), and tumor spread type (HR = 1.874, p = 0.012) as independent predictors of overall survival (OS). Tumor grade (HR 2.609, p = 0.008), the extent of resection (HR 0.488, p = 0.038), IDH status (HR 2.225, p = 0.025), and tumor spread type (HR 1.531, p = 0.038) were significant in predicting progression-free survival (PFS). CONCLUSION The current study proposes a classification of the insular glioma according to the tumor spread. It indicates that the tumors defined as type 1 have a relatively better nature and biological characteristics, and those defined as type 3 can be more aggressive and refractory. Besides its predictive value for prognosis, the classification has potential value in formulating surgical strategies for patients with insular gliomas.
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Affiliation(s)
- Bowen Xue
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Zonggang Hou
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Zhenghai Deng
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Shengjun Sun
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Department of RadiologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Chuanhao Zhang
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yuesong Pan
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yazhuo Zhang
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Beijing Neurosurgical Institute, Capital Medical UniversityBeijingChina
| | - Zhenye Li
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Jian Xie
- Department of NeurosurgeryBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
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d'Orio P, Squarza S, Revay M, Cardinale F, Castana L, Sartori I, Tassi L, Lo Russo G, Cossu M. Neurological morbidity of surgery for suprasylvian operculoinsular epilepsy. Epilepsia 2024; 65:402-413. [PMID: 38041557 DOI: 10.1111/epi.17844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE The objective of this study was to identify risk factors associated with surgery-related neurological morbidity in patients with drug-resistant epilepsy undergoing suprasylvian operculoinsular resections. As secondary outcomes, we also analyzed the risk factors for ischemic lesion (IL) of corona radiata and seizure recurrence. METHODS A retrospective analysis was conducted on a cohort of patients who underwent suprasylvian operculoinsular resections for drug-resistant epilepsy. The association of several presurgical, surgical, and postsurgical factors with both primary (persistent neurological deficits) and secondary (structural abnormalities on postoperative magnetic resonance imaging [MRI] and seizure recurrence) postoperative outcomes was investigated with univariate and multivariate statistical analysis. RESULTS The study included a total of 65 patients; 46.2% of patients exhibited postoperative neurological deficits, but only 12.3% experienced persistent deficits. On postoperative MRI, IL in the corona radiata and corticospinal tract Wallerian degeneration (CSTWd) were seen in 68% and 29% of cases, respectively. Only CSTWd was significantly associated with persistent neurological deficits (relative risk [RR] = 2.6). Combined operculoinsular resection (RR = 3.62) and surgery performed on the left hemisphere (RR = .37) were independently associated with IL in the corona radiata. Variables independently associated with CSTWd were the presence of malacic components in the IL (RR = 1.96), right central operculum resection (RR = 1.79), and increasing age at surgery (RR = 1.03). Sixty-two patients had a postoperative follow-up > 12 months (median = 56, interquartile range = 30.75-73.5), and 62.9% were in Engel class I at last outpatient control. The risk of seizure recurrence was reduced by selective opercular resection (RR = .25) and increased by the histological diagnosis of aspecific gliosis (RR = 1.39). SIGNIFICANCE This study provides insights into the risk factors associated with surgery-related neurological morbidity, as well as further evidence on the postoperative occurrence of subcortical injury and seizure recurrence in epileptic patients undergoing suprasylvian operculoinsular resections. The findings highlighted in this study may be useful to better understand the processes supporting the increased surgical risk in the operculoinsular region.
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Affiliation(s)
- Piergiorgio d'Orio
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Silvia Squarza
- Neuroradiology Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Revay
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Francesco Cardinale
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Laura Castana
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ivana Sartori
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Ikegaya N, Hayashi T, Higashijima T, Takayama Y, Sonoda M, Iwasaki M, Miyake Y, Sato M, Tateishi K, Suenaga J, Yamamoto T. Arteries Around the Superior Limiting Sulcus: Motor Complication Avoidance in Insular and Insulo-Opercular Surgery. Oper Neurosurg (Hagerstown) 2023; 25:e308-e314. [PMID: 37966479 DOI: 10.1227/ons.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Insulo-opercular surgery can cause ischemic motor complications. A source of this is the arteries around the superior limiting sulcus (SLS), which reach the corona radiata, but the detailed anatomy remains unclear. To characterize arteries around the SLS including the long insular arteries (LIAs) and long medullary arteries, we classified them and examined their distribution in relation to the SLS, which helps reduce the risk of ischemia. METHODS Twenty adult cadaveric hemispheres were studied. Coronal brain slices were created perpendicular to the SLS representing insular gyri (anterior short, middle short, posterior short, anterior long, and posterior long). The arteries within 10-mm proximity of the SLS that reached the corona radiata were excavated and classified by the entry point. RESULTS A total of 122 arteries were identified. Sixty-three (52%), 20 (16%), and 39 (32%) arteries penetrated the insula (LIAs), peak of the SLS, and operculum (long medullary arteries), respectively. 100 and six (87%) arteries penetrated within 5 mm of the peak of the SLS. The arteries were distributed in the anterior short gyrus (19%), middle short gyrus (17%), posterior short gyrus (20%), anterior long gyrus (19%), and posterior long gyrus (25%). Seven arteries (5.7%) had anastomoses after they penetrated the parenchyma. CONCLUSION Approximately 90% of the arteries that entered the parenchyma and reached the corona radiata were within a 5-mm radius of the SLS in both the insula and operculum side. This suggests that using the SLS as a landmark during insulo-opercular surgery can decrease the chance of ischemia.
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Affiliation(s)
- Naoki Ikegaya
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Takahiro Hayashi
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Takefumi Higashijima
- Department of Neurosurgery, Yokohama City University Medical center, Yokohama , Japan
| | - Yutaro Takayama
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Masaki Sonoda
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Kodaira , Japan
| | - Yohei Miyake
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Mitsuru Sato
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Kensuke Tateishi
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Jun Suenaga
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate school of medicine, Yokohama , Japan
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Osada Y, Kanamori M, Osawa SI, Kayano S, Uchida H, Shimoda Y, Mugikura S, Tominaga T, Endo H. Visualization of the lenticulostriate arteries, long insular arteries, and long medullary arteries on intra-arterial computed tomography angiography with ultrahigh resolution in patients with glioma. Acta Neurochir (Wien) 2023; 165:4213-4219. [PMID: 37726426 PMCID: PMC10739552 DOI: 10.1007/s00701-023-05794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The anatomical association between the lesion and the perforating arteries supplying the pyramidal tract in insulo-opercular glioma resection should be evaluated. This study reported a novel method combining the intra-arterial administration of contrast medium and ultrahigh-resolution computed tomography angiography (UHR-IA-CTA) for visualizing the lenticulostriate arteries (LSAs), long insular arteries (LIAs), and long medullary arteries (LMAs) that supply the pyramidal tract in two patients with insulo-opercular glioma. METHODS This method was performed by introducing a catheter to the cervical segment of the internal carotid artery. The infusion rate was set at 3 mL/s for 3 s, and the delay time from injection to scanning was determined based on the time-to-peak on angiography. On 2- and 20-mm-thick UHR-IA-CTA slab images and fusion with magnetic resonance images, the anatomical associations between the perforating arteries and the tumor and pyramidal tract were evaluated. RESULTS This novel method clearly showed the relationship between the perforators that supply the pyramidal tract and tumor. It showed that LIAs and LMAs were far from the lesion but that the proximal LSAs were involved in both cases. Based on these results, subtotal resection was achieved without complications caused by injury of perforators. CONCLUSION UHR-IA-CTA can be used to visualize the LSAs, LIAs, and LMAs clearly and provide useful preoperative information for insulo-opercular glioma resection.
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Affiliation(s)
- Yoshinari Osada
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan.
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan.
| | - Shingo Kayano
- Department of Radiological Technology, Tohoku University Hospital, Tohoku University, Sendai, Miyagi, Japan
| | - Hiroki Uchida
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshiteru Shimoda
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
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Hou Z, Huang Z, Li Z, Deng Z, Li G, Xu Y, Wang M, Sun S, Zhang Y, Qiao H, Xie J. Incidence of ischemic complications and technical nuances of arteries preservation for insular gliomas resection. Front Surg 2022; 9:956872. [PMID: 36311934 PMCID: PMC9614341 DOI: 10.3389/fsurg.2022.956872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Insular gliomas have complex anatomy and microvascular supply that make resection difficult. Furthermore, resection of insular glioma is associated with a significant risk of postoperative ischemic complications. Thus, this study aimed to assess the incidence of ischemic complications related to insular glioma resection, determine its risk factors, and describe a single surgeon's experience of artery-preserving tumor resection. Methods We enrolled 75 consecutive patients with insular gliomas who underwent transcortical tumor resection. Preoperative and postoperative demographic, clinical, radiological [including diffusion-weighted imaging (DWI)], intraoperative neurophysiological data, and functional outcomes were analyzed. Motor evoked potentials (MEPs) and radiological characteristics like the relationship between the proximal segment of the lateral lenticulostriate arteries (LLSAs) and the tumor, the flat inner edge sign (the inner edge of the insular glioma is well-defined) or obscure inner edge sign, the distance between the lesion and posterior limb of the internal capsule and the invasion of the superior limiting sulcus by the tumor were analyzed. Strategies such as "residual triangle," "basal ganglia outline reappearance," and "sculpting" technique were used to preserve the LLSAs and the main branches of M2 for maximal tumor resection according to the Berger-Sinai classification. Results Postoperative DWI showed acute ischemia in 44 patients (58.7%). Moreover, nine patients (12%) had developed new motor deficits, as determined by the treating neurosurgeons. The flat inner edge sign [odds ratio (OR), 0.144; 95% confidence interval (CI), 0.024-0.876) and MEPs (>50%) (OR, 18.182; 95% CI, 3.311-100.00) were significantly associated with postoperative core ischemia, which affected the posterior limb of the internal capsule or corona radiata. Conclusions Insular glioma resection was associated with a high incidence of ischemia, as detected by DWI, as well as new motor deficits that were determined by the treating neurosurgeons. Insular glioma patients with obscure inner edge signs and intraoperative MEPs decline >50% had a higher risk of developing core ischemia. With our strategies, maximal safe resection of insular gliomas may be achieved.
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Affiliation(s)
- Zonggang Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhenxing Huang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhenye Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhenghai Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gen Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaokai Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingran Wang
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Neuroimaging Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China,Correspondence: Jian Xie Hui Qiao
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Correspondence: Jian Xie Hui Qiao
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Isolan GR, Buffon V, Maldonado I, Monteiro JM, Yağmurlu K, Ribas CAPM, Roesler R, Malafaia O. Avoiding vascular complications in insular glioma surgery – A microsurgical anatomy study and critical reflections regarding intraoperative findings. Front Surg 2022; 9:906466. [PMID: 35990093 PMCID: PMC9388914 DOI: 10.3389/fsurg.2022.906466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionVascular lesions in insular glioma surgery can severely impact patients&apos; quality of life. This study aims to present the results of our dissections and authors’ reflections on the insular vascular anatomy.Matherials and MethodsThe insular vascularization was examined using ×3 to ×40 magnification in 20 cadaveric cerebral hemispheres in which the arteries and veins had been perfused with colored silicone.ResultsIn insular gliomas, this individualization of the anatomical structures is rarely possible, as the gyri are swollen by the tumor and lose their individuality. In the transsylvian approaches, the anatomical parameters for delimiting the insula in tumors are best provided by the superior and inferior circular sulci. The branches of the MCA are easily identified in the transcortical approach, but only at the end of the surgery after the tumor is resected.). One of the factors under-discussed in the literature is the involvement of the lenticulostriate arteries by the medial part of the tumor. In our experience of 52 patients (article submitted to publishing), LSTa were founded to be involved by the tumor in 13 cases. In 39 patients, there was no involvement of the LSTa, which allowed a more aggressive resection. Early preoperative identification of the anterior perforated substance on the MRI and its proximity to the tumor may help determine the route of the LSTa over the medial tumor boundaries.DiscussionOur reflections introduced our imaging and anatomical concept regarding LSTa in insular glioma surgery. Accurate identification of origin, route, and distribution of the LSTa is pivotal to surgical success, especially in the lateral group. The anatomical knowledge of their path directly impacts the extent of tumor resection and functional preservation.ConclusionKnowledge of microsurgical anatomy, brain mapping, and surgical experience counts a lot in this type of surgery, creating a reasonable procedure flowchart to be taken intraoperatively.
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Affiliation(s)
- Gustavo Rassier Isolan
- The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, RS, Brazil
- Mackenzie Evangelical Faculty of Paraná, Curitiba, PR, Brazil
- Correspondence: Gustavo Rassier Isolan
| | - Viviane Buffon
- The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, RS, Brazil
- Mackenzie Evangelical Faculty of Paraná, Curitiba, PR, Brazil
| | - Igor Maldonado
- U1253, iBrain (I.L.M.), Université de Tours, Institut National de la Santé et de la Recherche Médicale, Tours, France
- Groupe Hospitalier Universitaire Paris, Paris, France
| | - Jander Moreira Monteiro
- The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, RS, Brazil
- Mackenzie Evangelical Faculty of Paraná, Curitiba, PR, Brazil
| | - Kaan Yağmurlu
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | | | - Rafael Roesler
- Department of Pharmacology, Institute for Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Michele R, Ivana S, Maria DV, Luca B, Domenico L, Maria ZF, Alessandro DB, Silvio S, Khalid AO, Valeria M, Pietro A. Tracing in vivo the dorsal loop of the optic radiation: convergent perspectives from tractography and electrophysiology compared to a neuroanatomical ground truth. Brain Struct Funct 2022; 227:1357-1370. [PMID: 35320828 DOI: 10.1007/s00429-021-02430-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/12/2021] [Indexed: 01/18/2023]
Abstract
The temporo-parietal junction (TPJ) is a cortical area contributing to a multiplicity of visual, language-related, and cognitive functions. In line with this functional richness, also the organization of the underlying white matter is highly complex and includes several bundles. The few studies tackling the outcome and neurological burdens of surgical operations addressing TPJ document the presence of language disturbances and visual field damages, with the latter hardly recovered in time. This observation advocates for identifying and functionally monitoring the optic radiation (OR) bundles that cross the white matter below the TPJ. In the present study, we adopted a multimodal approach to address the anatomo-functional correlates of the OR's dorsal loop. In particular, we combined cadavers' dissection with tractographic and electrophysiological data collected in drug-resistant epileptic patients explored by stereoelectroencephalography (SEEG). Cadaver dissection allowed us to appreciate the course and topography of the dorsal loop. More surprisingly, both tractographic and electrophysiological observations converged on a unitary picture highly coherent with the data obtained by neuroanatomical observation. The combination of diverse and multimodal observations allows overcoming the limitations intrinsic to single methodologies, defining a unitary picture which makes it possible to investigate the dorsal loop both presurgically and at the individual patient level, ultimately contributing to limit the postsurgical damages. Notwithstanding, such a combined approach could serve as a model of investigation for future neuroanatomical inquiries tackling white matter fibers anatomy and function through SEEG-derived neurophysiological data.
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Affiliation(s)
- Rizzi Michele
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy
| | - Sartori Ivana
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy.
| | - Del Vecchio Maria
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy
| | - Berta Luca
- Department of Medical Physics, ASST GOM Niguarda, Milan, Italy
| | - Lizio Domenico
- Department of Medical Physics, ASST GOM Niguarda, Milan, Italy
| | - Zauli Flavia Maria
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - De Benedictis Alessandro
- Department of Neurosciences, Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sarubbo Silvio
- Department of Neurosurgery, Ospedale Santa Chiara, Trento, Italy
| | - Al-Orabi Khalid
- "C.Munari" Epilepsy Surgery Centre, ASST GOM Niguarda, Piazza Dell'Ospedale Maggiore, 20162, Milan, Italy
| | - Mariani Valeria
- Neurology and Stroke Unit, ASST Sette Laghi-Ospedale di Circolo, Varese, Italy
| | - Avanzini Pietro
- Institute of Neuroscience, National Research Council of Italy, Parma, Italy
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9
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Shen J, Guo F, Yang P, Xu F. Influence of hypertension classification on hypertensive intracerebral hemorrhage location. J Clin Hypertens (Greenwich) 2021; 23:1992-1999. [PMID: 34608743 PMCID: PMC8630601 DOI: 10.1111/jch.14367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/17/2021] [Accepted: 09/03/2021] [Indexed: 01/01/2023]
Abstract
The authors sought to explore whether hypertension classification was risk factor for lobar and non‐lobar hypertensive intracerebral hemorrhage (HICH) and the prognosis in patients with hematoma. This retrospective cohort study was conducted on HICH patients admitted at the First Affiliated Hospital of Soochow University. Observations with first‐ever intracerebral hemorrhage (ICH) were recruited. The authors divided the brain image into three groups according to the location of ICH to predict whether there were significant differences between lobar and non‐lobar ICH. A Mann‐Whitney U test was used and this retrospective trial also compared the operation and mortality rates. Our cohort included 209 patients (73.7% male; median age:60.5±16.7). The overall incidence of lobar HICH was less than non‐lobar HICH (24.4% vs. 68.4%), 7.2% cases of mixed HICH was included in this analysis. In a Mann‐Whitney U test analyze, it indicated that there were significant differences in hypertension classification between lobar and non‐lobar HICH (Z = ‐3.3, p<.05). And the percentage of hematoma in lobar areas with relatively slightly high blood pressure (BP) (high normal and grade 1 hypertension) accounts for 52.9% versus 30.1% in non‐lobar areas. The increasing trends of the prevalent rate of lobar ICH with BP rising were not remarkable. The non‐lobar HICH showed a sharper increase in the condition of grade 3 hypertension compared with lobar HICH. During the period of research, the fatality of lobar hemorrhage was 2.9% versus 7.7% (non‐lobar). Besides, the fatality incidence of HICH with relatively slightly high BP (high normal and grade 1 hypertension) was lower than poorly controlled hypertensive patients (grade 2 and grade 3 hypertension). (8.0% vs. 15.7%). The increase of hypertension classification will aggravate the occurrence of non‐lobar ICH and positively corrected with BP, but not in lobar areas. It is essential to understand the distinction influence of hypertension classification between lobar and non‐lobar ICH.
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Affiliation(s)
- Jun Shen
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - FengBao Guo
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Xu
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
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10
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Kim EH, Yoo J, Jung IH, Oh JW, Kim JS, Yoon JS, Moon JH, Kang SG, Chang JH, Roh TH. Endoscopic transorbital approach to the insular region: cadaveric feasibility study and clinical application (SevEN-005). J Neurosurg 2021; 135:1164-1172. [PMID: 33482646 DOI: 10.3171/2020.8.jns202255] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The insula is a complex anatomical structure. Accessing tumors in the insula remains a challenge due to its anatomical complexity and the high chance of morbidity. The goal of this study was to evaluate the feasibility of an endoscopic transorbital approach (ETOA) to the insular region based on a cadaveric study. METHODS One cadaveric head was used to study the anatomy of the insula and surrounding vessels. Then, anatomical dissection was performed in 4 human cadaveric heads using a dedicated endoscopic system with the aid of neuronavigation guidance. To assess the extent of resection, CT scanning was performed before and after dissection. The insular region was directly exposed by a classic transcranial approach to check the extent of resection from the side with a classic transcranial approach. RESULTS The entire procedure consisted of two phases: an extradural orbital phase and an intradural sylvian phase. After eyelid incision, the sphenoid bone and orbital roof were extensively drilled out with exposure of the frontal and temporal dural layers. After making a dural window, the anterior ramus of the sylvian fissure was opened and dissected. The M2 segment of the middle cerebral artery (MCA) was identified and traced posterolaterally. A small corticectomy was performed on the posterior orbital gyrus. Through the window between the lateral lenticulostriate arteries and M2, the cortex and medulla of the insula were resected in an anteroposterior direction without violation of the M2 segment of the MCA or its major branches. When confirmed by pterional craniotomy, the sylvian fissure and the MCA were found to be anatomically preserved. After validation of the feasibility and safety based on a cadaveric study, the ETOA was successfully performed in a patient with a high-grade glioma (WHO grade III) in the right insula. CONCLUSIONS The transorbital route can be considered a potential option to access tumors located in the insula. Using an ETOA, the MCA and its major branches were identified and preserved while removal was performed along the long axis of the insula. In particular, lesions in the anterior part of the insula are most benefited by this approach. Because this approach was implemented in only one patient, additional discussion and further verification is required.
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Affiliation(s)
- Eui Hyun Kim
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
- 2Brain Tumor Center, Severance Hospital, Seoul
| | - Jihwan Yoo
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
| | - In-Ho Jung
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
| | - Ji Woong Oh
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
| | - Ju-Seong Kim
- 3Department of Neurosurgery, Ewha Seoul Hospital, Ewha Womans University College of Medicine, Seoul
| | - Jin Sook Yoon
- 4Department of Ophthalmology, Yonsei University College of Medicine, Seoul; and
| | - Ju Hyung Moon
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
- 2Brain Tumor Center, Severance Hospital, Seoul
| | - Seok-Gu Kang
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
- 2Brain Tumor Center, Severance Hospital, Seoul
| | - Jong Hee Chang
- 1Department of Neurosurgery, Yonsei University College of Medicine, Seoul
- 2Brain Tumor Center, Severance Hospital, Seoul
| | - Tae Hoon Roh
- 5Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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11
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Vogels V, Dammers R, van Bilsen M, Volovici V. Deep Cerebral Perforators: Anatomical Distribution and Clinical Symptoms: An Overview. Stroke 2021; 52:e660-e674. [PMID: 34311568 DOI: 10.1161/strokeaha.120.034096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The anatomic distribution of the deep cerebral perforators is considered either a given or subject to enormous variability. Most published overviews on this topic only report findings from a limited number of anatomic dissections, and no attempt has been made to date to provide a comprehensive overview of all published data. A comprehensive literature search was performed on MEDLINE, Embase, and Google Scholar with the help of an information specialist. Three types of studies were included: (1) articles that described the anatomy and distribution territories of perforator groups arising from the arteries of the circle of Willis; (2) studies that evaluated the anatomy of the deep cerebral perforators using imaging techniques; and (3) studies that evaluated either microsurgically or radiologically confirmed perforator occlusion and reported the (magnetic resonance imaging-confirmed) distribution territory of the infarction together with a description of the clinical symptoms associated as a result of the infarction. A total of 2715 articles were screened and 53 were included. Of these, 40 dealt with the anatomic and imaging anatomy of perforator groups (37 reported results of dissections and 3 results of imaging studies), with a total of 2421 hemispheres investigated. Another 13 articles with 680 patients were included that evaluated perforator infarction territories. The deep cerebral perforator distribution shows large variability with poor concordance rates among reported studies, with the exception of the posterior communicating and anterior choroidal artery perforators. Despite the assumption that cerebral perforator anatomy is a given, studies show large variability in the anatomic distribution of various perforator groups. Perforator anatomy and relationships between perforator groups, as well as potential collateral circulation in these territories should be prioritized as a research topic in cerebrovascular disease in the near future.
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Affiliation(s)
- Valerie Vogels
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC Rotterdam, the Netherlands (V.Vogels, R.D., V.Volovici).,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands (M.v.B.)
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC Rotterdam, the Netherlands (V.Vogels, R.D., V.Volovici).,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands (M.v.B.)
| | - Martine van Bilsen
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC Rotterdam, the Netherlands (V.Vogels, R.D., V.Volovici).,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands (M.v.B.)
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC Rotterdam, the Netherlands (V.Vogels, R.D., V.Volovici).,Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands (M.v.B.)
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12
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Shibahara I, Sato S, Hide T, Saito R, Kanamori M, Sonoda Y, Tominaga T, Kumabe T. Postcentral gyrus resection of opercular gliomas is a risk factor for motor deficits caused by damaging the radiologically invisible arteries supplying the descending motor pathway. Acta Neurochir (Wien) 2021; 163:1269-1278. [PMID: 33537863 DOI: 10.1007/s00701-021-04737-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postoperative motor deficits are among the worst morbidities of glioma surgery. We aim to investigate factors associated with postoperative motor deficits in patients with frontoparietal opercular gliomas. METHODS Thirty-four patients with frontoparietal opercular gliomas were retrospectively investigated. We examined the postoperative ischemic changes and locations obtained from MRI. RESULTS Twenty-one patients (62%) presented postoperative ischemic changes. Postoperative MRI was featured with ischemic changes, all located at the subcortical area of the resection cavity. Six patients had postoperative motor deficits, whereas 28 patients did not. Compared to those without motor deficits, those with motor deficits were associated with old age, pre- and postcentral gyri resection, and postcentral gyrus resection (P = 0.023, 0,024, and 0.0060, respectively). A merged image of the resected cavity and T1-weighted brain atlas of the Montreal Neurological Institute showed that a critical area for postoperative motor deficits is the origin of the long insular arteries (LIAs) and the postcentral gyrus. Detail anatomical architecture created by the Human Connectome Project database and T2-weighted images showed that the subcortical area of the operculum of the postcentral gyrus is where the medullary arteries supply, and the motor pathways originated from the precentral gyrus run. CONCLUSIONS We verified that the origin of the LIAs could damage the descending motor pathways during the resection of frontoparietal opercular gliomas. Also, we identified that motor pathways run the subcortical area of the operculum of the postcentral gyrus, indicating that the postcentral gyrus is an unrecognized area of damaging the descending motor pathways.
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Affiliation(s)
- Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Sumito Sato
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takuichiro Hide
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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13
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Hameed NUF, Qiu T, Zhuang D, Lu J, Yu Z, Wu S, Wu B, Zhu F, Song Y, Chen H, Wu J. Transcortical insular glioma resection: clinical outcome and predictors. J Neurosurg 2019; 131:706-716. [PMID: 30485243 DOI: 10.3171/2018.4.jns18424] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/23/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Insular lobe gliomas continue to challenge neurosurgeons due to their complex anatomical position. Transcortical and transsylvian corridors remain the primary approaches for reaching the insula, but the adoption of one technique over the other remains controversial. The authors analyzed the transcortical approach of resecting insular gliomas in the context of patient tumor location based on the Berger-Sinai classification, achievable extents of resection (EORs), overall survival (OS), and postsurgical neurological outcome. METHODS The authors studied 255 consecutive cases of insular gliomas that underwent transcortical tumor resection in their division. Tumor molecular pathology, location, EOR, postoperative neurological outcome for each insular zone, and the accompanying OS were incorporated into the analysis to determine the value of this surgical approach. RESULTS Lower-grade insular gliomas (LGGs) were more prevalent (63.14%). Regarding location, giant tumors (involving all insular zones) were most prevalent (58.82%) followed by zone I+IV (anterior) tumors (20.39%). In LGGs, tumor location was an independent predictor of survival (p = 0.003), with giant tumors demonstrating shortest patient survival (p = 0.003). Isocitrate dehydrogenase 1 (IDH1) mutation was more likely to be associated with giant tumors (p < 0.001) than focal tumors located in a regional zone. EOR correlated with survival in both LGG (p = 0.001) and higher-grade glioma (HGG) patients (p = 0.008). The highest EORs were achieved in anterior-zone LGGs (p = 0.024). In terms of developing postoperative neurological deficits, patients with giant tumors were more susceptible (p = 0.038). Postoperative transient neurological deficit was recorded in 12.79%, and permanent deficit in 15.70% of patients. Patients who developed either transient or permanent postsurgical neurological deficits exhibited poorer survival (p < 0.001). CONCLUSIONS The transcortical surgical approach can achieve maximal tumor resection in all insular zones. In addition, the incorporation of adjunct technologies such as multimodal brain imaging and mapping of cortical and subcortical eloquent brain regions into the transcortical approach favors postoperative neurological outcomes, and prolongs patient survival.
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Affiliation(s)
- N U Farrukh Hameed
- 1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University
| | - Tianming Qiu
- 1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University
| | - Dongxiao Zhuang
- 1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University
| | - Junfeng Lu
- 1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University
| | - Zhengda Yu
- 1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University
| | - Shuai Wu
- 1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University
| | - Bin Wu
- 1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University
| | - Fengping Zhu
- 1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University
| | - Yanyan Song
- 2Department of Biostatistics, Medical School of Shanghai Jiaotong University; and
| | - Hong Chen
- 3Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinsong Wu
- 1Glioma Surgery Division, Neurosurgery Department of Huashan Hospital, Fudan University
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14
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Wang Y, Wang Y, Fan X, Li S, Liu X, Wang J, Jiang T. Putamen involvement and survival outcomes in patients with insular low-grade gliomas. J Neurosurg 2016; 126:1788-1794. [PMID: 27564467 DOI: 10.3171/2016.5.jns1685] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Insular glioma has a unique origin and biological behavior; however, the associations between its anatomical features and prognosis have not been well established. The object of this study was to propose a classification system of insular low-grade gliomas based on preoperative MRI findings and to assess the system's association with survival outcome. METHODS A total of 211 consecutively collected patients diagnosed with low-grade insular gliomas was analyzed. All patients were classified according to whether tumor involved the putamen on MR images. The prognostic role of this novel putaminal classification, as well as that of Yaşargil's classification, was examined using multivariate analyses. RESULTS Ninety-nine cases (46.9%) of insular gliomas involved the putamen. Those tumors involving the putamen, as compared with nonputaminal tumors, were larger (p < 0.001), less likely to be associated with a history of seizures (p = 0.04), more likely to have wild-type IDH1 (p = 0.003), and less likely to be totally removed (p = 0.02). Significant favorable predictors of overall survival on univariate analysis included a high preoperative Karnofsky Performance Scale score (p = 0.02), a history of seizures (p = 0.04), gross-total resection (p = 0.006), nonputaminal tumors (p < 0.001), and an IDH1 mutation (p < 0.001). On multivariate analysis, extent of resection (p = 0.035), putamen classification (p = 0.014), and IDH1 mutation (p = 0.026) were independent predictors of overall survival. No prognostic role was found for Yaşargil's classification. CONCLUSIONS The current study's findings suggest that the putamen classification is an independent predictor of survival outcome in patients with insular low-grade gliomas. This newly proposed classification allows preoperative survival prediction for patients with insular gliomas.
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Affiliation(s)
- Yongheng Wang
- Beijing Neurosurgical Institute, Capital Medical University
| | - Yinyan Wang
- Beijing Neurosurgical Institute, Capital Medical University;,Departments of 2 Neurosurgery and
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University;,Neuroradiology, Beijing Tiantan Hospital, Capital Medical University; and
| | - Shaowu Li
- Beijing Neurosurgical Institute, Capital Medical University;,Neuroradiology, Beijing Tiantan Hospital, Capital Medical University; and
| | - Xing Liu
- Beijing Neurosurgical Institute, Capital Medical University;,Neuroradiology, Beijing Tiantan Hospital, Capital Medical University; and
| | | | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University;,Departments of 2 Neurosurgery and.,Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
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15
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Reser DH, Majka P, Snell S, Chan JM, Watkins K, Worthy K, Quiroga MDM, Rosa MG. Topography of claustrum and insula projections to medial prefrontal and anterior cingulate cortices of the common marmoset (Callithrix jacchus
). J Comp Neurol 2016; 525:1421-1441. [DOI: 10.1002/cne.24009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 12/16/2022]
Affiliation(s)
- David H. Reser
- Department of Physiology; Monash University; Clayton Victoria 3800 Australia
- Neuroscience Program, Biomedicine Research Institute; Monash University; Clayton Victoria 3800 Australia
| | - Piotr Majka
- Department of Physiology; Monash University; Clayton Victoria 3800 Australia
- Neuroscience Program, Biomedicine Research Institute; Monash University; Clayton Victoria 3800 Australia
- Nencki Institute of Experimental Biology; Polish Academy of Sciences; 02-093 Warsaw Poland
| | - Shakira Snell
- Department of Physiology; Monash University; Clayton Victoria 3800 Australia
| | - Jonathan M.H. Chan
- Department of Physiology; Monash University; Clayton Victoria 3800 Australia
| | - Kirsty Watkins
- Department of Physiology; Monash University; Clayton Victoria 3800 Australia
| | - Katrina Worthy
- Department of Physiology; Monash University; Clayton Victoria 3800 Australia
| | | | - Marcello G.P. Rosa
- Department of Physiology; Monash University; Clayton Victoria 3800 Australia
- Neuroscience Program, Biomedicine Research Institute; Monash University; Clayton Victoria 3800 Australia
- ARC Centre of Excellence for Integrative Brain Function; Monash University Node; Clayton Victoria 3800 Australia
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16
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Delion M, Mercier P, Brassier G. Arteries and Veins of the Sylvian Fissure and Insula: Microsurgical Anatomy. Adv Tech Stand Neurosurg 2016:185-216. [PMID: 26508410 DOI: 10.1007/978-3-319-21359-0_7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a vascular anatomical study of the arteries and veins of the sylvian fissure and insula.A good knowledge of the sylvian fissure, the insula, and their vascular relationship would seem mandatory before performing surgery in this area, whatever the type of surgery (aneurysms, arteriovenous malformations, insular tumors).We start with the sylvian fissure and insula morphology, followed by the MCA description and its perforators, with special attention paid to the insular perforators. We demonstrate that the long insular perforators penetrating in the superior part of the posterior short gyrus and long gyri vascularize, respectively, the corticonuclear and corticospinal fasciculi. We particularly insist too on three anatomical constants regarding the vascularization of the insula, already described in the literature: The superior periinsular sulcus is the only sulcus on the lateral surface of the brain without an artery along its axis; the superior branch of the MCA supplies the anterior insular pole and both the anterior and middle short gyri in 100 % of cases; in at least 90 % of cases, the artery that supplied the central insular sulcus continued on to become the central artery.We end with the anatomical study of the veins and cisterns.
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Affiliation(s)
- Matthieu Delion
- Department of Neurosurgery, Angers Teaching Hospital, Angers, 49933, France.
- Anatomy Laboratory, Medical Faculty, rue haute de Reculée, Angers, 49045, France.
| | - Philippe Mercier
- Department of Neurosurgery, Angers Teaching Hospital, Angers, 49933, France
- Anatomy Laboratory, Medical Faculty, rue haute de Reculée, Angers, 49045, France
| | - Gilles Brassier
- Department of Neurosurgery, Rennes Teaching Hospital, Rennes, 35033, France
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17
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Delion M, Mercier P, Dinomais M. The long insular perforating arteries are essential cerebral perforating vessels too. Acta Neurochir (Wien) 2015; 157:1391-2. [PMID: 26051592 DOI: 10.1007/s00701-015-2464-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
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18
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Common features of the cerebral perforating arteries and their clinical significance. Acta Neurochir (Wien) 2015; 157:1393. [PMID: 26066534 DOI: 10.1007/s00701-015-2462-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
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