1
|
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.
Collapse
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
| |
Collapse
|
2
|
Yang ZC, Yeh FC, Xue BW, Yin CD, Song XY, Li G, Deng ZH, Sun SJ, Hou ZG, Xie J. Assessing Postoperative Motor Risk in Insular Low-Grade Gliomas Patients: The Potential Role of Presurgery MRI Corticospinal Tract Shape Measures. J Magn Reson Imaging 2024. [PMID: 38263789 DOI: 10.1002/jmri.29244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Insular low-grade gliomas (LGGs) are surgically challenging due to their proximity to critical structures like the corticospinal tract (CST). PURPOSE This study aims to determine if preoperative CST shape metrics correlate with postoperative motor complications in insular LGG patients. STUDY TYPE Retrospective. POPULATION 42 patients (mean age 40.26 ± 10.21 years, 25 male) with insular LGGs. FIELD STRENGTH/SEQUENCE Imaging was performed using 3.0 Tesla MRI, incorporating T1-weighted magnetization-prepared rapid gradient-echo, T2-weighted space dark-fluid with spin echo (SE), and diffusional kurtosis imaging (DKI) with gradient echo sequences, all integrated with echo planar imaging. ASSESSMENT Shape metrics of the CST, including span, irregularity, radius, and irregularity of end regions (RER and IER, respectively), were compared between the affected and healthy hemispheres. Total end region radius (TRER) was determined as the sum of RER 1 and RER 2. The relationships between shape metrics and postoperative short-term (4 weeks) and long-term (>8 weeks) motor disturbances assessing by British Medical Research Council grading system, was analyzed using multivariable regression models. STATISTICAL TESTING Paired t-tests compared CST metrics between hemispheres. Logistic regression identified associations between these metrics and motor disturbances. The models were developed using all available data and there was no independent validation dataset. Significance was set at P < 0.05. RESULTS Short-term motor disturbance risk was significantly related to TRER (OR = 199.57). Long-term risk significantly correlated with IER 1 (OR = 59.84), confirmed as a significant marker with an AUC of 0.78. Furthermore, the CST on the affected side significantly had the greater irregularity, larger TRER and RER 1, and smaller span compared to the healthy side. DATA CONCLUSION Preoperative evaluation of TRER and IER 1 metrics in the CST may serve as a tool for assessing the risk of postoperative motor complications in insular LGG patients. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Zuo-Cheng Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bo-Wen Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuan-Dong Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin-Yu Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gen Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zheng-Hai Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sheng-Jun Sun
- Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zong-Gang Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Staub-Bartelt F, Rapp M, Sabel M. Resection of Eloquent Located Brain Tumors by Mapping Only-A Feasibility Study. Brain Sci 2023; 13:1366. [PMID: 37891736 PMCID: PMC10605432 DOI: 10.3390/brainsci13101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Patients with eloquently located cerebral lesions require surgery that usually employs mapping and monitoring techniques for the preservation of motor and language function. However, in many cases, mapping only might be sufficient, reducing the need for technical and personnel logistics. Here, we report our experiences using a device that can be operated by the surgeon independently, providing mapping techniques but omitting monitoring techniques. METHODS For monopolar and bipolar cortical/subcortical stimulation, pre-set programs were available and intraoperatively used-two enabling EMG real-time tracking of eight muscles for monopolar (cortical/subcortical) mapping, and two programs for 60 Hz stimulation, one with EMG and one without. Motor mapping was performed under continuous observation of the screened EMG signal and acoustic feedback by the surgeon. For the 60 Hz stimulation, a standard bipolar stimulation probe was connected through a second port. The preoperative application of the subdermal EMG needles, as well as the intraoperative handling of the device, were performed by the surgeons independently. Postoperatively, an evaluation of the autonomous handling and feasibility of the device for the chosen test parameters was conducted. RESULTS From 04/19-09/21, 136 procedures in patients with eloquently located cerebral lesions were performed by using the "mapping-only" device. Mapping was performed in 82% of the monopolar cases and in 42% of the bipolar cases. Regarding the setup and sufficiency for the cortical/subcortical mapping, the device was evaluated as independently usable for motor and language mapping in 129 procedures (95%). Gross total resection was achieved, or functional limit throughout resection was reached, in 79% of the patients. 13 patients postoperatively suffered from a new neurological deficit. At the 3-6-month follow-up, three patients showed persistent deficit (2%). All of them had language disturbances. The setup time for the device was less than 7 min. CONCLUSIONS The device was evaluated as sufficient in over 90% of cases concerning monopolar and bipolar mapping, and the setup and handling was sufficient in all patients. With the present data we show that in well-selected cases, a very simple system providing mapping only is sufficient to achieve gross total resection with the preservation of functionality.
Collapse
|
4
|
Danielli E, Simard N, DeMatteo CA, Kumbhare D, Ulmer S, Noseworthy MD. A review of brain regions and associated post-concussion symptoms. Front Neurol 2023; 14:1136367. [PMID: 37602240 PMCID: PMC10435092 DOI: 10.3389/fneur.2023.1136367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
The human brain is an exceptionally complex organ that is comprised of billions of neurons. Therefore, when a traumatic event such as a concussion occurs, somatic, cognitive, behavioral, and sleep impairments are the common outcome. Each concussion is unique in the sense that the magnitude of biomechanical forces and the direction, rotation, and source of those forces are different for each concussive event. This helps to explain the unpredictable nature of post-concussion symptoms that can arise and resolve. The purpose of this narrative review is to connect the anatomical location, healthy function, and associated post-concussion symptoms of some major cerebral gray and white matter brain regions and the cerebellum. As a non-exhaustive description of post-concussion symptoms nor comprehensive inclusion of all brain regions, we have aimed to amalgamate the research performed for specific brain regions into a single article to clarify and enhance clinical and research concussion assessment. The current status of concussion diagnosis is highly subjective and primarily based on self-report of symptoms, so this review may be able to provide a connection between brain anatomy and the clinical presentation of concussions to enhance medical imaging assessments. By explaining anatomical relevance in terms of clinical concussion symptom presentation, an increased understanding of concussions may also be achieved to improve concussion recognition and diagnosis.
Collapse
Affiliation(s)
- Ethan Danielli
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Nicholas Simard
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Carol A. DeMatteo
- ARiEAL Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Dinesh Kumbhare
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephan Ulmer
- Neurorad.ch, Zurich, Switzerland
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Michael D. Noseworthy
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
- ARiEAL Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
5
|
A Review on the Surgical Management of Insular Gliomas. Neurol Sci 2023; 50:1-9. [PMID: 34711299 DOI: 10.1017/cjn.2021.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The surgical treatment of insular gliomas requires specialized knowledge. Over the last three decades, increased momentum in surgical resection of insular gliomas shifted the focus from one of expectant management to maximal safe resection to establish a diagnosis, characterize tumor genetics, treat preoperative symptoms (i.e., seizures), and delay malignant transformation through tumor cytoreduction. A comprehensive review of the literature was performed regarding insular glioma classification/genetics, insular anatomy, surgical approaches, and patient outcomes. Modern large, published series of insular resections have reported a median 80% resection, 80% improvement in preoperative seizures, and postsurgical permanent neurologic deficits of less than 10%. Major complication avoidance includes recognition and preservation of eloquent cortex for language and respecting the lateral lenticulostriate arteries.
Collapse
|
6
|
Zhang JJY, Lee KS, Wang DD, Hervey-Jumper SL, Berger MS. Seizure outcome after resection of insular glioma: a systematic review, meta-analysis, and institutional experience. J Neurosurg 2022; 138:1242-1253. [PMID: 36242570 PMCID: PMC10404476 DOI: 10.3171/2022.8.jns221067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gliomas arising from the insular cortex can be epileptogenic, with a significant proportion of patients having medically refractory epilepsy. The impact of surgery on seizure control for such tumors is not well established. In this study, the authors aimed to investigate seizure outcomes after resection of insular gliomas using a meta-analysis and institutional experience. METHODS Three databases (Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials) were systematically searched for published studies of seizure outcomes after insular glioma resection from database inception to March 27, 2021. In addition, data were retrospectively collected on all adults (age > 17 years) who had undergone insular glioma resection between June 1997 and June 2015 at the authors' institution. Primary outcome measures were seizure freedom rates at 1 year and the last follow-up. Secondary outcome measures consisted of persistent postoperative neurological deficit beyond 90 days, mortality, and tumor progression or recurrence. RESULTS Eight studies reporting on 453 patients who had undergone 460 operations were included in the meta-analysis. The pooled mean age of the patients was 42 years. The pooled percentages of patients with extents of resection (EORs) ≥ 90%, 70%-89%, and < 70% were 55%, 33%, and 11%, respectively. The pooled seizure freedom rate at 1 year was 73% for Engel class IA and 78% for Engel class I. The pooled seizure freedom rate at the last follow-up was 60% for Engel class IA and 79% for Engel class I. The pooled percentage of persistent neurological deficit beyond 90 days was 3%. At the authors' institution, 109 patients had undergone resection of insular glioma. A greater EOR was the only significant independent predictor of seizure freedom after surgery (HR 0.290, p = 0.017). The optimal threshold for seizure freedom corresponded to an EOR of 81%. Patients with an EOR > 81% had a significantly higher seizure freedom rate (OR 2.16, p = 0.048). CONCLUSIONS Maximal safe resection can be performed with minimal surgical morbidity to achieve favorable seizure freedom rates in both the short and long term. When gross-total resection is not possible, an EOR > 81% confers the greatest sensitivity and specificity for achieving seizure freedom. Systematic review registration no.: CRD42021249404 (https://www.crd.york.ac.uk/prospero/).
Collapse
Affiliation(s)
- John J Y Zhang
- 1Department of Neurological Surgery, University of California, San Francisco, California.,2Department of Neurosurgery, National Neuroscience Institute, Singapore; and
| | - Keng Siang Lee
- 1Department of Neurological Surgery, University of California, San Francisco, California.,3Bristol Medical School, University of Bristol, United Kingdom
| | - Doris D Wang
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Shawn L Hervey-Jumper
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Mitchel S Berger
- 1Department of Neurological Surgery, University of California, San Francisco, California
| |
Collapse
|
7
|
Ribeiro L, Ng S, Duffau H. Recurrent insular low-grade gliomas: factors guiding the decision to reoperate. J Neurosurg 2022; 138:1216-1226. [PMID: 36308479 DOI: 10.3171/2022.9.jns221286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Reoperation has been established as an effective therapeutic strategy in recurrent diffuse low-grade gliomas (LGGs). Insular gliomas represent a specific surgical challenge because of the surrounding vascular and functional structures. The aim of this study was to investigate the main clinicoradiological factors guiding the decision to reoperate on recurrent insular LGGs (ILGGs).
METHODS
In this retrospective consecutive series, the authors screened all patients operated on for an ILGG in their institution who further presented with a tumor regrowth without the development of contrast enhancement. They compared patients who were subsequently offered a reoperation under awake mapping at recurrence or who underwent reoperation after adjuvant treatment had reduced the volume of the initial tumor recurrence (with a proven pathological diagnosis of LGG after the second surgery) to patients who were not selected for a reoperation. The first group (reoperated group; n = 20) included all recurrent ILGG patients who underwent second resection, and the second group (nonreoperated group; n = 60) included patients who did not undergo reoperation but underwent adjuvant oncological treatment.
RESULTS
Factors significantly associated with reoperation were extent of resection (EOR) at first surgery (91.9% vs 89.7%, p = 0.014), residual tumor volume (9.5 ± 7.1 mL [range 0–30 mL] vs 6.3 ± 7.3 mL [range 0–30 mL], p = 0.02) at first surgery and left temporopolar infiltration at the time of tumor recurrence (Liebermeister statistical analysis, 4293 voxels survived false discovery rate correction with p < 0.05; maximal z-statistic = 6.50). Infiltration of the anterior perforated substance at tumor recurrence was significantly anticorrelated to reoperation (179 voxels survived false discovery rate correction with p < 0.05; minimal z-statistic = −4.33). The mean EOR was 83.7% at reoperation with a 90% survival rate at last follow-up (9.3 ± 3.8 years), low postsurgical morbidity (Karnofsky Performance Status score ≥ 80 in 95% of patients), a high rate of postoperative professional resumption (95%), and seizure control in 57.1% of patients.
CONCLUSIONS
In selected patients with recurrent ILGG without radiographic evidence of malignant transformation, reoperation with intraoperative awake mapping is associated with favorable oncological outcomes and a low postsurgical morbidity. A greater EOR and a lower residual tumor volume at first surgery were significantly associated with reoperation. Patients who benefited from a second surgery typically had a recurrent pattern within cortical areas (such as the temporopolar region), while other patients typically presented with a deeper infiltrative pattern within the anterior perforated substance and the surrounding white matter pathways. Such original findings may be helpful to select the optimal indications of reoperation in recurrent ILGG.
Collapse
Affiliation(s)
- Lucas Ribeiro
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier; and
| | - Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier; and
- Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," Institute of Functional Genomics, INSERM U1191, University of Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier; and
- Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors," Institute of Functional Genomics, INSERM U1191, University of Montpellier, France
| |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Midzyanovskaya IS, Birioukova LM, Storvik M, Luijtelaar GV, Tuomisto LM. The prefrontal cortex shows widespread decrease in H3 histamine receptor binding densities in rats with genetic generalized epilepsies. Epilepsy Res 2022; 182:106921. [DOI: 10.1016/j.eplepsyres.2022.106921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/19/2022] [Accepted: 04/01/2022] [Indexed: 11/03/2022]
|
10
|
Li M, Ma X, Mai C, Fan Z, Wang Y, Ren Y. Knowledge Atlas of Insular Epilepsy: A Bibliometric Analysis. Neuropsychiatr Dis Treat 2022; 18:2891-2903. [PMID: 36540673 PMCID: PMC9760072 DOI: 10.2147/ndt.s392953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE In order to determine research hotspots and prospective directions, this work used VOSviewer and CiteSpace to assess the current state of insular epilepsy research. METHODS We looked for pertinent research about insular epilepsy published between the first of January 2000 and the thirtieth of April 2022 in the Web of Science Core Collection (WoSCC) database. CiteSpace and VOSviewer were used to build a knowledge atlas by analyzing authors, institutions, countries, keywords with citation bursts, keyword clustering, keyword co-occurrence, publishing journals, reference co-citation patterns, and other factors. RESULTS A total of 305 publications on insular epilepsy were found. Nguyen DK had the most articles published (37), whereas Mauguière F and Isnard J had the highest average number of citations/publications (39.37 and 38.09, respectively). The leading countries and institutions in this field were the United States (82 papers) and Université de Montréal (40 papers). Authors, countries, and institutions appear to be actively collaborating. Hot topics and research frontiers included surgical treatment, functional network connectivity, and the application of neuroimaging methods to study insular epilepsy. CONCLUSION In summary, the most influential articles, authors, journals, organizations, and countries on the subject of insular epilepsy were determined by this analysis. This study investigated the area of insular epilepsy research and forecasted upcoming trends using co-occurrence and evolution methods.
Collapse
Affiliation(s)
- Manli Li
- Department of Physiology, Sanquan College of Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Xiaoli Ma
- Department of Physiology, Sanquan College of Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Chendi Mai
- Department of Physiology, Sanquan College of Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Zhiru Fan
- Department of Physiology, Sanquan College of Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Yangyang Wang
- Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People's Republic of China
| | - Yankai Ren
- Department of Physiology, Sanquan College of Xinxiang Medical University, Xinxiang, People's Republic of China
| |
Collapse
|
11
|
Bykanov AE, Pitskhelauri DI, Batalov AI, Young R, Trube MA, Holodny AI, Pronin IN, Zagidullin T. Sensitivity of three-dimensional time-of-flight 3.0 T magnetic resonance angiography in visualizing the number and course of lenticulostriate arteries in patients with insular gliomas. BRAIN & SPINE 2021; 2:100856. [PMID: 36248136 PMCID: PMC9560693 DOI: 10.1016/j.bas.2021.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 05/26/2023]
Abstract
Background Neurosurgical resection of insular gliomas is complicated by the possibility of iatrogenic injury to the lenticulostriate arteries (LSAs) and is associated with devastating neurological complications, hence the need to accurately assess the number of LSAs and their relationship to the tumor preoperatively. Methods The study included 24 patients with insular gliomas who underwent preoperative 3D-TOF MRA to visualize LSAs. The agreement of preoperative magnetic resonance imaging with intraoperative data in terms of the number of LSAs and their invasion by the tumor was assessed using the Kendall rank correlation coefficient and Cohen's Kappa with linear weighting. Agreement between experts performing image analysis was estimated using Cohen's Kappa with linear weighting. Results The number of LSAs arising from the M1 segment varied from 0 to 9 (mean 4.3 ± 0.37) as determined by 3D-TOF MRA and 2-6 (mean 4.25 ± 0.25) as determined intraoperatively, κ = 0.51 (95% CI: 0.25-0.76) and τ = 0.64 (p < 0.001). LSAs were encased by the tumor in 11 patients (confirmed intraoperatively in 9 patients). LSAs were displaced medially in 8 patients (confirmed intraoperatively in 8 patients). The tumor partially involved the LSAs and displaced them in 5 patients (confirmed intraoperatively in 7 patients), κ = 0.87 (95% CI: 0.70-1), τ = 0.93 (p < 0.001). 3D-TOF MRA demonstrated high sensitivity (100%, 95% CI: 0.63-1) and high specificity (86.67%, 95% CI: 0.58-0.98) in determining the LSA-tumor interface. Conclusions 3D-TOF MRA at 3T demonstrated sensitivity in determining the LSA-tumor interface and the number of LSAs in patients with insular gliomas.
Collapse
Affiliation(s)
| | | | - Artem I. Batalov
- Neuroradiology (A.I.B., I.N.P.) N.N, Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Robert Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY, 10065, USA
| | - Maxim A. Trube
- Peoples' Friendship University of Russia, Faculty of Medicine, Moscow, Russia
| | - Andrei I. Holodny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY, 10065, USA
- Department of Neuroscience, Weill-Cornell Graduate School of the Medical Sciences, 1300 York Ave, New York, NY, 10065, USA
| | - Igor N. Pronin
- Neuroradiology (A.I.B., I.N.P.) N.N, Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | | |
Collapse
|
12
|
Panigrahi M, Doshi S, K Chandrasekhar YB, Vooturi S. Avoiding Complications in Surgical Resection of Insular Gliomas - Single Surgeon Experience. Neurol India 2021; 69:904-909. [PMID: 34507410 DOI: 10.4103/0028-3886.325334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Aims Insular gliomas remain one of most challenging locations for aggressive resection. We report our experience and strategies we employed to avoid complications in immediate post-operative period of surgical resection of insular gliomas. Methods Retrospective analysis of data collected in 61 consecutive patients who underwent surgical resection of insular gliomas between May 2013 and May 2016 was done. Primary outcome measures were neurological deficits and death in the immediate post-operative period to three months follow-up. Results The average age of the study population was 42.57 ± 10.98 years with 41 (67.2%) men. Glioma was on the right side in 35 (57.3%) patients. Surgery for recurrent glioma was performed in three (4.9%) patients. The average MIB index of the entire group was 10.1 ± 13.9. While 23 (37.7%) patients underwent the TO approach, 38 (62.3%) underwent TS approach. In the immediate post-operative period, significantly higher number of patients under TS approach had post-surgical complications (8.6% vs 34.2%; P = 0.032). The surgical approaches did not differ significantly for outcome, mortality and complications at three month post-operatively (0.0% vs 10.5%; P = 0.287). However, a trend for lower complications at three months was observed with TO approach. Conclusion We report that morbidity and mortality in immediate post-operative period can be reduced by: a) pre-surgical assessment of confinement of glioma in respect to lenticulo-striate arteries, b) Intra-operative use of functional-MRI, DTI tractography and ICG angiography, c) Application of Berger-Sinai classification to localize the glioma, d) selecting either TS or TO approach based on Berger-Sinai classification.
Collapse
Affiliation(s)
- Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Shrut Doshi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Y Bv K Chandrasekhar
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Sudhindra Vooturi
- Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| |
Collapse
|
13
|
Pallud J, Zanello M, Moiraghi A, Peeters S, Trancart B, Edjlali M, Oppenheim C, Varlet P, Chrétien F, Dhermain F, Roux A, Dezamis E. Surgery of Insular Diffuse Gliomas-Part 1: Transcortical Awake Resection Is Safe and Independently Improves Overall Survival. Neurosurgery 2021; 89:565-578. [PMID: 34383938 DOI: 10.1093/neuros/nyab254] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Insular diffuse glioma resection is at risk of vascular injury and of postoperative new neurocognitive deficits. OBJECTIVE To assess safety and efficacy of surgical management of insular diffuse gliomas. METHODS Observational, retrospective, single-institution cohort analysis (2005-2019) of 149 adult patients surgically treated for an insular diffuse glioma: transcortical awake resection with intraoperative functional mapping (awake resection subgroup, n = 61), transcortical asleep resection without functional mapping (asleep resection subgroup, n = 50), and stereotactic biopsy (biopsy subgroup, n = 38). All cases were histopathologically assessed according to the 2016 World Health Organization classification and cIMPACT-NOW update 3. RESULTS Following awake resection, 3/61 patients had permanent motor deficit, seizure control rates improved (89% vs 69% preoperatively, P = .034), and neurocognitive performance improved from 5% to 24% in tested domains, despite adjuvant oncological treatments. Resection rates were higher in the awake resection subgroup (median 94%) than in the asleep resection subgroup (median 46%; P < .001). There was more gross total resection (25% vs 12%) and less partial resection (34% vs 80%) in the awake resection subgroup than in the asleep resection subgroup (P < .001). Karnofsky Performance Status score <70 (adjusted hazard ratio [aHR] 2.74, P = .031), awake resection (aHR 0.21, P = .031), isocitrate dehydrogenase (IDH)-mutant grade 2 astrocytoma (aHR 5.17, P = .003), IDH-mutant grade 3 astrocytoma (aHR 6.11, P < .001), IDH-mutant grade 4 astrocytoma (aHR 13.36, P = .008), and IDH-wild-type glioblastoma (aHR 21.84, P < .001) were independent predictors of overall survival. CONCLUSION Awake surgery preserving the brain connectivity is safe, allows larger resections for insular diffuse gliomas than asleep resection, and positively impacts overall survival.
Collapse
Affiliation(s)
- Johan Pallud
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Bénédicte Trancart
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Myriam Edjlali
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Pascale Varlet
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Department of Neuropathology, GHU Paris-Sainte-Anne Hospital, Paris, France
| | - Fabrice Chrétien
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Department of Neuropathology, GHU Paris-Sainte-Anne Hospital, Paris, France
| | - Frédéric Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| |
Collapse
|
14
|
Pepper J, Cuthbert H, Scott T, Ughratdar I, Wykes V, Watts C, D'Urso P, Karabatsou K, Moor CC, Albanese E. Seizure Outcome After Surgery for Insular High-Grade Glioma. World Neurosurg 2021; 154:e718-e723. [PMID: 34343689 DOI: 10.1016/j.wneu.2021.07.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The insular cortex is an eloquent island of mesocortex surrounded by vital structures making this region relatively challenging to neurosurgeons. Historically, lesions in this region were considered too high risk to approach given the strong chance of poor surgical outcome. Advances in recent decades have meant that surgeons can more safely access this eloquent region. Seizure outcome after excision of insular low-grade gliomas is well reported, but little is known about seizure outcomes after excision of insular high-grade gliomas. METHODS A retrospective analysis was performed of all patients presenting with new-onset seizures during 2015-2019 who underwent excision of an insular high-grade glioma at 3 regional neurosurgical centers in the United Kingdom. RESULTS We identified 38 patients with a mean (SD) age of 45.7 (15.3) years with median follow-up of 21 months. At long-term follow-up, of 38 patients, 23 were seizure-free (Engel class I), 2 had improved seizures (Engel class II), 6 had poor seizure control (Engel class III/IV), and 7 died. CONCLUSIONS Excision of insular high-grade gliomas is safe and results in excellent postoperative seizure control.
Collapse
Affiliation(s)
- Joshua Pepper
- Department of Neurosurgery, University Hospital of North Midlands, Stoke on Trent, United Kingdom.
| | - Hadleigh Cuthbert
- Department of Neurosurgery, University Hospital of North Midlands, Stoke on Trent, United Kingdom
| | - Teresa Scott
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Ismail Ughratdar
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Victoria Wykes
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Colin Watts
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Pietro D'Urso
- Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom
| | | | - Carl-Christian Moor
- Department of Neurology, University Hospital of North Midlands, Stoke on Trent, United Kingdom
| | - Erminia Albanese
- Department of Neurosurgery, University Hospital of North Midlands, Stoke on Trent, United Kingdom
| |
Collapse
|
15
|
Dziedzic TA, Bala A, Marchel A. Anatomical aspects of the insula, opercula and peri-insular white matter for a transcortical approach to insular glioma resection. Neurosurg Rev 2021; 45:793-806. [PMID: 34292438 PMCID: PMC8827298 DOI: 10.1007/s10143-021-01602-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 11/01/2022]
Abstract
The insula is a lobe located deep in each hemisphere of the brain and is surrounded by eloquent cortical, white matter, and basal ganglia structures. The aim of this study was to provide an anatomical description of the insula and white matter tracts related to surgical treatment of gliomas through a transcortical approach. The study also discusses surgical implications in terms of intraoperative brain mapping. Five adult brains were prepared according to the Klingler technique. Cortical anatomy was evaluated with the naked eye, whereas white matter dissection was performed with the use of a microscope. The widest exposure of the insular surface was noted through the temporal operculum, mainly in zones III and IV according to the Berger-Sanai classification. By going through the pars triangularis in all cases, the anterior insular point and most of zone I were exposed. The narrowest and deepest operating field was observed by going through the parietal operculum. This method provided a suitable approach to zone II, where the corticospinal tract is not covered by the basal ganglia and is exposed just under the superior limiting sulcus. At the subcortical level, the identification of the inferior frontoocipital fasciculus at the level of the limen insulae is critical in terms of preserving the lenticulostriate arteries. Detailed knowledge of the anatomy of the insula and subcortical white matter that is exposed through each operculum is essential in preoperative planning as well as in the intraoperative decision-making process in terms of intraoperative brain mapping.
Collapse
Affiliation(s)
- Tomasz Andrzej Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097, Warszawa, Poland.
| | - Aleksandra Bala
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097, Warszawa, Poland.,Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097, Warszawa, Poland
| |
Collapse
|
16
|
Pitskhelauri D, Bykanov A, Konovalov A, Danilov G, Buklina S, Sanikidze A, Sufianov R. Transsylvian Insular Glioma Surgery: New Classification System, Clinical Outcome in a Consecutive Series of 79 Cases. Oper Neurosurg (Hagerstown) 2021; 20:541-548. [PMID: 33677610 DOI: 10.1093/ons/opab051] [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] [Received: 04/22/2020] [Accepted: 12/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgery of insular glial tumors remains a challenge because of high incidence of postoperative neurological deterioration and the complex anatomy of the insular region. OBJECTIVE To explore the prognostic role of our and Berger-Sanai classifications on the extent of resection (EOR) and clinical outcome. METHODS From 2012 to 2017, a transsylvian removal of insular glial tumors was performed in 79 patients. The EOR was assessed depending on magnetic resonance imaging scans performed in the first 48 h after surgery. RESULTS The EOR ≥90% was achieved in 30 (38%) cases and <90% in 49 (62.0%) cases. In the early postoperative period, the new neurological deficit was observed in 31 (39.2%) patients, and in 5 patients (6.3%), it persisted up to 3 mo.We proposed a classification of insular gliomas based on its volumetric and anatomical characteristics. A statistically significant differences were found between proposed classes in tumor volume before and after surgery (P < .001), EOR (P = .02), rate of epileptic seizures before the surgical treatment (P = .04), and the incidence of persistent postoperative complications (P = .03).In the logistic regression model, tumor location in zone II (Berger-Sanai classification) was the predictor significantly related to less likely EOR of ≥90% and the maximum rate of residual tumor detection (P = .02). CONCLUSION The proposed classification of the insular gliomas was an independent predictor of the EOR and persistent postoperative neurological deficit. According to Berger-Sanai classification, zone II was a predictor of less EOR through the transsylvian approach.
Collapse
Affiliation(s)
- David Pitskhelauri
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Andrey Bykanov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alexander Konovalov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Gleb Danilov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Svetlana Buklina
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alexander Sanikidze
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Rinat Sufianov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| |
Collapse
|
17
|
Liakos F, Komaitis S, Drosos E, Neromyliotis E, Skandalakis GP, Gerogiannis AI, Kalyvas AV, Troupis T, Stranjalis G, Koutsarnakis C. The Topography of the Frontal Terminations of the Uncinate Fasciculus Revisited Through Focused Fiber Dissections: Shedding Light on a Current Controversy and Introducing the Insular Apex as a Key Anatomoclinical Area. World Neurosurg 2021; 152:e625-e634. [PMID: 34144169 DOI: 10.1016/j.wneu.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent studies advocate a connectivity pattern wider than previously believed of the uncinate fasciculus that extends to the ventrolateral and dorsolateral prefrontal cortices. These new percepts on the connectivity of the tract suggest a more expansive role for the uncinate fasciculus. Our aim was to shed light on this controversy through fiber dissections. METHODS Twenty normal adult human formalin-fixed cerebral hemispheres were used. Focused dissections on the insular, orbitofrontal, ventromedial, ventrolateral, and dorsolateral prefrontal areas were performed to record the topography of the frontal terminations of the uncinate fasciculus. RESULTS Three discrete fiber layers were consistently disclosed: the first layer was recorded to terminate at the posterior orbital gyrus and pars orbitalis, the second layer at the posterior two thirds of the gyrus rectus, and the last layer at the posterior one third of the paraolfactory gyrus. The insular apex was documented as a crucial landmark regarding the topographic differentiation of the uncinate and occipitofrontal fasciculi (i.e., fibers that travel ventrally belong to the uncinate fasciculus whereas those traveling dorsally are occipitofrontal fibers). CONCLUSIONS The frontal terminations of the uncinate fasciculus were consistently documented to project to the posterior orbitofrontal area. The area of the insular apex is introduced for the first time as a crucial surface landmark to effectively distinguish the stems of the uncinate and occipitofrontal fasciculi. This finding could refine the spatial resolution of awake subcortical mapping, especially for insular lesions, and improve the accuracy of in vivo diffusion tensor imaging protocols.
Collapse
Affiliation(s)
- Faidon Liakos
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Drosos
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Neromyliotis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece
| | | | | | - Aristotelis V Kalyvas
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Troupis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Edinburgh Microneurosurgery Education Laboratory, Department of Clinical Neurosciences, Edinburgh, United Kingdom; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece.
| |
Collapse
|
18
|
Zarino B, Sirtori MA, Meschini T, Bertani GA, Caroli M, Bana C, Borellini L, Locatelli M, Carrabba G. Insular lobe surgery and cognitive impairment in gliomas operated with intraoperative neurophysiological monitoring. Acta Neurochir (Wien) 2021; 163:1279-1289. [PMID: 33236177 DOI: 10.1007/s00701-020-04643-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND For a long time, surgery of insular gliomas was considered at high risk for postoperative cognitive deficits, but recent studies highlighted the feasibility of the surgical approach. The aims of our study were to investigate the presence of language impairment before and after surgery and the relationship between language impairment and tumor volume preoperatively and extent of resection (EOR) 3 months after surgery. METHODS Thirty-five patients with insular gliomas underwent an extensive language assessment before and few days after surgery, and after 3 months. Intraoperative neurophysiological monitoring (IOM) and brain mapping with direct electrical stimulation (DES) were used in all the cases; 8 patients underwent awake craniotomy. Statistical analysis was performed on the language tests administered. RESULTS Patients with pure left insular lesion showed language impairment before and after surgery. Overall, patients with a left lesion showed a drop of performance after surgery followed by a partial recovery. Moreover, when the tumor involved the insula and adjacent networks, we observed a more severe deficit. No correlations were found between tumor volume, EOR, and language impairment. CONCLUSIONS Left insular lobe is an important hub in language networks; its involvement determines pre- and postsurgical deficits, together with the involvement of white matter connections. Tumor volume and EOR are not risk factors per se directly related to language functioning. Surgery of insular gliomas is possible with a pre- and intraoperative extensive study of the patient with IOM and awake surgery, and encouraged by the trend of cognitive recovery highlighted.
Collapse
Affiliation(s)
- Barbara Zarino
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Padiglione Monteggia, 20122, Milan, Italy.
| | - Martina Andrea Sirtori
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Padiglione Monteggia, 20122, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Tommaso Meschini
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giulio Andrea Bertani
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Padiglione Monteggia, 20122, Milan, Italy
| | - Manuela Caroli
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Padiglione Monteggia, 20122, Milan, Italy
| | - Cristina Bana
- Neuropathophysilogy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Linda Borellini
- Neuropathophysilogy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Locatelli
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Padiglione Monteggia, 20122, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giorgio Carrabba
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Padiglione Monteggia, 20122, Milan, Italy
| |
Collapse
|
19
|
Fang S, Zhou C, Wang Y, Jiang T. Contralesional functional network reorganization of the insular cortex in diffuse low-grade glioma patients. Sci Rep 2021; 11:623. [PMID: 33436741 PMCID: PMC7804949 DOI: 10.1038/s41598-020-79845-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
Diffuse low-grade gliomas (DLGGs) growing on the insular lobe induce contralesional hemispheric insular lobe compensation of damaged functioning by increasing cortical volumes. However, it remains unclear how functional networks are altered in patients with insular lobe DLGGs during functional compensation. Thirty-five patients with insular DLGGs were classified into the left (insL, n = 16) and right groups (insR, n = 19), and 33 healthy subjects were included in the control group. Resting state functional magnetic resonance imaging was used to generate functional connectivity (FC), and network topological properties were evaluated using graph theoretical analysis based on FC matrices. Network-based statistics were applied to compare differences in the FC matrices. A false discovery rate was applied to correct the topological properties. There was no difference in the FC of edges between the control and insL groups; however, the nodal shortest path length of the right insular lobe was significantly increased in the insL group compared to the control group. Additionally, FC was increased in the functional edges originating from the left insular lobe in the insR group compared to the control group. Moreover, there were no differences in topological properties between the insR and control groups. The contralesional insular lobe is crucial for network alterations. The detailed patterns of network alterations were different depending on the affected hemisphere. The observed network alterations might be associated with functional network reorganization and functional compensation.
Collapse
Affiliation(s)
- Shengyu Fang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China
| | - Chunyao Zhou
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China
| | - Yinyan Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. .,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China.
| | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. .,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, the Western Road of the southern 4th Ring Road, Beijing, 100070, China. .,Research Unit of Accurate Diagnosis, Treatment, and Translational Medicine of Brain Tumors Chinese (2019RU11), Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
20
|
Pitskhelauri DI, Ishkinin RE, Bykanov AE, Sanikidze AZ, Buklina SB, Abramyan AA, Pronin IN. [Anterior transperiinsular approach to the head of the caudate nucleus and mediobasal frontal lobe]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:54-60. [PMID: 34951760 DOI: 10.17116/neiro20218506154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The head of the caudate nucleus and adjacent mediobasal frontal lobe are deeply localized and have complex anatomical and topographic relationships with surrounding functionally significant cerebral structures. These aspects determine difficult surgical treatment of pathology in this zone. OBJECTIVE To propose a new anterior transperiinsular approach for optimizing surgical access to the head of the caudate nucleus and mediobasal frontal lobe. MATERIAL AND METHODS Two patients with cavernoma of the head of the caudate nucleus and oligodendroglioma of the head of the caudate nucleus and mediobasal frontal lobe underwent resection via transsylvian anterior transperiinsular approach in 2018. In both cases, tumors were localized in dominant hemisphere. Standard MRI was performed before and after surgery. Luria's neurological and neuropsychological examination was carried out before surgery, in 7 days after surgery and then every 3 months. RESULTS Surgical access was performed via stage-by-stage proximal dissection of Sylvian fissure with visualization of anterior and superior periinsular grooves. After that, periinsular groove was dissected at the base of anterior short gyrus. Then, we moved apart white matter using microinstruments and approached the area of interest. In case of this trajectory, surgical approach was performed at the level of the upper parts of inferior frontooccipital fascicle under the arcuate fascicle. Both patients underwent total resection of tumors that was confirmed by MRI. No pre- and postoperative neurological or neuropsychological abnormalities were observed. CONCLUSION Anterior transperiinsular approach provides minimally invasive access to the head of the caudate nucleus and mediobasal frontal lobe. It can be used on dominant hemisphere without significant risk of speech or other cognitive impairments. The advantages of this approach are minimal damage to associative pathways and small distance between periinsular groove and zone of interest. Dissection of commissural fibers of the corpus callosum is not required compared to conventional transcallosal approach.
Collapse
Affiliation(s)
| | | | - A E Bykanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - S B Buklina
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
| |
Collapse
|
21
|
Isolan GR, Campero A, Ajler PM, Farina EM, Frigeri TM, Dini LI. El lóbulo de la ínsula: Parte 2 - anatomía microquirúrgica y correlación clínico-quirúrgica. Surg Neurol Int 2020. [DOI: 10.25259/sni_679_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Antecedentes:
El conocimiento profundo de la anatomía microquirúrgica del lóbulo de la ínsula es crucial para operar pacientes con tumores en esta región. El objetivo de la segunda parte de este estudio es correlacionar la anatomía microquirúrgica con casos ilustrativos retirados de nuestra casuística de 35 pacientes en los cuales fueron realizados 44 cirugías de tumores en relación con el lóbulo de la ínsula.
Métodos:
A lo largo de marzo de 2007 y agosto de 2014, 44 microcirugías fueron realizadas en 35 pacientes portadores de tumores insulares y los hallazgos de las cirugías y mapeo cerebral se correlacionaron con la anatomía microquirúrgica.
Resultados:
De una serie de 44 pacientes con tumores de la ínsula, la mayoría de los casos eran gliomas de bajo grado de malignidad (29 casos). El inicio de los síntomas en 34 pacientes fue epilepsia, siendo esta refractaria al tratamiento medicamentoso en 12 casos. El grado de resección fue subtotal o total en la mayoría de los casos de la serie. La mejoría en la calidad de vida (epilepsia, etc.) estuvo presente en más de la mitad de los pacientes. El dé cit neurológico permanente estuvo presente en tres pacientes.
Conclusión:
En los tumores insulares, es tan importante el conocimiento profundo de la anatomía, como el saber utilizar e interpretar en tiempo real las observaciones de la monitorización neuro siológica intraoperatoria.
Collapse
Affiliation(s)
- Gustavo Rassier Isolan
- Department of Surgery, The Center for Advanced Neurology and Neurosurgery, Porto Alegre, Rio Grande do Sul, Brazil,
| | - Alvaro Campero
- Department of Neurosurgery, Hospital Padila, Country Las Yungas, Yerba Buena, Tucumán,
| | - Pablo Marcelo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Perón, Buenos Aires, Argentina,
| | - Edgar Manuel Farina
- Serviço de Neurocirurgia, Hospital Ministro Costa Cavalcanti Sanatório Le Blanc, Rua Joao Rouver, Foz do Iguaçu, Parana,
| | - Thomas More Frigeri
- Department of Neurosurgery, Pontifical Catholic University of Rio Grande do Sul, Luciana de Abreu, Porto Alegre,
| | - Leandro Infantini Dini
- Department of Neurosurgery, Center for Advanced Neurology and Neurosurgery, São Leopoldo, Rio Grande do Sul, Brazil
| |
Collapse
|
22
|
Isolan GR, Campero A, Ajler P, Farina EM, Frigeri TM, Dini LI. Parte I: Anatomía microquirúrgica tridimensional de la ínsula. Surg Neurol Int 2020. [DOI: 10.25259/sni_557_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Antecedentes:
El lóbulo de la ínsula, o ínsula, se encuentra oculto en la super cie lateral del cerebro. La ínsula está localizada profundamente en el surco lateral o cisura silviana, recubierta por los opérculos frontal, parietal y temporal. Estudiar la compleja anatomía del lóbulo de la ínsula, una de las regiones de mayor complejidad quirúrgica del cerebro humano, y su correlación anatómica con casos quirúrgicos.
Métodos:
En la primera parte de este estudio presentamos los resultados de nuestras disecciones microquirúrgicas en fotografías 2 D y 3D; en la segunda parte de nuestro trabajo, la correlación anatómica con una serie de 44 cirugías en pacientes con tumores de la ínsula, principalmente gliomas, operados entre 2007 y 2014.
Resultados:
Extenso conjunto de bras subcorticales, incluyendo el fascículo uncinado, fronto-occipital inferior y el fascículo arcuato, conectan la ínsula a las regiones vecinas. Varias estructuras anatómicas responsables por dé cits neurológicos severos están íntimamente relacionadas con la cirugía de la ínsula, tales como lesiones de la arteria cerebral Media, cápsula interna, áreas del lenguaje en el hemisferio dominante y arterias lenticuloestriadas.
Conclusión:
El entrenamiento en laboratorio de neuroanatomía, estudio de material impreso en 3D, el conocimiento sobre neuro siología intra-operatoria y el uso de armamento neuroquirúrgico moderno son factores que in uencian en los resultados quirúrgicos.
Collapse
Affiliation(s)
- Gustavo Rassier Isolan
- Department of Surgery, Center for Advanced Neurology and Neurosurgery, Porto Alegre, Rio Grande do Sul, Brazil,
| | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla, Country Las Yungas, Yerba Buena, Tucumuán, Argentina,
| | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Peron, Buenos Aires, Argentina,
| | - Edgar Manuel Farina
- Department of Serviço de Neurocirurgia, Hospital Ministro Costa Cavalcanti Sanatório Le Blanc, Foz do Iguacu, Paraná, Brazil,
| | - Thomas More Frigeri
- Department of Neurosurgery, Pontificical Catholic University of Rio Grande do Sul, Porto Alegre,
| | - Leandro Infantini Dini
- Department of Neurosurgery, Center for Advanced Neurology and Neurosurgery, São Leopoldo, Rio Grande do Sul, Brazil
| |
Collapse
|
23
|
Fang S, Li Y, Wang Y, Zhang Z, Jiang T. Awake craniotomy for gliomas involving motor-related areas: classification and function recovery. J Neurooncol 2020; 148:317-325. [PMID: 32350781 DOI: 10.1007/s11060-020-03520-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Motor mapping with direct cortical stimulation (DCS) is useful for motor function preservation. Nevertheless, many patients still experience postoperative motor dysfunction after motor mapping. This study aimed to provide a classification of gliomas involved in motor-related areas to help understand which types of gliomas are prone to induce postoperative motor impairments. METHODS Sixty-four patients were retrospectively recruited. Based on tumor location, four types of gliomas were identified: (I) precentral gyrus; (II) premotor and/or supplementary motor areas but not invading pre-central gyrus; (III) adjacent to the posterior limb of the internal capsule; and (IV) other supra-tentorial area. The recovery of motor function was evaluated by muscle strength testing before surgery and 3 days, 7 days, 14 days, and 3 months after surgery. RESULTS Half of the patients experienced postoperative transient motor impairment within a week. Six patients suffered from permanent motor dysfunction, and four of them had type III glioma. Compared with types I and IV, patients with type III gliomas took more than three times as long to recover. Furthermore, patients with types I and II gliomas were more susceptible to preoperative epilepsy than those with types III and IV. There was no difference in postoperative seizure control between the four types. CONCLUSIONS Our classification of gliomas involving motor-related eloquent areas was useful for predicting postoperative motor functional prognosis in patients who underwent motor mapping with DCS. Even if no positive sites were detected, a conservative strategy of tumor resection is recommended in cases that gliomas located close to the posterior limb of the internal capsule.
Collapse
Affiliation(s)
- Shengyu Fang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, The Western Road of the Southern 4th Ring Road, Beijing, 100070, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, The Western Road of the Southern 4th Ring Road, Beijing, 100070, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, The Western Road of the Southern 4th Ring Road, Beijing, 100070, China.
| | - Zhong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, The Western Road of the Southern 4th Ring Road, Beijing, 100070, China.
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, The Western Road of the Southern 4th Ring Road, Beijing, 100070, China. .,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. .,Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China.
| |
Collapse
|
24
|
Hervey-Jumper SL, Berger MS. Insular glioma surgery: an evolution of thought and practice. J Neurosurg 2020; 130:9-16. [PMID: 30611160 DOI: 10.3171/2018.10.jns181519] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVEThe goal of this article is to review the history of surgery for low- and high-grade gliomas located within the insula with particular focus on microsurgical technique, anatomical considerations, survival, and postoperative morbidity.METHODSThe authors reviewed the literature for published reports focused on insular region anatomy, neurophysiology, surgical approaches, and outcomes for adults with World Health Organization grade II-IV gliomas.RESULTSWhile originally considered to pose too great a risk, insular glioma surgery can be performed safely due to the collective efforts of many individuals. Similar to resection of gliomas located within other cortical regions, maximal resection of gliomas within the insula offers patients greater survival time and superior seizure control for both newly diagnosed and recurrent tumors in this region. The identification and the preservation of M2 perforating and lateral lenticulostriate arteries are critical steps to preventing internal capsule stroke and hemiparesis. The transcortical approach and intraoperative mapping are useful tools to maximize safety.CONCLUSIONSThe insula's proximity to middle cerebral and lenticulostriate arteries, primary motor areas, and perisylvian language areas makes accessing and resecting gliomas in this region challenging. Maximal safe resection of insular gliomas not only is possible but also is associated with excellent outcomes and should be considered for all patients with low- and high-grade gliomas in this area.
Collapse
|
25
|
Ghali MGZ. Preservation of the Lenticulostriate Arteries During Insular Glioma Resection. Asian J Neurosurg 2020; 15:16-21. [PMID: 32181167 PMCID: PMC7057893 DOI: 10.4103/ajns.ajns_146_18] [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: 07/11/2018] [Accepted: 10/15/2019] [Indexed: 11/21/2022] Open
Abstract
Insular gliomas represent 25% and 10% of low- and high-grade gliomas, respectively. Their resection proves challenging due to the intimate involvement of eloquent parenchyma and the lenticulostriate arteries (LSAs), limiting facility of achieving maximal safe resection. The majority of postoperative deficits following insular glioma resection is attributed to compromise of the LSAs. It is contemporaneously critical and challenging to preserve these vessels, given they are numerous and small, with an intraparenchymal course hidden from direct visualization during the operative intervention. A lesser degree of medially directed displacement of the LSAs predicts tumoral encasement of these vessels, which portends a decreased likelihood for achieving a gross total resection and increased probability of postoperative morbidity. Preservation of these vessels thus requires knowledge of their location during the entirety of the insular glioma resection and is facilitated by pre- and intra-operative imaging. Intraoperative real-time tracking, however, may prove rather challenging, especially with transcortical access. Conventional catheter digital subtraction angiography, computed tomographic angiography, magnetic resonance imaging and angiography, and three-dimensional ultrasound powered Doppler have proven effective modalities in assessing lenticulostriate position, and their use facilitates a greater extent of resection while minimizing the attendant morbidity consequent to LSA injury.
Collapse
|
26
|
Li Z, Li G, Liu Z, Pan Y, Hou Z, Wu L, Huang Z, Zhang Y, Xie J. Transcortical approach for insular gliomas: a series of 253 patients. J Neurooncol 2020; 147:59-66. [PMID: 32006193 DOI: 10.1007/s11060-020-03390-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE The object of this study was to identify the distribution characteristics of insular gliomas and evaluate the efficiency of transcortical approach. METHODS Insular gliomas patients who underwent transcortical approach for the first time between March 2011 and July 2019 at our institute were analyzed. RESULTS A total of 253 primary insular gliomas patients were enrolled in the study. Of all patients, 176 patients (69.6%) underwent gross total resection, 61 patients (24.1%) underwent subtotal resection and 16 patients (6.3%) underwent partial resection. According to Berger-Sanai classification, the gross total resection rates of different types of insular gliomas were as follows: Zone I (90.1%), zone II (50.0%), zone III (40.0%), zone IV (89.5%), zone I + II (43.5%), zone I + IV (74.6%), zone II + III (44.4%), zone III + IV (41.7%), Giant (34.5%). According to our modified classification, the gross total resection rates were as follows: anterior type (84.9%), posterior type (45.8%), anterior-posterior type (42.9%), giant type (34.5%). After surgery, new limb motor deficit was observed in 28 patients (11.1%), and 5 patients (2.0%) were left long-term limb motor disability. New language impairment occurred in 23 patients (9.1%), and 3 patients (1.2%) were left long-term language disability. The patients were followed up for 1 to 89.2 months (average, 39.9 ± 20.3 months). At the end of follow-up, tumor progression occurred in 98 (38.7%) patients and 71 (28.1%) patients died of their disease. CONCLUSION This study demonstrated that the maximal safe resection of insular gliomas can be achieved by transcortical approach. Insular gliomas had the characteristic of forward distribution, anterior transcortical approach can provide enough surgical freedom for anterior type of insular gliomas. If anterior tumors can make route to the posterior parts, anterior transcortical approach was also applied to some anterior-posterior and giant types of insular gliomas without resection of excessive brain, which may reduce the incidence of neurological complications.
Collapse
Affiliation(s)
- Zhenye Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Gen Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhenxing Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zonggang Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhenxing Huang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China.
| |
Collapse
|
27
|
Mandonnet E. Transopercular Resection of IDH–Mutated Insular Glioma: A Critical Appraisal of an Initial Experience. World Neurosurg 2019; 132:e563-e576. [DOI: 10.1016/j.wneu.2019.08.071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 01/24/2023]
|
28
|
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] [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.
Collapse
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
| |
Collapse
|
29
|
Wang DD, Deng H, Hervey-Jumper SL, Molinaro AA, Chang EF, Berger MS. Seizure Outcome After Surgical Resection of Insular Glioma. Neurosurgery 2019; 83:709-718. [PMID: 29126238 DOI: 10.1093/neuros/nyx486] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/31/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A majority of patients with insular tumors present with seizures. Although a number of studies have shown that greater extent of resection improves overall patient survival, few studies have documented postoperative seizure control after insular tumor resection. OBJECTIVE To (1) characterize seizure control rates in patients undergoing insular tumor resection, (2) identify predictors of seizure control, and (3) evaluate the association between seizure recurrence and tumor progression. METHODS The study population included adults who had undergone resection of insular gliomas between 1997 and 2015 at our institution. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed. RESULTS One-hundred nine patients with sufficient clinical data were included in the study. At 1 yr after surgery, 74 patients (68%) were seizure free. At final follow-up, 42 patients (39%) were seizure free. Median time to seizure recurrence was 46 mo (95% confidence interval 31-65 mo). Multivariate Cox regression analysis revealed that greater extent of resection (hazard ratio = 0.2899 [0.1129, 0.7973], P = .0127) was a significant predictor of seizure freedom. Of patients who had seizure recurrence and tumor progression, seizure usually recurred within 3 mo prior to tumor progression. Repeat resection offered additional seizure control, as 8 of the 22 patients with recurrent seizures became seizure free after reoperation. CONCLUSION Maximizing the extent of resection in insular gliomas portends greater seizure freedom after surgery. Seizure recurrence is associated with tumor progression, and repeat operation can provide additional seizure control.
Collapse
Affiliation(s)
- Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Annette A Molinaro
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, California
| |
Collapse
|
30
|
Deora H, Das KK, Jaiswal A, Behari S. Letter to the Editor. Tumor extension determines approach in insular gliomas. J Neurosurg 2019; 132:2010-2011. [PMID: 31443069 DOI: 10.3171/2019.5.jns191308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Harsh Deora
- 1National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; and
| | - Kuntal Kanti Das
- 2Sanjay Gandhi Post Graduate Institute of Medical Education and Research, Lucknow, India
| | - Awadhesh Jaiswal
- 2Sanjay Gandhi Post Graduate Institute of Medical Education and Research, Lucknow, India
| | - Sanjay Behari
- 2Sanjay Gandhi Post Graduate Institute of Medical Education and Research, Lucknow, India
| |
Collapse
|
31
|
Pastor-Escartín F, García-Catalán G, Holanda VM, Muftah Lahirish IA, Quintero RB, Neto MR, Quilis-Quesada V, Ibaoc KB, González Darder JM, de Oliveira E. Microsurgical Anatomy of the Insular Region and Operculoinsular Association Fibers and its Neurosurgical Application. World Neurosurg 2019; 129:407-420. [PMID: 31132493 DOI: 10.1016/j.wneu.2019.05.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/08/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the three-dimensional relationships of the operculoinsular compartments, using standard hemispheric and white matter fiber dissection and review the anatomy of association fibers related to the operculoinsular compartments of the Sylvian fissure and the main white matter tracts located deep into the insula. The secondary aim of this study was to improve the knowledge on this complex region to safely address tumor, vascular, and epilepsy lesions with an integrated perspective of the topographic and white matter fiber anatomy using 2D and 3D photographs. METHODS Six cadaveric hemispheres were dissected. Two were fixed with formalin and the arteries were injected with red latex dye; the remaining four were prepared using the Kingler method and white fiber dissections were performed. RESULTS The insula is located entirely inside the Sylvian fissure. The topographic hemispheric anatomy, Sylvian fissure, opercula, surrounding sulci and gyri, as well as the M2, M3, and M4 segments were identified. The anatomy of the insula, with the sulci and gyri and the limiting sulci, were also identified and described. The main white matter fiber tracts of the operculoinsular compartments of the Sylvian fissure as well as the main association and commissural fibers located deep in the insula were dissected and demonstrated. CONCLUSIONS Complementing topographic anatomy with detailed study of white matter fibers and their integration can help the neurosurgeon to safely approach lesions in the insular region, improving postoperative results in the microsurgical treatment of aneurysmal lesions, insular tumors, or epilepsy surgery.
Collapse
Affiliation(s)
- Félix Pastor-Escartín
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Beneficência Portuguesa Hospital, São Paulo, Brazil; Department of Microsurgical Anatomy and Neurosurgery, Beneficência Portuguesa Hospital, São Paulo, Brazil; Department of Neurosurgery, Hospital Clínico universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine, University of València, Valencia, Spain
| | - Guillermo García-Catalán
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Beneficência Portuguesa Hospital, São Paulo, Brazil; Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Vanessa M Holanda
- Department of Microsurgical Anatomy and Neurosurgery, Beneficência Portuguesa Hospital, São Paulo, Brazil; College of Medicine and Science, Mayo Clinic, Jacksonville, Florida, USA.
| | - Issa Ali Muftah Lahirish
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Beneficência Portuguesa Hospital, São Paulo, Brazil
| | - Rubén Batista Quintero
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Beneficência Portuguesa Hospital, São Paulo, Brazil
| | - Mateus Regin Neto
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Beneficência Portuguesa Hospital, São Paulo, Brazil; College of Medicine and Science, Mayo Clinic, Jacksonville, Florida, USA
| | - Vicent Quilis-Quesada
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Department of Neurosurgery, Hospital Clínico universitario de Valencia, Valencia, Spain; College of Medicine and Science, Mayo Clinic, Jacksonville, Florida, USA; Hospital Clínico Universitario de Valencia, Valencia, Spain; Department of Human Anatomy and Embriology, Valencia, Spain; Faculty of Medicine, University of València, Valencia, Spain
| | - Khalil Bergado Ibaoc
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Beneficência Portuguesa Hospital, São Paulo, Brazil
| | - José Manuel González Darder
- Department of Neurosurgery, Hospital Clínico universitario de Valencia, Valencia, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine, University of València, Valencia, Spain
| | - Evandro de Oliveira
- Institute of Neurological Sciences (ICNE), São Paulo, Brazil; Microneurosurgery Laboratory, Beneficência Portuguesa Hospital, São Paulo, Brazil; College of Medicine and Science, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
32
|
Ding H, Zhou J, Guan Y, Zhai F, Wang M, Wang J, Luang G. Bipolar electro-coagulation with cortextomy in the treatment of insular and insulo-opercular epilepsy explored by stereoelectro-encephalography. Epilepsy Res 2018; 145:18-26. [DOI: 10.1016/j.eplepsyres.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/16/2018] [Accepted: 05/14/2018] [Indexed: 11/26/2022]
|
33
|
Abstract
Focal epilepsy originating from the insular cortex is rare. One reason is the small amount of cortical tissue compared with other lobes of the brain. However, the incidence of insular epilepsy might be underestimated because of diagnostic difficulties. The semiology and the surface EEG are often not meaningful or even misleading, and elaborated imaging might be necessary. The close connections of the insular cortex with other potentially epileptogenic areas, such as the temporal lobe or frontal/central cortex, is increasingly recognized as possible reason for failure of epilepsy surgery for temporal or extratemporal seizures. Therefore, some centers consider invasive EEG recording of the insular cortex not only in case of insular epilepsy but also in other focal epilepsies with nonconclusive results from the presurgical work-up. The surgical approach to and resection of insular cortex is challenging because of its deep location and proximity to highly eloquent brain structures. Over the last decades, technical adjuncts like navigation tools, electrophysiological monitoring and intraoperative imaging have improved the outcome after surgery. Nevertheless, there is still a considerable rate of postoperative transient or permanent deficits, in some cases as unavoidable and calculated deficits. In most of the recent series, seizure outcome was favorable and comparable with extratemporal epilepsy surgery or even better. Up to now, the data volume concerning long-term follow-up is limited. This review focusses on the surgical challenges of resections to treat insular epilepsy, on prognostic factors concerning seizure outcome, on postoperative deficits and complications. Moreover, less invasive surgical techniques to treat epilepsy in this highly eloquent area are summarized.
Collapse
|
34
|
Bouthillier A, Nguyen DK. Epilepsy Surgeries Requiring an Operculoinsular Cortectomy: Operative Technique and Results. Neurosurgery 2018; 81:602-612. [PMID: 28419327 DOI: 10.1093/neuros/nyx080] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/04/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Epilepsy surgeries requiring an operculoinsulectomy pose significant difficulties because the perisylvian area is highly vascular, deep, and functional. OBJECTIVE To report the operative technique and results of epilepsy surgeries requiring an operculoinsular cortectomy at our institution. METHODS The data of all consecutive patients who had undergone an epilepsy surgery requiring an operculoinsular cortectomy with a minimum follow-up of 1 yr were reviewed. Tumor and vascular malformation cases were excluded. Surgical techniques are described based on findings during surgery. RESULTS Twenty-five patients underwent an epilepsy surgery requiring an operculoinsular cortectomy: mean age at surgery was 35 y (9-51), mean duration of epilepsy was 19 y (5-36), 14 were female, and mean duration of follow-up was 4.7 y (1-16). Magnetic resonance imaging of the operculoinsular area was normal or revealed questionable nonspecific findings in 72% of cases. Investigation with intracranial EEG electrodes was done in 17 patients. Surgery was performed on the dominant side for language in 7 patients. An opercular resection was performed in all but 2 patients who only had an insulectomy. Engel class I seizure control was achieved in 80% of patients. Postoperative neurological deficits (paresis, dysphasia, alteration of taste, smell, hearing, pain, and thermal perceptions) were frequent (75%) but always transient except for 1 patient with persistent mild alteration of thermal and pain perception. CONCLUSION Surgical treatment of operculoinsular epilepsy is effective in achieving seizure control and is associated with an acceptable long-term complication rate.
Collapse
Affiliation(s)
- Alain Bouthillier
- Division of Neurosurgery, Hôpital Notre-Dame (CHUM), Université de Montréal, Quebec, Canada
| | - Dang Khoa Nguyen
- Division of Neurology, Hôpital Notre-Dame (CHUM), Université de Montréal, Quebec, Canada
| |
Collapse
|
35
|
Intraoperative linguistic performance during awake brain surgery predicts postoperative linguistic deficits. J Neurooncol 2018; 139:215-223. [PMID: 29637508 PMCID: PMC6061224 DOI: 10.1007/s11060-018-2863-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022]
Abstract
Introduction Awake craniotomy pursues a balance between extensive tumor resection and preservation of postoperative language function. A dilemma exists in patients whose tumor resection is restricted due to signs of language impairment observed during awake craniotomy. In order to determine the degree to which recovery of language function caused by tumor resection can be achieved by spontaneous neuroplasticity, the change in postoperative language function was compared to quantified intraoperative linguistic performance. Methods The modified, short-form Boston Diagnostic Aphasia Examination (sfBDAE) was used to assess pre- and postoperative language functions; visual object naming (DO 80) and semantic-association (Pyramid and Palm Tree Test, PPTT) tests assessed intraoperative linguistic performance. DO 80 and PPTT were performed alternatively during subcortical functional monitoring while performing tumor resection and sfBDAE was assessed 1-week postoperatively. Results Most patients with observed language impairment during awake surgery showed improved language function postoperatively. Both intraoperative DO 80 and PPTT showed significant correlation to postoperative sfBDAE domain scores (p < 0.05), with a higher correlation observed with PPTT. A linear regression model showed that only PPTT predicted the postoperative sfBDAE domain scores with the adjusted R2 ranging from 0.51 to 0.89 (all p < 0.01). Receiver operating characteristic analysis showed a cutoff value of PPTT that yielded a sensitivity of 80% and specificity of 100%. Conclusion PPTT may be a feasible tool for intraoperative linguistic evaluation that can predict postoperative language outcomes. Further studies are needed to determine the extent of tumor resection that optimizes the postoperative language following neuroplasticity.
Collapse
|
36
|
Corrivetti F, Froelich S, Mandonnet E. Endoscopic Approach of the Insula Through the Anterior Middle Temporal Gyrus: A Feasibility Study in the Laboratory. Oper Neurosurg (Hagerstown) 2018; 14:441-448. [PMID: 28973523 DOI: 10.1093/ons/opx128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 07/06/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Insular glioma surgery still represents a challenge. Nonetheless, advances in microsurgical anatomy and brain mapping techniques have allowed an increase in the extent of resection with acceptable morbidity rates. Transsylvian and transcortical approaches constitute the main surgical corridors, the latter providing considerable advantages and a high degree of reliability. Nevertheless, both surgical corridors yield remarkable difficulties in reaching the most posterior insular region. OBJECTIVE To study the feasibility of an endoscopic transtemporal approach in brain specimens, with the aim to provide a suitable access for posterior insular region. METHODS Four postmortem human hemispheres, embalmed using Klingler's technique, were dissected by means of a 30° rigid endoscope. The specimens underwent magnetic resonance imaging scans and, using the neuronavigation system, we were able to design a safe cortical window and an optimized endoscopic trajectory for the posterior insular dissection. RESULTS Insular dissection was led subpially through a small 2-cm cortical access, located in the anterior part of the middle temporal gyrus. During the posterior insula dissection, the endoscope allowed for optimized surgical view all along the long gyri, up to the posterior insular point. Anterior insular dissection was accomplished with more difficulties, as the endoscopic trajectory was not aligned to the axis of the short gyri. CONCLUSION This new surgical approach provides a favorable transcortical access to reach the most posterior insular portion. It seems to be a promising tool, in combination with intraoperative functional brain mapping, to further improve extent of resection rates in insular glioma surgery.
Collapse
|
37
|
Diagnostic evaluation and surgical management of pediatric insular epilepsy utilizing magnetoencephalography and invasive EEG monitoring. Epilepsy Res 2018; 140:72-81. [DOI: 10.1016/j.eplepsyres.2017.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 11/28/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022]
|
38
|
|
39
|
Rao AS, Thakar S, Sai Kiran NA, Aryan S, Mohan D, Hegde AS. Analogous Three-Dimensional Constructive Interference in Steady State Sequences Enhance the Utility of Three-Dimensional Time of Flight Magnetic Resonance Angiography in Delineating Lenticulostriate Arteries in Insular Gliomas: Evidence from a Prospective Clinicoradiologic Analysis of 48 Patients. World Neurosurg 2017; 109:e426-e433. [PMID: 29017985 DOI: 10.1016/j.wneu.2017.09.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Three-dimensional (3D) time of flight (TOF) imaging is the current gold standard for noninvasive, preoperative localization of lenticulostriate arteries (LSAs) in insular gliomas; however, the utility of this modality depends on tumor intensity. METHODS Over a 3-year period, 48 consecutive patients with insular gliomas were prospectively evaluated. Location of LSAs and their relationship with the tumor were determined using a combination of contrast-enhanced coronal 3D TOF magnetic resonance angiography and coronal 3D constructive interference in steady state (CISS) sequences. These findings were analyzed with respect to extent of tumor resection and early postoperative motor outcome. RESULTS Tumor was clearly visualized in 29 (60.4%) patients with T1-hypointense tumors using 3D TOF and in all patients using CISS sequences. Using combined 3D TOF and CISS, LSA-tumor interface was well seen in 47 patients, including all patients with T1-heterointense or T1-isointense tumors. Extent of resection was higher in the LSA-pushed group compared with the LSA-encased group. In the LSA-encased group, 6 (12.5%) patients developed postoperative hemiparesis; 2 (4.2%) cases were attributed to LSA injury. CONCLUSIONS Contrast-enhanced 3D TOF can delineate LSAs in almost all insular gliomas but is limited in identifying the LSA-tumor interface. This limitation can be overcome by addition of analogous CISS sequences that delineate the LSA-tumor interface regardless of tumor intensity. Combined 3D TOF and 3D CISS is a useful tool for surgical planning and safer resections of insular tumors and may have added surgical relevance when included as an intraoperative adjunct.
Collapse
Affiliation(s)
- Arun S Rao
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Sumit Thakar
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
| | | | - Saritha Aryan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Dilip Mohan
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| | - Alangar S Hegde
- Department of Neurological Sciences, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
| |
Collapse
|
40
|
Sughrue M, Bonney PA, Burks JD, Othman J, Baker C, Glenn CA, Teo C. Multilobar Insular-Involving Gliomas: Results with Hyperaggressive Resection. Cureus 2017; 9:e1623. [PMID: 29098133 PMCID: PMC5659303 DOI: 10.7759/cureus.1623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Hyperaggressive resection refers to a philosophy that maximal resection should be pursued in gliomas, wherever possible. In this study, we provide a detailed report of the outcomes with hyperaggressive surgery for multilobar insular-involving gliomas (MIGs). Methods We report outcomes in patients with MIGs undergoing surgery aiming at gross total resection in all cases. Risk factors for neurologic deficits and survival were modeled using logistic and Cox regression. Results There were 72 consecutive patients, of whom 53 (74%) had undergone previous surgery. A greater than 90% resection was obtained in 67 patients (93%). Nineteen of 23 patients (83%) with Grade 2 tumors survived to the end of the follow-up period. Patients with Grade 3 tumors experienced 75% two-year survival rates and 48% four-year survival rates. Patients with Grade 4 tumors experienced 55% one-year survival rates and 33% two-year survival rates; eight of 33 patients (24%) lived longer than three years and three of 33 patients were alive at five years. Fifty-eight of 68 patients (85%) surviving to the three-month follow-up had a Karnofsky performance status (KPS) of 70 or greater, and 31 of 72 patients (43%) experienced improvement in KPS postoperatively. Permanent weakness occurred in 12 patients (17%), and permanent speech problems in three patients (13% of left-sided tumors). Conclusion Hyperaggressive surgical resection of MIGs yields rates of neurologic deficits within acceptable ranges and are lower than expected. In many cases, patients exceed the long-term survival expectations of conventional treatment.
Collapse
Affiliation(s)
- Michael Sughrue
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Phillip A Bonney
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Joshua D Burks
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Jad Othman
- Prince of Wales Private Hospital, University of New South Wales
| | - Cordell Baker
- Department of Neurosurgery, University of Oklahoma Health Sciences Center
| | - Chad A Glenn
- Neurosurgery, University of Oklahoma Health Sciences Center
| | - Charles Teo
- Prince of Wales Private Hospital, University of New South Wales
| |
Collapse
|
41
|
Volumetric Analysis of Extent of Resection, Survival, and Surgical Outcomes for Insular Gliomas. World Neurosurg 2017; 103:265-274. [DOI: 10.1016/j.wneu.2017.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/30/2017] [Accepted: 04/01/2017] [Indexed: 12/20/2022]
|
42
|
Murrone D, Maduri R, Afif A, Chirchiglia D, Pelissou-Guyotat I, Guyotat J, Signorelli F. Insular gliomas: a surgical reappraisal based on a systematic review of the literature. J Neurosurg Sci 2017; 63:566-580. [PMID: 28548479 DOI: 10.23736/s0390-5616.17.04045-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Insular gliomas are heterogeneous lesions whose management presents multiple challenges for their tendency to affect young patients in good neurological and cognitive conditions, their deep anatomic location and proximity with critical functional and vascular structures. The appropriate management of insular gliomas requires a multidisciplinary evidence-centred teamwork grounded on the best anatomic, neurophysiological and oncological knowledge. The present study provides a reappraisal of the management of insular gliomas based on a systematic review of the literature with the aim of guiding clinicians in the management of such tumors. EVIDENCE ACQUISITION A systematic review of the literature from the Medline, Embase and Cochrane Central databases was performed. From 2006 to 2016, all articles meeting specific inclusion criteria were included. EVIDENCE SYNTHESIS The present work summarizes the most relevant evidence about insular gliomas management. The anatomy and physiology of the insula, the new WHO 2016 classification and clinico-radiological presentation of insular gliomas are reviewed. Surgical pearls of insular gliomas resection as well as oncologic and functional outcomes after insular gliomas treatment are discussed. CONCLUSIONS Management of insular gliomas remains challenging despite improvement in surgical and oncological techniques. However, the literature review supports a growing evidence that recent developments in the multidisciplinary care account for constant improvements of survival and quality of life.
Collapse
Affiliation(s)
- Domenico Murrone
- Service of Neurosurgery, "Di Venere" Hospital of Bari, Bari, Italy
| | - Rodolfo Maduri
- Department of Clinical Neurosciences, Service of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Afif Afif
- Service of Neurosurgery A, "Pierre Wertheimer" Neurological Neurosurgical Hospital of Lyon, Lyon, France
| | - Domenico Chirchiglia
- Department of Medical Sciences, "Magna Græcia" University of Catanzaro, Catanzaro, Italy
| | - Isabelle Pelissou-Guyotat
- Service of Neurosurgery A, "Pierre Wertheimer" Neurological Neurosurgical Hospital of Lyon, Lyon, France
| | - Jacques Guyotat
- Service of Neurosurgery A, "Pierre Wertheimer" Neurological Neurosurgical Hospital of Lyon, Lyon, France
| | - Francesco Signorelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs "Aldo Moro" University, Bari, Italy -
| |
Collapse
|
43
|
Language Mapping Using fMRI and Direct Cortical Stimulation for Brain Tumor Surgery: The Good, the Bad, and the Questionable. Top Magn Reson Imaging 2016; 25:1-10. [PMID: 26848555 DOI: 10.1097/rmr.0000000000000074] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Language functional magnetic resonance imaging for neurosurgical planning is a useful but nuanced technique. Consideration of primary and secondary language anatomy, task selection, and data analysis choices all impact interpretation. In the following chapter, we consider practical considerations and nuances alike for language functional magnetic resonance imaging in the support of and comparison with the neurosurgical gold standard, direct cortical stimulation. Pitfalls and limitations are discussed.
Collapse
|
44
|
Mandonnet E, Martino J, Sarubbo S, Corrivetti F, Bouazza S, Bresson D, Duffau H, Froelich S. Neuronavigated Fiber Dissection with Pial Preservation: Laboratory Model to Simulate Opercular Approaches to Insular Tumors. World Neurosurg 2016; 98:239-242. [PMID: 27765721 DOI: 10.1016/j.wneu.2016.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Advances in the oncologic and functional results of insular surgery have been reported recently. Such successes have been made possible by the advent of the transopercular approach under awake monitoring and by improved anatomic and functional knowledge of white matter pathways surrounding the insula. Nonetheless, given the rarity of insular tumors, it is difficult to get familiar with the complex 3-dimensional anatomy of the different neuronal and vascular structures encountered during a transopercular insular resection. We thus propose to develop a laboratory model allowing to train transopercular approaches of the insula. METHODS Two hemispheres prepared with Klinger's technique were dissected under light microscope, preserving all pial membranes. The different steps of the dissection were video recorded. RESULTS Preservation of pial membranes enabled us to simulate subpial resection, both during operculum removal and during insular cortex resection. The medial wall of the resection was defined by the inferior-fronto-occipital fasciculus, protecting from the lenticulostriate arteries. CONCLUSION In this paper, we show that Klinger dissection with preservation of pial membranes provides a realistic model of insular surgery, allowing surgeons to learn and train on this highly specialized surgery.
Collapse
Affiliation(s)
- Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; University Paris 7, Paris, France; IMNC UMR8165, Orsay, France.
| | - Juan Martino
- Department of Neurological Surgery, Hospital Universitario Marques de Valdecilla and Fundacion Instituto de Investigacion Marques de Valdecilla (IDIVAL), Trento APSS, Italy
| | - Silvio Sarubbo
- Department of Neurosciences, Division of Neurosurgery, Structural and Functional Connectivity Lab Project, 'S. Chiara' Hospital, Trento APSS, Italy; Structural and Functional Connectivity Lab Project, Division of Neurosurgery, 'S. Chiara' Hospital, Trento APSS, Italy
| | - Francesco Corrivetti
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; Department of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Damien Bresson
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier Medical University Center, Montpellier, France; Institute of Neuroscience of Montpellier, INSERM U1051, Montpellier, France
| | - Sebastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; University Paris 7, Paris, France; Laboratory of Experimental Neurosurgery, Paris, France
| |
Collapse
|
45
|
Clinical considerations and surgical approaches for low-grade gliomas in deep hemispheric locations: insular lesions. Childs Nerv Syst 2016; 32:1875-93. [PMID: 27659830 DOI: 10.1007/s00381-016-3183-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 12/31/2022]
Abstract
Insula and paralimbic region represent a common location for gliomas in adulthood. However, limbic and paralimbic tumors are rare in children. Reports of pediatric insular tumors are scarce in literature, and most of them are included in adult's series, so their management and outcome can be outlined only after extracting data from these reports. Due to their predominantly low grade, they usually have a benign course for some time, what make them ideal candidates for total resection. However, their intricate location and spread to key areas, including the temporal lobe, make them a surgical challenge. The transsylvian route, with or without resection of the frontal and/or temporal operculae, which requires exposure of part or all of the insula is commonly selected for insular tumor approaches. Intraoperative functional mapping is a standard procedure for resection of central region tumors in adults. In children and young individuals, awake craniotomy is not always possible and surgical planning usually relay on functional and anatomical preoperative studies. The main goal when approaching an insular tumor is to achieve the largest extent of resection to increase overall patient survival while preserving the functional status, minimizing postoperative morbidity and increasing the quality of life. The extent of resection seems to be correlated also with the control of associated (and usually intractable) epilepsy.
Collapse
|
46
|
Howie E, Bambrough J, Karabatsou K, Fox JR. Patient experiences of awake craniotomy: An Interpretative Phenomenological Analysis. J Health Psychol 2016; 21:2612-2623. [PMID: 25943343 DOI: 10.1177/1359105315581513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Awake craniotomy with language mapping enables maximum resection of tumours in eloquent areas while preserving function. This study aims to understand the lived experiences of those undergoing an awake craniotomy. Six participants who underwent awake craniotomy were interviewed, and the data were analysed using Interpretative Phenomenological Analysis. Themes were identified as 'Unspeakable Fear', 'Dissociation' and 'Control and Responsibility'. Participants discussed how surgery was a threat to the sense of self. Dissociation during surgery operated as a protective mechanism, while the surgical team all had roles in maintaining this bubble of dissociation, such as being a support to the patient's emotional needs.
Collapse
Affiliation(s)
- Emma Howie
- 1 Royal Manchester Children's Hospital, UK.,2 The University of Manchester, UK
| | - Jacki Bambrough
- 2 The University of Manchester, UK.,3 Salford Royal Hospital, UK
| | | | - John Re Fox
- 4 University of London, UK.,5 Barnet, Enfield and Haringey Mental Health NHS Trust, UK
| |
Collapse
|
47
|
The transsylvian approach for resection of insular gliomas: technical nuances of splitting the Sylvian fissure. J Neurooncol 2016; 130:283-287. [PMID: 27294356 DOI: 10.1007/s11060-016-2154-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/26/2016] [Indexed: 12/19/2022]
Abstract
Insular gliomas represent a unique surgical challenge due to the complex anatomy and nearby vascular elements associated within the Sylvian fissure. For certain tumors, the transsylvian approach provides an effective technique for achieving maximal safe resection. The goal of this manuscript and video are to present and discuss the surgical nuances and appropriate application of splitting the Sylvian fissure. Our hope is that this video highlights the safety and efficacy of the transsylvian approach for appropriately selected insular gliomas.
Collapse
|
48
|
Michaud K, Duffau H. Surgery of insular and paralimbic diffuse low-grade gliomas: technical considerations. J Neurooncol 2016; 130:289-298. [DOI: 10.1007/s11060-016-2120-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/02/2016] [Indexed: 01/16/2023]
|
49
|
Benet A, Hervey-Jumper SL, Sánchez JJG, Lawton MT, Berger MS. Surgical assessment of the insula. Part 1: surgical anatomy and morphometric analysis of the transsylvian and transcortical approaches to the insula. J Neurosurg 2016; 124:469-81. [DOI: 10.3171/2014.12.jns142182] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Transcortical and transsylvian corridors have been previously described as the main surgical approaches to the insula, but there is insufficient evidence to support one approach versus the other. The authors performed a cadaveric comparative study regarding insular exposure, surgical window and freedom, between the transcortical and transsylvian approaches (with and without cutting superficial sylvian bridging veins). Surgical anatomy and skull surface reference points to the different insular regions are also described.
METHODS
Sixteen cadaveric specimens were embalmed with a customized formula to enhance neurosurgical simulation. Two different blocks were defined in the study: first, transsylvian without (TS) and with the superficial sylvian bridging veins cut (TSVC) and transcortical (TC) approaches to the insula were simulated in all (16) specimens. Insular surface exposure, surgical window and surgical freedom were calculated for each procedure and related to the Berger-Sanai insular glioma classification (Zones I–IV) in 10 specimens. Second, the venous drainage pattern and anatomical landmarks considered critical for surgical planning were studied in all specimens.
RESULTS
In the insular Zone I (anterior-superior), the TC approach provided the best insular exposure compared with both TS and TSVC. The surgical window obtained with the TC approach was also larger than that obtained with the TS. The TC approach provided 137% more surgical freedom than the TS approach. Only the TC corridor provided complete insular exposure. In Zone II (posterior-superior), results depended on the degree of opercular resection. Without resection of the precentral gyrus in the operculum, insula exposure, surgical windows and surgical freedom were equivalent. If the opercular cortex was resected, the insula exposure and surgical freedom obtained through the TC approach was greater to that of the other groups. In Zone III (posterior-inferior), the TC approach provided better surgical exposure than the TS, yet similar to the TSVC. The TC approach provided the best insular exposure, surgical window, and surgical freedom if components of Heschl’s gyrus were resected. In Zone IV (anterior-inferior), the TC corridor provided better exposure than both the TS and the TSVC. The surgical window was equivalent. Surgical freedom provided by the TC was greater than the TS approach. This zone was completely exposed only with the TC approach. A dominant anterior venous drainage was found in 87% of the specimens. In this group, 50% of the specimens had good alternative venous drainage. The sylvian fissure corresponded to the superior segment of the squamosal suture in 14 of 16 specimens. The foramen of Monro was 1.9 cm anterior and 4.42 cm superior to the external acoustic meatus. The M2 branch over the central sulcus of the insula became the precentral M4 (rolandic) artery in all specimens.
CONCLUSIONS
Overall, the TC approach to the insula provided better insula exposure and surgical freedom compared with the TS and the TSVC. Cortical and subcortical mapping is critical during the TC approach to the posterior zones (II and III), as the facial motor and somatosensory functions (Zone II) and language areas (Zone III) may be involved. The evidence provided in this study may help the neurosurgeon when approaching insular gliomas to achieve a greater extent of tumor resection via an optimal exposure.
Collapse
|
50
|
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.
Collapse
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
| |
Collapse
|