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

The evaluation of neurovascular relationships in trigeminal neuralgia: a pilot study on the optimal combination of high-resolution three-dimensional MR sequences

“…Moreover, contrast-enhanced 3D-TOF can depict peritumoural lenticulostriate arteries (LSAs) in insular gliomas but is poor in outlining the vessel-tumour interface. However, the combination with analogous constructive interference in steady-state (CISS) sequences can be helpful to overcome this limitation to depict the LSA-tumour interface without regard to tumour intensity (26) .…”

Preservation of the lenticulostriate arteries during insular glioma resection

“…The microsurgical resection of insular gliomas carries a significant risk of injury to the lenticulostriate arteries (LSAs) emanating from the precommunicating segment of the anterior cerebral artery and sphenoidal segment of the middle cerebral artery and supplying the deep white matter tracts and basal nuclei. [1][2][3][4][5][6] Iatrogenic injury of these fine vessels may precipitate the development of new onset hemiparesis [1][2][3][4][5] consequent to ischemic infarction of the highly eloquent pyramidal white matter tracts. [6] The LSAs may sustain damage as a consequence of suction aspirator trauma to the abluminal surface of the vessel wall during tumoral coagulation.…”

“…[7,8] A plethora of examples of postoperative deficits sustained consequent to LSA injury or coagulation during insular glioma resection abound in the literature. [1][2][3][4][5]9,10] The preservation of the LSAs thus proves indispensable in order to ensure good neurological outcome. [2,4,9,[11][12][13][14][15] Consequently, in order to mitigate these attendant risks accompanying insular glioma extirpation, the optimization of microsurgical resection technique is of utmost importance.…”

“…[7,[11][12][13]18,19] While preoperative imaging represents an excellent modality in identifying the location of the LSAs relative to tumor and healthy parenchyma, [1,2,10,15,19,20] microsurgical dissection and tumor debulking generate intraoperative brain shifts [8,9] effectively changing the relationship between the tumor and the LSAs, invoking the necessity of innovation in real-time tracking imaging modalities. [1,5,[8][9][10]15,21] anatomy of the lenticulostriate arteries, as a series of fine branches varying from 5 to 24 vessels [22] arising principally from the inferomedial aspect of the M1 segment of the middle cerebral artery, typically as a single branch subsequently dividing into smaller branches [Figures 1 and 2]. The vessels may alternatively originate as two main stem arteries from the sphenoidal segment of the middle cerebral artery or the proximal aspect of the insular middle cerebral artery, subsequently dividing extensively, or as multiple small vessels directly emanating from the parent trunks of the middle cerebral artery (MCA).…”

“…[26,27] Since parenchyma irrigated by the lenticulostriate arteries typically does not receive significant collateral flow, iatrogenic injury to a single lenticulostriate vessel may cause basal ganglionic or internal capsular infarction, [21] resulting in dense hemiplegia. [1][2][3][4][5] Preservation of middle cerebral artery branches during Sylvian dissection proves equivalently critical during the microsurgical extirpation of insular gliomas. Insular vessels deriving from the middle cerebral artery may be classified as short branches (85%-90%) supplying insular cortex and extreme capsule, intermediate (10%) branches irrigating claustrum and external capsule, or long (3%-5%) branches providing blood flow to the corona radiata.…”