Magnetic resonance imaging for preoperative identification of the lenticulostriate arteries in insular glioma surgery

Saito, Ryuta; Kumabe, Toshihiro; Inoue, Takashi; Takada, Shihomi; Yamashita, Yoshihisa; Kanamori, Masayuki; Sonoda, Yukihiko; Tominaga, Teiji

doi:10.3171/2008.11.jns08858

Cited by 36 publications

(38 citation statements)

References 14 publications

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“…In insular gliomas surgery, an injury to the lateral lenticulostriate arteries represents the main cause of permanent neurological deficit, leading to permanent hemiparesis due to a deep stroke in the internal capsule. 8,19,28,31 The present work revealed that in insulo-opercular gliomas, the distance between the limen insulae and the IFOF and uncinate fasciculus was enlarged, while the distance between the lateral margin of the anterior perforated substance and the lateral surface of the tracts was reduced. Consequently, at the limen insulae, gliomas seem to grow in the space between the tracts and the insular surface, compressing the tracts in a medial direction.…”

Section: Transopercular Approach To Insulo-opercular Gliomassupporting

confidence: 47%

Subcortical anatomy as an anatomical and functional landmark in insulo-opercular gliomas: implications for surgical approach to the insular region

Martino¹,

Mato²,

Lucas

et al. 2015

JNS

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T he insula of Riel is located at the depth of the sylvian cistern, covered by the frontal, parietal, and temporal operculi. It overlies the striatum and thalamus, and it is covered by the trunk of the middle cerebral artery and its branches. 30,39 Insular gliomas are frequently encountered in neurosurgical practice, as the insula appears to be a preferential location for low-grade gliomas. An epidemiological study performed by Duffau and Capelle 9 showed that these lesions accounted for up to 25% of all low-grade gliomas and 10% of all high-grade gliomas.The insular region is a highly connected area, as an intricate network of afferent and efferent projections connect it with adjacent and distant cortical regions. 14,21,26,30 There are 2 prominent associative bundles that run under the in- obJect Little attention has been given to the functional challenges of the insular approach to the resection of gliomas, despite the potential damage of essential neural networks that underlie the insula. The object of this study is to analyze the subcortical anatomy of the insular region when infiltrated by gliomas, and compare it with the normal anatomy in nontumoral hemispheres. methods Ten postmortem human hemispheres were dissected, with isolation of the inferior fronto-occipital fasciculus (IFOF) and the uncinate fasciculus. Probabilistic diffusion tensor imaging (DTI) tractography was used to analyze the subcortical anatomy of the insular region in 10 healthy volunteers and in 22 patients with insular Grade II and Grade III gliomas. The subcortical anatomy of the insular region in these 22 insular gliomas was compared with the normal anatomy in 20 nontumoral hemispheres. results In tumoral hemispheres, the distances between the peri-insular sulci and the lateral surface of the IFOF and uncinate fasciculus were enlarged (p < 0.05). Also in tumoral hemispheres, the IFOF was identified in 10 (90.9%) of 11 patients with an extent of resection less than 80%, and in 4 (36.4%) of 11 patients with an extent of resection equal to or greater than 80% (multivariate analysis: p = 0.03). coNclusioNs Insular gliomas grow in the space between the lateral surface of the IFOF and uncinate fasciculus and the insular surface, displacing and compressing the tracts medially. Moreover, these tracts may be completely infiltrated by the tumor, with a total disruption of the bundles. In the current study, the identification of the IFOF with DTI tractography was significantly associated with the extent of tumor resection. If the IFOF is not identified preoperatively, there is a high probability of achieving a resection greater than 80%.

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Section: Transopercular Approach To Insulo-opercular Gliomassupporting

confidence: 47%

Subcortical anatomy as an anatomical and functional landmark in insulo-opercular gliomas: implications for surgical approach to the insular region

Martino¹,

Mato²,

Lucas

et al. 2015

JNS

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“…This "windowing technique" permits tumor removal along the course of the uncinate fasciculus, generating supra-and infrasylvian resection cavities that are eventually connected to one another underneath the skeletonized sylvian vessels. Finally, identification of the lenticulostriate arteries 10 and motor mapping of the internal capsule allows delineation of the medial border of resection in most cases. …”

Section: Microsurgical Techniquementioning

confidence: 99%

Insular glioma resection: assessment of patient morbidity, survival, and tumor progression

Sanai¹,

Polley

Berger³

2010

JNS

285

276

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Object Insular gliomas remain surgically challenging cases due to complex anatomy, including surrounding vasculature and the relationship to functional structures. To define the morbidity profile associated with aggressive insular glioma removal as well as its impact on long-term outcome, the authors retrospectively evaluated the extent of resection (EOR) in the context of this complex anatomy and function and assessed its role in determining disease progression, malignant transformation, and, ultimately, patient survival. Methods The study population included adults who had undergone initial or repeat resection of insular gliomas of all grades. Tumor location was identified according to a proposed quadrant-style classification (Zones I–IV) of the insula. Low- and high-grade gliomas were volumetrically analyzed using FLAIR and contrast-enhanced T1-weighted MR imaging, respectively. Results One hundred fifteen procedures involving 104 patients with insular gliomas were identified. Patients presented with low-grade gliomas (LGGs) in 70 cases (60%) and high-grade gliomas (HGGs) in 45 (40%). Zone I (anterior-superior) was the most common site within the insula (40 patients [39%]), followed by Zone I+IV (anteriorsuperior + anterior-inferior; 26 patients [25%]). The median EOR was 82% (range 31–100%) for low-grade lesions and 81% (range 47–100%) for high-grade lesions. Zone I was associated with the highest median EOR (86%), and among all lesion grades, the insular quadrant anatomy was predictive of the EOR (p = 0.0313). Overall, there were 16 deaths (15%) during a median follow-up of 4.2 years. There were no surgery-related deaths, and new, permanent postoperative deficits were noted in 6 patients (6%). Among LGGs, tumor progression and malignant transformation were identified in 20 (29%) and 14 cases (20%), respectively. Among HGGs, progression was identified in 16 cases (36%). Patients with LGGs resected ≥ 90% had a 5-year overall survival (OS) rate of 100%, whereas those with lesions resected < 90% had a 5-year OS rate of 84%. Patients with HGGs resected ≥ 90% had a 2-year OS rate of 91%; when the EOR was < 90%, the 2-year OS rate was 75%. The EOR was predictive of OS both in cases of LGGs (hazard ratio [HR] 0.955, 95% CI 0.921–0.992, p = 0.017) and HGGs (HR 0.955, 95% CI 0.918–0.994, p = 0.024). Progression-free survival (PFS) was also predicted by the EOR in both LGGs (HR 0.973, 95% CI 0.948–0.998, p = 0.0414) and HGGs (HR 0.958, 95% CI 0.919–0.999, p = 0.0475). Interestingly, among patients with LGGs, malignant progression was also significantly associated with a lower EOR (HR 0.968, 95% CI 0.393–0.998, p = 0.0369). Conclusions Aggressive resection of insular gliomas of all grades can be accomplished with an acceptable morbidity profile and is predictive of improved OS and PFS. Among insular LGGs, a greater EOR is also associated with longer malignant PFS. Data in this study also suggest that insular gliomas generally follow a more indolent course than similar lesions in other brain regions.

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“…Согласно R. Saito и соавт. [17], визу-ализация ЛСА в предоперационном периоде с по-мощью 3D-TOF МРА позволяет снизить риск их интраоперационного повреждения и увеличить сте-пень резекции опухоли. Однако авторы не указыва-ют числа пациентов, которым сделано исследова-ние, а приводят лишь три клинических примера ис-пользования методики.…”

Section: рис 4 клиническое наблюдение 4 повреждение дистального учunclassified

3D-TOF MR-angiography with high spatial resolution for surgical planning in insular lobe gliomas

Bykanov¹,

Pitskhelauri²,

Pronin³

et al. 2015

Vopr. neirokhir.

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Magnetic resonance imaging for preoperative identification of the lenticulostriate arteries in insular glioma surgery

Cited by 36 publications

References 14 publications

Subcortical anatomy as an anatomical and functional landmark in insulo-opercular gliomas: implications for surgical approach to the insular region

Subcortical anatomy as an anatomical and functional landmark in insulo-opercular gliomas: implications for surgical approach to the insular region

Insular glioma resection: assessment of patient morbidity, survival, and tumor progression

3D-TOF MR-angiography with high spatial resolution for surgical planning in insular lobe gliomas

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