Resection of insular gliomas: the importance of lenticulostriate artery position

Moshel, Yaron A.; Marcus, Joshua; Parker, Erik C.; Kelly, Patrick J.

doi:10.3171/jns/2008/109/11/0825

Cited by 87 publications

(127 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, they represent a very important deep limit to prevent any damage to perforating arteries, explaining why no stroke occurred in the present selected subset of patients who underwent operations while awake, contrary to the other patient series reported in the literature in which permanent deficits were always observed, mostly due to vascular injury. 33,38,39,47,50,53,54 On the other hand, because most paralimbic Grade II gliomas migrate along the fasciculi 35 and then into the anterior perforating substance, 12 preservation of functional pathways under the insula also explains why only 3 patients underwent a complete resection in this series (Table 2), in addition to the 5 patients with a left insula still involved in language, as mentioned above.…”

Section: Intraoperative Mappingmentioning

confidence: 87%

“…Nonetheless, several reports in the past decade have demonstrated that it was possible to perform insular glioma resection with substantial but acceptable complication rates. 12,17,23,25,29,33,38,39,47,50,53,54 Surprisingly, most of these studies were mainly focused on motor function, in particular with the use of intraoperative motor tract monitoring, 40 while possible language disturbances have not been accurately assessed using an extensive and longitudinal examination by a speech therapist. In this paper, we report for the first time the results of an objective language examination performed by a speech therapist before, during, immediately after, and 3 months after an awake surgery for a Grade II glioma involving the dominant insula in a homogeneous series of 24 patients.…”

Section: Sulamentioning

confidence: 99%

“…12,17,23,25,29,33,38,39,47,50,53,54 However, these patient series were essentially focused on motor function, in particular with the use of intraoperative motor tract monitoring, 39 whereas possible language disorders have received less attention. No previous studies have accurately assessed language disturbances using objective and longitudinal examination by a specialist before, during, and after surgery (immediately and at 3 months) within the dominant insula.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Functional outcome after language mapping for insular World Health Organization Grade II gliomas in the dominant hemisphere: experience with 24 patients

Duffau

Moritz‐Gasser

Gatignol

2009

FOC

142

View full text Add to dashboard Cite

Object Despite the report of recent experiences of insular surgery in the past decade, there has been no series specifically dedicated to studying functional outcome following resection of insular WHO Grade II gliomas involving the dominant hemisphere, in patients with no or only mild preoperative language deficit. In this article, the authors analyze the contribution of awake mapping for preservation of brain function, especially language, in a homogeneous series of 24 patients who underwent surgery for insular Grade II gliomas within the dominant insular lobe. Methods Twenty-four patients underwent surgery for an insular Grade II glioma involving the dominant hemisphere (22 left, 2 right), revealed by seizures in all but 1 case. The preoperative neurological examination result was normal in 17 patients (71%), whereas 7 patients presented with language disorders detected using an accurate language assessment performed by a speech therapist. All surgeries were performed on awake patients utilizing intra-operative language mapping involving cortical and subcortical stimulation. Results There were no intrasurgical complications or postsurgical sensorimotor deficits. Despite an immediate postoperative language worsening in 12 cases (50%), all patients recovered to a normal status within 3 months, and 6 cases even improved in comparison with their preoperative examination results. The 24 patients returned to normal social and professional lives. Moreover, the surgery had a favorable impact on epilepsy in all but 4 cases (83%). On control MR imaging, 62.5% of resections were total or subtotal. Three patients underwent a second or third awake surgery, with no additional deficit. All but 2 patients (92%) are alive after a mean follow-up of 3 years (range 3–133 months). Conclusions Although insular surgery was long believed to be too risky, the present results show that the rate of permanent deficit, especially dysphasia, following resection of Grade II gliomas involving the dominant insula has been dramatically reduced (none in this patient series), thanks to the systematic use of intraoperative awake mapping, even in cases of repeated operations. Furthermore, patient quality of life may be improved due to a decrease of epilepsy after surgery. Thus, the authors suggest systematically considering resection when an insular Grade II glioma is diagnosed after seizures in a patient with no or mild deficit, even a glioma invading the dominant hemisphere.

show abstract

Section: Intraoperative Mappingmentioning

confidence: 87%

Section: Sulamentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Functional outcome after language mapping for insular World Health Organization Grade II gliomas in the dominant hemisphere: experience with 24 patients

Duffau

Moritz‐Gasser

Gatignol

2009

FOC

142

View full text Add to dashboard Cite

show abstract

“…Surgery of the insular area is known to be challenging because of its close relationship with vascular structures. 8,15,26,36,[38][39][40] Immediate postoperative deficits have been previously reported with incidence rates between 9.2% and 74% in the literature. Comparison in incidence rate of transient or permanent complications is difficult considering that these series have mostly dealt with patients with tumors or vascular malformations often extending outside the insula both to surrounding lobes and in deeper subcortical structures.…”

Section: Discussionmentioning

confidence: 99%

Vascular consequences of operculoinsular corticectomy for refractory epilepsy

Finet¹,

Nguyen

Bouthillier³

2015

JNS

View full text Add to dashboard Cite

OBJECT Surgery in the insular region is considered challenging because of its vascular relationships, the proximity of functional structures, and its deep location in the sylvian fissure. The authors report the incidence and consequences of ischemic lesions after operculoinsular corticectomy for refractory epilepsy. METHODS The authors retrospectively reviewed the data of all patients who underwent an insular resection with or without an opercular resection for refractory epilepsy at their center. All patients underwent postoperative MRI, enabling a radiological analysis of the ischemic lesions as a result of the corticectomies. The resections were classified according to the location and extent of the insular corticectomy and the type of operculectomy. Each patient underwent clinical follow-up. RESULTS Twenty patients underwent surgery. All patients underwent insular corticectomy with or without an operculectomy. Ischemic lesions were identified in 12 patients (60%). In these patients, 11 ischemic lesions (55%) were related to the insular corticectomy, and 1 was related to the associated periinsular resection. The ischemic lesions associated with the insulectomies were typically located in the corona radiata running from the insula to the periventricular region. Nine patients (45%) developed a postoperative neurological deficit, among whom 6 (67%) had an insular corticectomy–related ischemic lesion. All reported neurological deficits were transient. Five patients (25%) had ischemic lesions without neurological deficit. CONCLUSIONS Operculoinsular corticectomies are associated with ischemic lesions in approximately 60% of patients. However, given that no patient had a definitive postoperative deficit, these ischemic lesions have few clinical consequences. Therefore, this surgical procedure can be considered reasonably safe for the treatment of refractory epilepsy.

show abstract

“…5,6,39,40 Motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) were also recorded during surgery, to continuously monitor the integrity of motor and somatosensory pathways (64-channel Eclipse Neurovascular Workstation, Axon Systems, Inc.; 32-channel video polygraphic station, Brain Quick SystemPlus, MicroMed). The selection of the anesthesiological protocol was based on the preoperative evaluation of hemispheric dominance.…”

Section: Surgical Procedures and Intraoperative Electrocorticographymentioning

confidence: 99%

Surgery for insular low-grade glioma: predictors of postoperative seizure outcome

Ius

Pauletto

Isola

et al. 2014

JNS

View full text Add to dashboard Cite

Object. Although a number of recent studies on the surgical treatment of insular low-grade glioma (LOG) have demonstrated that aggressive resection leads to increased overall patient survival and decreased malignant progression, less attention has been given to the results with respect to tumor-related epilepsy. The aim of this investigation was to evaluate the impact of volumetric, histological, and intraoperative neurophysiological factors on seizure outcome in patients with insular LGG. \ud Methods. The authors evaluated predictors of seizure outcome with special emphasis on both the extent of tumor resection (EOR) and the tumor's infiltrative pattern quantified by computing the difference between the preoperative T2- and Ti-weighted MR images (Delta VT2T1) in 52 patients with preoperative drug-resistant epilepsy. \ud Results. The 12-month postoperative seizure outcome (Engel class) was as follows: seizure free (Class I), 67.31%; rare seizures (Class II), 7.69%; meaningful seizure improvement (Class III), 15.38%; and no improvement or worsening (Class IV), 9.62%. Poor seizure control was more common in patients with a longer preoperative seizure history (p < 0.002) and higher frequency of seizures (p = 0.008). Better seizure control was achieved in cases with EOR >= 90% (p < 0.001) and Delta VT2T1 < 30 cm(3) (p < 0.001). In the final model, Delta VT2T1 proved to be the strongest independent predictor of seizure outcome in insular LGG patients (p < 0.0001). \ud Conclusions. No or little postoperative seizure improvement occurs mainly in cases with a prevalent infiltrative tumor growth pattern, expressed by high Delta VT2T1 values, which consequently reflects a smaller BOR

show abstract

Resection of insular gliomas: the importance of lenticulostriate artery position

Cited by 87 publications

References 23 publications

Functional outcome after language mapping for insular World Health Organization Grade II gliomas in the dominant hemisphere: experience with 24 patients

Functional outcome after language mapping for insular World Health Organization Grade II gliomas in the dominant hemisphere: experience with 24 patients

Vascular consequences of operculoinsular corticectomy for refractory epilepsy

Surgery for insular low-grade glioma: predictors of postoperative seizure outcome

Contact Info

Product

Resources

About