Seizure Outcome After Surgical Resection of Insular Glioma

Wang, Doris D.; Deng, Hansen; Hervey-Jumper, Shawn L.; Molinaro, Annette; Chang, Edward F.; Berger, Mitchel S.

doi:10.1093/neuros/nyx486

Cited by 28 publications

(17 citation statements)

References 33 publications

(35 reference statements)

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“…In addition to offering a survival benefit, maximizing EOR for insular gliomas improves seizure control. 48 Furthermore, recurrence of seizures often predicts glioma recurrence and progression. 48 Quality of life, as it relates to language outcomes, is also an important consideration.…”

Section: Surgery For Insular Tumors In the Modern Eramentioning

confidence: 99%

“…48 Furthermore, recurrence of seizures often predicts glioma recurrence and progression. 48 Quality of life, as it relates to language outcomes, is also an important consideration. Despite the uncinate fasciculus and IFOF extending through the insula and the superior longitudinal fasciculus and arcuate fasciculus extending in superior and posterior directions, awake language mapping allows for the surgeon to identify language sites in this critical region (Fig.…”

Section: Surgery For Insular Tumors In the Modern Eramentioning

confidence: 99%

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Insular glioma surgery: an evolution of thought and practice

Hervey-Jumper¹,

Berger²

2019

Journal of Neurosurgery

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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.

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Section: Surgery For Insular Tumors In the Modern Eramentioning

confidence: 99%

Section: Surgery For Insular Tumors In the Modern Eramentioning

confidence: 99%

Insular glioma surgery: an evolution of thought and practice

Hervey-Jumper¹,

Berger²

2019

Journal of Neurosurgery

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“…Insular gliomas are often characterized by cognitive impairment and seizures hard-to-control (7)(8)(9). Recent studies highlighted the role of surgical resection in insular gliomas and its influence on progression free-survival, on postponing malignant transformation, and on seizure control (5,7,(10)(11)(12)(13)(14). Although these data stressed the need to improve resection also in the giant subtype, the preservation at the same time of patients' functional integrity is a challenge.…”

Section: Introductionmentioning

confidence: 99%

“…Insular gliomas are often characterized by cognitive impairment and seizures hard-to-control ( 7 – 9 ). Recent studies highlighted the role of surgical resection in insular gliomas and its influence on progression free-survival, on postponing malignant transformation, and on seizure control ( 5 , 7 , 10 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

Challenging Giant Insular Gliomas With Brain Mapping: Evaluation of Neurosurgical, Neurological, Neuropsychological, and Quality of Life Results in a Large Mono-Institutional Series

et al. 2021

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ObjectiveGiant insular tumors are commonly not amenable to complete resection and are associated with a high postoperative morbidity rate. Transcortical approach and brain mapping techniques allow to identify peri-insular functional networks and, with neurophysiological monitoring, to reduce vascular-associated insults. Cognitive functions to be mapped are still under debate, and the analysis of the functional risk of surgery is currently limited to neurological examination. This work aimed to investigate the neurosurgical outcome (extent of resection, EOR) and functional impact of giant insular gliomas resection, focusing on neuropsychological and Quality of Life (QoL) outcomes.MethodsIn our retrospective analysis, we included all patients admitted in a five-year period with a radiological diagnosis of giant insular glioma. A transcortical approach was adopted in all cases. Resections were pursued up to functional boundaries defined intraoperatively by brain mapping techniques. We examined clinical, radiological, and intra-operative factors possibly affecting EOR and postoperative neurological, neuropsychological, and Quality of Life (QoL) outcomes.ResultsWe finally enrolled 95 patients in the analysis. Mean EOR was 92.3%. A Gross Total Resection (GTR) was obtained in 70 cases (73.7%). Five patients reported permanent morbidity (aphasia in 3, 3.2%, and superior quadrantanopia in 2, 2.1%). Suboptimal EOR associated with poor seizures control postoperatively. Extensive intraoperative mapping (inclusive of cognitive, visual, and haptic functions) decreased long-term neurological, neuropsychological, and QoL morbidity and increased EOR. Tumor infiltration of deep perforators (vessels arising either medial to lenticulostriate arteries through the anterior perforated substance or from the anterior choroidal artery) associated with a higher chance of postoperative ischemia in consonant areas, with the persistence of new-onset motor deficits 1-month post-op, and with minor EOR. Ischemic insults in eloquent sites represented the leading factor for long-term neurological and neuropsychological morbidity.ConclusionIn giant insular gliomas, the use of a transcortical approach with extensive brain mapping under awake anesthesia ensures broad insular exposure and extension of the surgical resection preserving patients’ functional integrity. The relation between tumor mass and deep perforators predicts perioperative ischemic insults, the most relevant risk factor for long-term and permanent postoperative morbidity.

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“…The GBM population showed a significant decrease in the rate of seizures following surgical resection, and these results are in line with previous reports regarding the beneficial effects of surgery in alleviating seizures among glioma patients, yet no differences were noted in relation to post-op restriction status. 31 , 32 .…”

Section: Discussionmentioning

confidence: 99%

Clinical and prognostic implications of rim restriction following glioma surgery

Berger

Tzarfati

Serafimova

et al. 2022

Sci Rep

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Rim restriction surrounding the resection cavity of glioma is often seen on immediate post-op diffusion-weighted imaging (DWI). The etiology and clinical impact of rim restriction are unknown. We evaluated the incidence, risk factors and clinical consequences of this finding. We evaluated patients that underwent surgery for low-grade glioma (LGG) and glioblastoma (GBM) without stroke on post-operative imaging. Analyses encompassed pre- and postoperative clinical, radiological, intraoperative monitoring, survival, functional and neurocognitive outcomes. Between 2013 and 2017, 63 LGG and 209 GBM patients (272 in total) underwent surgical resection and were included in our cohort. Post-op rim restriction was demonstrated in 68 patients, 32% (n = 20) of LGG and 23% (n = 48) of GBM patients. Risk factors for restriction included temporal tumors in GBM (p = 0.025) and insular tumors in LGG (p = 0.09), including longer surgery duration in LGG (p = 0.008). After a 1-year follow-up, LGG patients operated on their dominant with post-op restriction had a higher rate of speech deficits (46 vs 9%, p = 0.004). Rim restriction on postoperative imaging is associated with longer duration of glioma surgery and potentially linked to brain retraction. It apparently has no direct clinical consequences, but is linked to higher rates of speech deficits in LGG dominant-side surgeries.

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Seizure Outcome After Surgical Resection of Insular Glioma

Abstract: 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.

Cited by 28 publications

References 33 publications

Insular glioma surgery: an evolution of thought and practice

Insular glioma surgery: an evolution of thought and practice

Challenging Giant Insular Gliomas With Brain Mapping: Evaluation of Neurosurgical, Neurological, Neuropsychological, and Quality of Life Results in a Large Mono-Institutional Series

Clinical and prognostic implications of rim restriction following glioma surgery

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