Surgical Resection of Intrinsic Insular Tumors

Hentschel, Stephen J.; Lang, Frederick F.

doi:10.1227/01.neu.0000163603.70972.ab

Cited by 68 publications

(82 citation statements)

References 8 publications

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“…12,17,22,35,38,39,44 In our series, no ischemic lesion was attributed to an LLA interruption. The ischemic lesions typically encountered after insular corticectomies were linked to injuries of long perforating branches of the M 2 segments of the MCA.…”

Section: Discussionmentioning

confidence: 45%

Vascular consequences of operculoinsular corticectomy for refractory epilepsy

Finet¹,

Nguyen

Bouthillier³

2015

JNS

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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.

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Section: Discussionmentioning

confidence: 45%

Vascular consequences of operculoinsular corticectomy for refractory epilepsy

Finet¹,

Nguyen

Bouthillier³

2015

JNS

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“…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.…”

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confidence: 99%

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

141

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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.

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“…Functional guidance using a bipolar subcortical stimulation has been employed by several groups. 5,15,17,23,32 It has been described as a useful mapping tool for identifying the deep motor tracts at the medial and dorsal part of insular gliomas but it does not allow monitoring of the function.The purpose of this study was to establish a protocol in which we could use both modalities, TCES for monitoring and subcortical stimulation for mapping. For this purpose, we modified the monopolar stimulation technique for subcortical stimulation.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Subcortical mapping and monitoring during insular tumor surgery

Kombos

Süss²,

Vajkoczy³

2009

FOC

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Object The treatment of insular tumors is controversial. Surgical treatment is associated with a higher morbidity rate than other therapies. The present work presents a new method in which the descending motor pathways are monitored during surgery for insular tumors. Methods Intraoperative monitoring was performed in a combination of 2 techniques. The motor cortex was stimulated with a transcranial electrical stimulus. In addition, direct subcortical stimulation was performed with an electrical anodal monopolar stimulus. Compound motor action potentials (CMAPs) were recorded from target muscles. Results Fifteen patients were included in this preliminary study. Following transcranial stimulation, CMAPs were recorded in all cases. Subcortical stimulation was successful in 12 cases. Significant CMAP alterations were recorded in 5 patients. There were no false-negative results in the series. Conclusions The technique presented here is a safe method. It allows a quantitative monitoring of motor function and functional mapping of the pyramidal tract during insular surgery.

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Surgical Resection of Intrinsic Insular Tumors

Cited by 68 publications

References 8 publications

Vascular consequences of operculoinsular corticectomy for refractory epilepsy

Vascular consequences of operculoinsular corticectomy for refractory epilepsy

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

Subcortical mapping and monitoring during insular tumor surgery

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