Introduction: Insular glioma resection can posses technical difficulties, handling MCA branches, trunks and lenticulostriate perforators. After managing this initial part of surgery and partial devascularization of the tumour the decision on how deep to proceed towards putamen is crucial.

Methods: The monitoring of MEP is mandatory, navigation in combination with ultrasound is helpful, but in some instances misleading.

Results: Our experience since 2007 amounts to 15 patients, 5 surgeries we performed in two phases due to significant residual tumour, during this period we added 4 resurgeries for late reccurence. 3 gliomas were GBM, 2 of them radically resected, one resection was subtotal leaving medial remnant of the tumour. In T2W hyperintense gliomas with no enhancement we archieved average 86% radicality according to volumetry (cm3). We were surprised with high occurence of anaplastic astrocytoma (5/12) and low grade glioma with high proliferation index Ki67 (5/12) with the need of adjuvant oncological treatement. Till now we did not record any permanent neurological deficit.

Conclusions: As the main factors to archieve satisfactory results in this area we believe in rigorous microsurgery, perfect knowledge of anatomy and electrofysiological monitoring (continuous MEP in the critical phase of surgery).

Patient Care: Added on 8/1/2012

Learning Objectives:

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