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  • Insular Glioma Surgery – Complication Avoidance versus Radicality

    Final Number:

    Robert Bartos MD PhD; Ales Hejcl MD, PhD; Martin Sames; T. Radovnicky; A. Malucelli

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    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:

    References: 1,Yasargil MG, von Ammon K, Cavazos E, Doczi T, Reeves JD, Roth P. Tumours of the limbic and paralimbic systems. Acta Neurochir 118: 40-52, 1992. 2, Türe U, Yasargil MG, Al-Mefty O, Yasargil DC. Topographic anatomy of the insular region. J Neurosurg 90(4): 720-733, 1999. 3, Türe U, Yasargil MG, Al-Mefty O, Yasargil DC. Arteries of the insula. J Neurosurg 92(4): 676-687, 2000. 4, Lang FF, Olansen NE, DeMonte F, Gokaslan ZL, Holland EC, Kalhorn C, Sawaya R. Surgical resection of intrinsic insular tumors: complication avoidance. J Neurosurg 95(4):638-650, 2001. 5, Moshel YA, Marcus JDS, Parker EC, Kelly PJ. Resection of insular gliomas: the importance of lenticulostriate artery position. J Neurosurg 109: 825-834, 2008. 6, Simon M, Neuloh G, von Lehe M, Meyer B, Schramm J. Insular gliomas: the case for surgical management. J Neurosurg 110(4): 685-695, 2008. 7, Sanai N, Polley M-Y, Berger MS. Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. J Neurosurg 112:1–9, 2010.

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