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Tumors involving the insular lobe and perisylvian opercula of the dominant hemisphere are frequently managed conservatively regardless of their nature and clinical evolution, even if impending infiltration of nearby eloquent areas endangers their function. Our and other authors’ experience (Duffau 2009, Duffau et al, 2000; 2001; 2006; 2009; Lang et al, 2001; Kim et al, 2002; Moshel et al, 2008; Saito et al, 2010; Sanai et al, 2010; Signorelli et al, 2010; 2011; Simon et al, 2009; Skrap et al, 2012; Yasargil et al, 1992; Wu et al, 2011; Zentner et al, 1996) demonstrate that wide surgical resection of these lesions are nonetheless feasible since tumor burden often displaces eloquent sites at the tumor boundaries (Duffau 2000; Duffau et al, 2000; 2001; 2006; 2009; Signorelli et al, 2010; 2011) and compensatory areas take over the lost function of infiltrated nervous tissue. However, accurate anatomic and functional knowledge of the sylvian fissure and structures located nearby is essential to perform any surgical act in this area, in order to decrease the risks of postoperative permanent deficits (Duffau 2009; Duffau et al, 2009; Moshel et al, 2009; Signorelli et al, 2010; 2011). Here we report our recent experience with tumors infiltrating left insula and perisylvian opercula and point out technical details helpful in guiding surgery through this region, with the purpose of locating and respecting neural and vascular structures and eloquent sites.

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Surgical Resection of Tumors Infiltrating Left Insula and Perisylvian Opercula — Utility of Anatomic Landmarks Implemented by Intraoperative Functional Brain Mapping