Open AccessInsular Glioma Surgery: Seven Rules - A case study
Author(s) -
Jander Moreira Monteiro,
Victor Matheus Olaves Marques,
Danna Gomes Mateus,
Guilherme Pamplona Bueno de Andrade,
Bruna Antunes Martins de Carvalho,
Viviane Aline Buffon,
Samir Ale Bark,
Samuel Dobrowolsky,
Francisco Luiz Souza Braga,
Gustavo Rassier Isolan
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.352
Subject(s) - insula , insular cortex , internal capsule , neurophysiology , medicine , glioma , microsurgery , glioblastoma , surgery , psychology , radiology , neuroscience , magnetic resonance imaging , cancer research , white matter
Background: The best treatment for insular gliomas is surgical resection. The surgical treatment complexity of these lesions is due to the anatomy of the insula, and its proximity to functional cortical and subcortical structures, and to vascular structures. Efforts to preserve the integrity of these structures based exclusively on microsurgical anatomy do not guarantee that the patient will not present motor or language deficit in the postoperative period. Objectives: To present seven rules to achieve greater therapeutic success, aiming at increasing disease-free survival and the patient’s quality of life. Methods: Review article based on the senior author experience in insular microsurgical anatomy dissections, and 45 microsurgeries for insular gliomas, performed between 2006 and 2018. Results: There are 4 anatomical rules (fronto-orbital branch of the facial nerve, insular cortex, sylvian fissure and lenticulostriate arteries) and 3 functional rules (cortical mapping, subcortical mapping and internal capsule). Conclusions: Primarily, one must have a great anatomical domain and expertise in neurophysiological monitoring to obtain satisfactory results in the surgery of insular gliomas.