Abstract
In this video, the authors present a connectome-guided surgical resection of an insular glioma in a 39-year-old woman. Preoperative study with constrained spherical deconvolution (CSD)–based tractography revealed the surrounding brain connectome architecture around the tumor relevant for safe surgical resection. Connectomic information provided detailed maps of the surrounding language and salience networks, including eloquent white matter fibers and cortical regions, which were visualized intraoperatively with image guidance and artificial intelligence (AI)–based brain mapping software. Microsurgical dissection is presented with detailed discussion of the safe boundaries and angles of resection when entering the insular operculum defined by connectomic information.The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21194
Highlights
We demonstrate the use of connectomics and tractographic visualization using artificial intelligence to help improve the resection of an insular glioma
You can see that the two components are connected via the frontal aslant tract, and the frontal aslant tract is named because it runs aslant to the overall anterior-posterior white matter of this part of the brain.[2]
If you look at the middle cingulate component, it is important to note that in addition to the areas that are in the Brodmann area 32 complex, as you can see in the upper left, there is an area called SCEF, which stands for supplementary and cingulate eye field
Summary
We demonstrate the use of connectomics and tractographic visualization using artificial intelligence to help improve the resection of an insular glioma. This is a middle cingulate and anterior insula network. This area is better thought of as a key component of both the salience network and the supplementary motor area.
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