Microsurgical treatment of the insular lobe gliomas

Abstract

Objective To investigate the preoperative evaluation methods and intraoperative measures of the extent of resection and blood vessel protection in insular glioma resection surgery via transsylvian approach. Methods The clinical data in 46 patients with glioma mainly in insular lobe treated by surgery at the Department of Neurosurgery, Brain Hospital Affiliated to Nanjing Medical University from January 2008 to July 2014 were analyzed retrospectively. M2 was exposed after separating lateral fissure via the pterion or extended pterional approach. After processing the short perforator from M2, the gliomas were resected piecemeal. The outermost artery of internal capsule did not participate in the insular lobe glioma blood supply, and it was the inner side border for glioma resection. Results Under the microscope, the gliomas of 38 patients were resected near totally and were confirmed by the postoperative imaging. The gliomas of 8 patients were resected subtotally, 2 had hemiplegia after procedure, and one had subdural hemorrhage. After procedure, 3 patients had contralateral limb hemiparesis (strength grade IV). One had a transient mixed aphasia. Conclusions Preoperative imaging findings, especially 3D-TOF of the relationship in between the gilomas and vessels, have an important guiding role for intraoperative blood vessel protection. The outermost artery of internal capsule is the medial boundary of giloma resection. Key words: Giloma; Microsurgery; Blood vessels; Insular lobe