Резекция доминирующих островковых глиом низкой степени злокачественности

Resection of dominant-side insular gliomas poses challenges due to the involvement or close proximity of eloquent cortex, the basal ganglia, and middle cerebral artery branches and perforators. The degree of surgical resection of low-grade gliomas is positively correlated with outcome. Therefore the goal of surgery is maximal tumor resection along with preservation of the patient's neurological function. Intra-operative stimulation mapping of the associated eloquent cortices during an awake craniotomy, along with neuro-navigation and microsurgical techniques, safely facilitates maximal tumor resection. The authors, using the accompanying 3-D video, demonstrate their preferred techniques for intra-operative stimulation mapping and microsurgical resection of a dominant insular low-grade glioma. The patient is a 32-year-old woman who underwent resection of a recurrent left frontotemporal and insular WHO grade II oligoastrocytoma. Surveillance MR imaging demonstrated recurrent tumor approximately 4 years after her initial resection. Motor function of her face and tongue as well as expressive and receptive language function were mapped at 6mA under awake conditions using electrocorticography to assess for afterdischarges. An anterior temporal lobectomy was then performed, including the superior temporal gyrus, because no language function was localized there. This expanded the operative corridor to the insula, and the remainder of the tumor was removed underneath frontal operculae using microsurgical techniques and subcortical mapping at 8mA. A near gross total resection was achieved, and the patient recovered from surgery without any complication. This video has been taken from Resection of Dominant Insular Low-Grade Gliomas: Microsurgical Techniques and Mapping Strategies, an article appearing in a future issue of Neurosurgery. It was submitted by corresponding author Aaron A. Cohen-Gadol, MD, MSc from the Department of Neurological Surgery at Indiana University School of Medicine in Indianapolis, Indiana.