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A Review on the Surgical Management of Insular Gliomas

Published online by Cambridge University Press:  29 October 2021

Jaclyn J. Renfrow*
Affiliation:
Department of Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
Bao-Quynh Julian
Affiliation:
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
Desmond A. Brown
Affiliation:
Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
Stephen B. Tatter
Affiliation:
Department of Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
Adrian W. Laxton
Affiliation:
Department of Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
Glenn J. Lesser
Affiliation:
Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA Department of Internal Medicine – Section on Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
Roy E. Strowd
Affiliation:
Brain Tumor Center of Excellence, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA Department of Internal Medicine – Section on Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
Ian F. Parney
Affiliation:
Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
*
Correspondence author: Jaclyn Renfrow, Department of Neurological Surgery, 200 First Street SW, Rochester, MN 55905, USA. Email: jaclyn.renfrow@gmail.com

Abstract

The surgical treatment of insular gliomas requires specialized knowledge. Over the last three decades, increased momentum in surgical resection of insular gliomas shifted the focus from one of expectant management to maximal safe resection to establish a diagnosis, characterize tumor genetics, treat preoperative symptoms (i.e., seizures), and delay malignant transformation through tumor cytoreduction. A comprehensive review of the literature was performed regarding insular glioma classification/genetics, insular anatomy, surgical approaches, and patient outcomes. Modern large, published series of insular resections have reported a median 80% resection, 80% improvement in preoperative seizures, and postsurgical permanent neurologic deficits of less than 10%. Major complication avoidance includes recognition and preservation of eloquent cortex for language and respecting the lateral lenticulostriate arteries.

Résumé :

RÉSUMÉ :

Analyse de la prise en charge chirurgicale des gliomes de la région insulaire.

Le traitement chirurgical des gliomes de la région insulaire nécessite assurément des connaissances spécialisées. Au cours des trois dernières décennies, un accroissement de la résection de ces gliomes a permis de passer d’une prise en charge expectante (expectant management) à une résection à la fois maximale et sécuritaire permettant d’établir des diagnostics, de caractériser la génétique des tumeurs, de traiter les symptômes préopératoires (c’est-à-dire des crises convulsives) et de retarder la transformation maligne grâce à la cytoréduction des tumeurs. Nous avons donc effectué une revue complète de la littérature en ce qui regarde la classification et la génétique des gliomes de la région insulaire, l’anatomie de cette région, les méthodes chirurgicales et l’évolution de l’état de santé des patients. Les grandes études modernes de série de cas portant sur la résection de la région insulaire ont signalé un taux médian de résection de 80 %, une amélioration de 80 % des crises convulsives préopératoires ainsi que des déficits neurologiques permanents post-chirurgicaux inférieurs à 10 %. Pour éviter des complications majeures, il importe de reconnaître et de préserver les régions « éloquentes » du cortex liées au langage et d’éviter une atteinte des artères lenticulo-striées latérales.

Type
Review Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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References

Yaşargil, MG, Reeves, JD. Tumours of the limbic and paralimbic system. Acta Neurochir (Wien). 1992;116:147–49. DOI 10.1007/bf01540867.CrossRefGoogle ScholarPubMed
Sanai, N, Polley, M-Y, Berger, MS. Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. J Neurosurg. 2010;112:19. DOI 10.3171/2009.6.JNS0952.CrossRefGoogle ScholarPubMed
Skrap, M, Mondani, M, Tomasino, B, et al. Surgery of insular nonenhancing gliomas: volumetric analysis of tumoral resection, clinical outcome, and survival in a consecutive series of 66 cases. Neurosurgery. 2012;70:1081–93. DOI 10.1227/NEU.0b013e31823f5be5.CrossRefGoogle Scholar
Duffau, H, Capelle, L. Preferential brain locations of low-grade gliomas. Cancer. 2004;100:2622–26. DOI 10.1002/cncr.20297.CrossRefGoogle ScholarPubMed
Mandonnet, E, Capelle, L, Duffau, H. Extension of paralimbic low grade gliomas: toward an anatomical classification based on white matter invasion patterns. J Neurooncol. 2006;78:179–85. DOI 10.1007/s11060-005-9084-y.CrossRefGoogle ScholarPubMed
Kalani, MYS, Kalani, MA, Gwinn, R, Keogh, B, Tse, VCK. Embryological development of the human insula and its implications for the spread and resection of insular gliomas. Neurosurg Focus. 2009;27:E2. DOI 10.3171/2009.5.FOCUS0997.CrossRefGoogle ScholarPubMed
Hervey-Jumper, SL, Li, J, Osorio, JA, et al. Surgical assessment of the insula. Part 2: validation of the Berger-Sanai zone classification system for predicting extent of glioma resection. J Neurosurg. 2016;124:482–88. DOI 10.3171/2015.4.JNS1521.CrossRefGoogle ScholarPubMed
Sanai, N, Chang, S, Berger, MS, Parsa, AT, Berger, MS. Low-grade gliomas in adults. J Neurosurg. 2011;115:118. DOI 10.3171/2011.7.JNS10238.CrossRefGoogle ScholarPubMed
Duffau, H. A personal consecutive series of surgically treated 51 cases of insular WHO Grade II glioma: advances and limitations. J Neurosurg. 2009;110:696708. DOI 10.3171/2008.8.JNS08741.CrossRefGoogle ScholarPubMed
Cavaliere, R, Lopes, MBS, Schiff, D. Low-grade gliomas: an update on pathology and therapy. Lancet Neurol. 2005;4:760–70. DOI 10.1016/S1474-4422(05)70222-2.CrossRefGoogle ScholarPubMed
Smith, JS, Chang, EF, Lamborn, KR, et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008;26:1338–45. DOI 10.1200/JCO.2007.13.9337.CrossRefGoogle ScholarPubMed
Delgado-López, PD, Corrales-García, EM, Martino, J, Lastra-Aras, E, Dueñas-Polo, MT. Diffuse low-grade glioma: a review on the new molecular classification, natural history and current management strategies. Clin Transl Oncol. 2017;19:931–44. DOI 10.1007/s12094-017-1631-4.CrossRefGoogle ScholarPubMed
Murphy, ES, Leyrer, CM, Parsons, M, et al. Risk factors for malignant transformation of low-grade glioma. Int J Radiat Oncol. 2018;100:965–71. DOI 10.1016/J.IJROBP.2017.12.258.CrossRefGoogle ScholarPubMed
Rezvan, A, Christine, D, Christian, H, et al. Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients. Acta Neurochir (Wien). 2009;151:1359–65. DOI 10.1007/s00701-009-0435-x.CrossRefGoogle Scholar
Chaichana, KL, McGirt, MJ, Laterra, J, Olivi, A, Quiñones-Hinojosa, A. Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas. J Neurosurg. 2010;112:1017. DOI 10.3171/2008.10.JNS08608.CrossRefGoogle ScholarPubMed
Yaşargil, MG, Krisht, AF, Türe, U, Al-Mefty, O, Yaşargil, DCH. Microsurgery of insular gliomas. Contemp Neurosurg. 2017;39:18. DOI 10.1097/01.CNE.0000522111.96155.e8.Google Scholar
Gozé, C, Mansour, L, Rigau, V, Duffau, H. Distinct IDH1/IDH2 mutation profiles in purely insular versus paralimbic WHO Grade II gliomas. J Neurosurg. 2013;118:866–72. DOI 10.3171/2012.11.JNS121100.CrossRefGoogle ScholarPubMed
Louis, DN, Perry, A, Reifenberger, G, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016;131:803–20. DOI 10.1007/s00401-016-1545-1.CrossRefGoogle ScholarPubMed
Gozé, C, Rigau, V, Gibert, L, Maudelonde, T, Duffau, H. Lack of complete 1p19q deletion in a consecutive series of 12 WHO grade II gliomas involving the insula: a marker of worse prognosis? J Neurooncol. 2009;91:15. DOI 10.1007/s11060-008-9680-8.CrossRefGoogle Scholar
Wu, A, Aldape, K, Lang, FF. High rate of deletion of chromosomes 1p and 19q in insular oligodendroglial tumors. J Neurooncol. 2010;99:5764. DOI 10.1007/s11060-009-0100-5.CrossRefGoogle ScholarPubMed
Eseonu, CI, ReFaey, K, Garcia, O, Raghuraman, G, Quinones-Hinojosa, A. Volumetric analysis of extent of resection, survival, and surgical outcomes for insular gliomas. World Neurosurg. 2017;103:265–74. DOI 10.1016/j.wneu.2017.04.002.CrossRefGoogle ScholarPubMed
Duffau, H, Gatignol, P, Mandonnet, E, Capelle, L, Taillandier, L. Intraoperative subcortical stimulation mapping of language pathways in a consecutive series of 115 patients with Grade II glioma in the left dominant hemisphere. J Neurosurg. 2008;109:461–71. DOI 10.3171/JNS/2008/109/9/0461.CrossRefGoogle Scholar
Ribas, EC, Yagmurlu, K, Wen, HT, Rhoton, AL. Microsurgical anatomy of the inferior limiting insular sulcus and the temporal stem. J Neurosurg. 2015;122:1263–73. DOI 10.3171/2014.10.JNS141194.CrossRefGoogle ScholarPubMed
Türe, U, Yaşargil, DCH, Al-Mefty, O, Yaşargil, MG. Topographic anatomy of the insular region. J Neurosurg. 1999;90:720–33. DOI 10.3171/jns.1999.90.4.0720.CrossRefGoogle ScholarPubMed
Michaud, K, Duffau, H. Surgery of insular and paralimbic diffuse low-grade gliomas: technical considerations. J Neurooncol. 2016;130:289–98. DOI 10.1007/s11060-016-2120-2.CrossRefGoogle ScholarPubMed
Dronkers, NF, Plaisant, O, Iba-Zizen, MT, Cabanis, EA. Paul Broca’s historic cases: high resolution MR imaging of the brains of Leborgne and Lelong. Brain. 2007;130:1432–41. DOI 10.1093/brain/awm042.CrossRefGoogle ScholarPubMed
Duffau, H. The anatomo-functional connectivity of language revisited. Neuropsychologia. 2008;46:927–34. DOI 10.1016/j.neuropsychologia.2007.10.025.CrossRefGoogle ScholarPubMed
Hickok, G, Poeppel, D. The cortical organization of speech processing. Nat Rev Neurosci. 2007;8:393402. DOI 10.1038/nrn2113.CrossRefGoogle ScholarPubMed
Houston, J, Allendorfer, J, Nenert, R, Goodman, AM, Szaflarski, JP. White matter language pathways and language performance in healthy adults across ages. Front Neurosci. 2019;13:433. DOI 10.3389/fnins.2019.01185.CrossRefGoogle ScholarPubMed
Lang, FF, Olansen, NE, DeMonte, F, et al. Surgical resection of intrinsic insular tumors: complication avoidance. J Neurosurg. 2001;95:638–50. DOI 10.3171/jns.2001.95.4.0638.CrossRefGoogle ScholarPubMed
Signorelli, F, Guyotat, J, Elisevich, K, Barbagallo, GMV. Review of current microsurgical management of insular gliomas. Acta Neurochir (Wien). 2010;152:1926. DOI 10.1007/s00701-009-0450-y.CrossRefGoogle ScholarPubMed
Türe, U, Yaşargil, MG, Al-Mefty, O, Yaşargil, DC. Arteries of the insula. J Neurosurg. 2000;92:676–87. DOI 10.3171/jns.2000.92.4.0676.CrossRefGoogle ScholarPubMed
Velasquez, C, Caballero, H, Vazquez-Barquero, A, et al. Insular gliomas with exophytic extension to the sylvian cistern: a glioma growth pattern that has gone previously unnoticed. World Neurosurg. 2016;87:200–06. DOI 10.1016/j.wneu.2015.12.035.CrossRefGoogle Scholar
Moshel, Y, Marcus, J, Parker, E, Kelly, P. Resection of insular gliomas: the importance of lenticulostriate artery position. J Neurosurg. 2008;109:825–34. DOI 10.3171/JNS/2008/109/11/0825.CrossRefGoogle ScholarPubMed
Saito, R, Kumabe, T, Inoue, T, et al. Magnetic resonance imaging for preoperative identification of the lenticulostriate arteries in insular glioma surgery. J Neurosurg. 2009;111:278–81. DOI 10.3171/2008.11.JNS08858.CrossRefGoogle ScholarPubMed
Ghali, MZ. Preservation of the lenticulostriate arteries during insular glioma resection. Asian J Neurosurg. 2020;15:16. DOI 10.4103/ajns.AJNS_146_18.Google ScholarPubMed
Ebeling, U, Kothbauer, K. Circumscribed low grade astrocytomas in the dominant opercular and insular region: a pilot study. Acta Neurochir (Wien). 1995;132:6674. DOI 10.1007/bf01404850.CrossRefGoogle ScholarPubMed
Benet, A, Hervey-Jumper, SL, González Sánchez, JJ, Lawton, MT, Berger, MS. Surgical assessment of the insula. Part 1: surgical anatomy and morphometric analysis of the transsylvian and transcortical approaches to the insula. J Neurosurg. 2016;124:469–81. DOI 10.3171/2014.12.JNS142182.CrossRefGoogle ScholarPubMed
Hentschel, SJ, Lang, FF. Surgical resection of intrinsic insular tumors. Oper Neurosurg. 2005;57:176–83. DOI 10.1227/01.NEU.0000163603.70972.AB.CrossRefGoogle ScholarPubMed
Przybylowski, CJ, Baranoski, JF, So, VM, Wilson, J, Sanai, N. Surgical morbidity of transsylvian versus transcortical approaches to insular gliomas. J Neurosurg. 2020;132:1731–38. DOI 10.3171/2018.12.JNS183075.CrossRefGoogle Scholar
LeRoux, PD, Berger, MS, Haglund, MM, Pilcher, WH, Ojemann, GA. Resection of intrinsic tumors from nondominant face motor cortex using stimulation mapping: report of two cases. Surg Neurol. 1991;36:4448. DOI 10.1016/0090-3019(91)90132-s.CrossRefGoogle ScholarPubMed
Wang, P, Wu, M-C, Chen, S-J, Xu, X-P, Yang, Y, Cai, J. Microsurgery resection of intrinsic insular tumors via transsylvian surgical approach in 12 cases. Cancer Biol Med. 2012;9:4447. DOI 10.3969/j.issn.2095-3941.2012.01.008.Google ScholarPubMed
Baydin, S, Gungor, A, Holanda, VM, Tanriover, N, Danish, SF. Microneuroanatomy of the anterior frontal laser trajectory to the insula. World Neurosurg. 2019;132:e909–21. DOI 10.1016/j.wneu.2019.07.130.CrossRefGoogle ScholarPubMed
Hafez, DM, Liekweg, C, Leuthardt, EC. Staged laser interstitial thermal therapy (LITT) treatments to left insular low-grade glioma. Neurosurgery. 2019;9:e1778. DOI 10.1093/neuros/nyz120.Google Scholar
De Witt Hamer, PC, Robles, SG, Zwinderman, AH, Duffau, H, Berger, MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30:2559–65. DOI 10.1200/JCO.2011.38.4818.CrossRefGoogle ScholarPubMed
Hervey-Jumper, SL, Li, J, Lau, D, et al. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg. 2015;123:325–39. DOI 10.3171/2014.10.JNS141520.CrossRefGoogle Scholar
Alimohamadi, M, Shirani, M, Shariat Moharari, R, et al. Application of awake craniotomy and intraoperative brain mapping for surgical resection of insular gliomas of the dominant hemisphere. World Neurosurg. 2016;92:151–58. DOI 10.1016/j.wneu.2016.04.079.CrossRefGoogle ScholarPubMed
Sanai, N, Mirzadeh, Z, Berger, MS. Functional outcome after language mapping for glioma resection. N Engl J Med. 2008;358:1827. DOI 10.1056/NEJMoa067819.CrossRefGoogle ScholarPubMed
Rey-Dios, R, Cohen-Gadol, AA. Technical nuances for surgery of insular gliomas: lessons learned. Neurosurg Focus. 2013;34:E6. DOI 10.3171/2012.12.FOCUS12342.CrossRefGoogle ScholarPubMed
Duffau, H, Capelle, L, Lopes, M, Faillot, T, Sichez, J-P, Fohanno, D. The insular lobe: physiopathological and surgical considerations. Neurosurgery. 2000;47:801–11. DOI 10.1097/00006123-200010000-00001.CrossRefGoogle ScholarPubMed
Duffau, H, Capelle, L, Sichez, J-P, et al. Intra-operative direct electrical stimulations of the central nervous system: the salpêtrière experience with 60 patients. Acta Neurochir (Wien). 1999;141:1157–67. DOI 10.1007/s007010050413.CrossRefGoogle ScholarPubMed
Bello, L, Gallucci, M, Fava, M, et al. Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas. Neurosurgery. 2007;60:6782. DOI 10.1227/01.NEU.0000249206.58601.DE.CrossRefGoogle ScholarPubMed
Sanai, N, Polley, M-Y, McDermott, MW, Parsa, AT, Berger, MS. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg. 2011;115:38. DOI 10.3171/2011.2.JNS10998.CrossRefGoogle ScholarPubMed
Zentner, J, Meyer, B, Stangl, A, Schramm, J. Intrinsic tumors of the insula: a prospective surgical study of 30 patients. J Neurosurg. 1996;85:263–71. DOI 10.3171/jns.1996.85.2.0263.CrossRefGoogle ScholarPubMed
Vanaclocha, V, Sáiz-Sapena, N, García-Casasola, C. Surgical treatment of insular gliomas. Acta Neurochir (Wien). 1997;139:1126–34. DOI 10.1007/bf01410972 discussion 1134-35.CrossRefGoogle ScholarPubMed
Neuloh, G, Pechstein, U, Schramm, J. Motor tract monitoring during insular glioma surgery. J Neurosurg. 2007;106:582–92. DOI 10.3171/jns.2007.106.4.582.CrossRefGoogle ScholarPubMed
Simon, M, Neuloh, G, Von Lehe, M, Meyer, B, Schramm, J. Insular gliomas: the case for surgical management - Clinical article. J Neurosurg. 2009;110:685–95. DOI 10.3171/2008.7.JNS17639.CrossRefGoogle Scholar
Hervey-Jumper, SL, Berger, MS. Maximizing safe resection of low- and high-grade glioma. J Neurooncol. 2016;130:269–82. DOI 10.1007/s11060-016-2110-4.CrossRefGoogle ScholarPubMed