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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 Open the ORCID record for Jaclyn J. Renfrow [Opens in a new window] ,
Bao-Quynh Julian ,
Desmond A. Brown ,
Stephen B. Tatter ,
Adrian W. Laxton ,
Glenn J. Lesser ,
Roy E. Strowd  and
Ian F. Parney
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
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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.

Keywords

GlioblastomaGliomasHigh-grade gliomaLow-grade gliomaInsulaBrain tumorNeuroanatomy
Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 50 , Issue 1 , January 2023 , pp. 1 - 9
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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