The insular lobe: physiopathological and surgical considerations

Area of Science:

• Neurosurgery
• Neuro-oncology
• Brain mapping

Background:

• Insular gliomas pose surgical challenges due to proximity to critical structures like the internal capsule and lenticulostriate arteries.
• The functional role of the insula is not fully understood, adding complexity to surgical planning and execution.

Observation:

• Twelve patients with low-grade insular gliomas underwent surgery using direct cerebral stimulation and neuronavigation.
• Intraoperative mapping identified the internal capsule and language areas (in awake patients on the dominant hemisphere).
• Resection extent varied, with four total, six subtotal, and two partial resections.

Findings:

• Direct cerebral stimulation and neuronavigation facilitated insular tumor resection with reduced risk of neurological deficits.
• Seven patients experienced immediate postoperative deficits, but six recovered within three months.
• Surgery on the dominant hemisphere, while feasible, is limited by the insula's crucial role in language processing.

Implications:

• Intraoperative brain mapping techniques enhance surgical safety for insular gliomas.
• Careful consideration and advanced techniques are necessary for operating on the dominant insula to preserve language function.
• This approach holds promise for improving outcomes in challenging brain tumor surgeries.