Review of current microsurgical management of insular gliomas

The insular lobe is a functionally complex structure, harbouring peculiar anatomical and vascular features and specific neuronal connectivity with surrounding cerebral structures. It is situated in the depth of the Sylvian fissure and can be affected by either low-grade or high-grade gliomas. Because of its complexity, surgery of insular tumours has been traditionally regarded as hazardous. Nonetheless, currently improved diagnostic, neurophysiological and surgical tools allow the neurosurgeon to perform surgery of insular gliomas in a safer way, thus bringing forward the pioneering work performed by neurosurgeons in the past two decades.The aim of this paper is to provide the reader with an updated review of the anatomy, the clinical picture, diagnosis and surgical management of insular gliomas.