Transopercular Insular Approach, Overcoming the Training Curve Using a Cadaveric Simulation Model: 2-Dimensional...

Area of Science:

• Neurosurgery
• Surgical Education
• Neuroanatomy

Background:

• The transopercular approach to the insula is crucial for resecting specific types of insular low-grade gliomas.
• The complex anatomy and infrequent location of the insula present significant surgical challenges, hindering mastery of the approach.

Purpose of the Study:

• To describe a realistic, cost-effective cadaveric laboratory training model for simulating the transopercular resection of temporo-insular low-grade gliomas.
• To facilitate the acquisition of essential surgical skills for this challenging procedure in a controlled environment.

Main Methods:

• A cadaver head was fixed using Kingler's technique, with vascular coloration and frozen hemisphere for white matter tract dissection.
• Neuronavigation data from a glioma patient provided tractography and eloquent area information for simulation.
• A fronto-temporal craniotomy was performed, followed by identification of landmarks, simulated functional mapping, and transopercular corticectomy with subpial resection.

Main Results:

• The model successfully simulated the transopercular approach, demonstrating detailed Sylvian vessel and insular cortex identification.
• Resection limits and implicated white matter bundles (uncinate and fronto-occipital fascicles) were clearly exposed.
• The integration of simulated navigation enhanced understanding of complex white matter anatomy.

Conclusions:

• This cadaveric model offers a simple, cost-effective, and realistic simulation for transopercular insula surgery.
• It enables surgical skill development for treating insular tumors safely and improves comprehension of associated white matter anatomy.