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Related Experiment Video

Updated: Jun 19, 2025

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Transsylvian Insular Glioma Surgery.

David Pitskhelauri1, Andrey Bykanov1, Alexander Sanikidze1

  • 1N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia.

World Neurosurgery
|July 26, 2024
PubMed
Summary

Microsurgical removal is key for insular gliomas. This case highlights advanced techniques for safely resecting tumors near critical brain structures like middle cerebral artery branches and lenticulostriate arteries.

Keywords:
Glial tumorsInsular glioma surgeryTranssylvian approach

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Area of Science:

  • Neurosurgery
  • Neuro-oncology
  • Neuroanatomy

Background:

  • Microsurgical removal is the primary treatment for insular gliomas.
  • The complex anatomy of the insular region, including middle cerebral artery (MCA) branches and lenticulostriate arteries (LSAs), presents significant surgical challenges.
  • Tumor extension to the anterior perforated substance complicates surgery in nearly 30% of cases.

Observation:

  • A 33-year-old female presented with generalized seizures and a left insular lobe tumor.
  • MRI revealed tumor extension to the anterior perforated substance and mesial temporal lobe.
  • Surgical intervention was chosen due to tumor size and patient symptoms.

Findings:

  • The video demonstrates a transsylvian approach for insular glioma resection.
  • Key surgical steps include Sylvian fissure dissection, management of MCA branches and LSAs, and tumor removal from the anterior perforated substance.
  • Identifying and protecting LSAs was the most critical aspect of the procedure.

Implications:

  • Advanced microsurgical techniques are essential for successful insular glioma resection.
  • Careful patient selection is crucial for optimizing surgical outcomes.
  • The transsylvian approach, when performed with meticulous technique, can achieve acceptable rates of postoperative neurological deficits.