目的:累及后岛的低级别胶质瘤(LGG)的手术方法具有挑战性,尤其是在左半球,感觉运动的风险很高,语言,或视觉恶化。在这项研究中,据报道,有5例右利手患者患有左后岛叶LGG,通过详细介绍一种经皮质皮质下皮质入路。方法:使用皮质和轴突电刺激标测在清醒的患者中完成了五项手术。神经胶质瘤是通过左罗兰和/或顶叶手术切除的,保留皮层下的连通性。结果:5例患者的皮质图呈阳性,能够选择最佳的经皮质入路,4例患者通过前外侧上脑回和/或3例患者通过中央后外侧回(1例患者通过左颞上回)。此外,在所有情况下都确定了白质束,即,上纵束的外侧部分(5例),弓形束(四例),丘脑皮质体感通路(4例),运动路径(一例),语义通路(三种情况),和视神经束(一例)。两名患者实现了LGG的完全切除,三名患者几乎完全切除。术后没有永久性感觉运动,语言,或视觉缺陷。结论:在清醒患者中,通过parietoolandic手术的经皮质入路代表了安全有效的进入左后岛叶LGG的途径。在该交叉大脑区域中需要使用白质束的直接电刺激来检测和保留功能连通性,以防止其他可预测的手术后损伤。
Objective: Surgical approach to low-grade glioma (LGG) involving the posterior insula is challenging, especially in the left hemisphere, with a high risk of sensorimotor, language, or visual deterioration. In this study, a
case series of 5 right-handed patients harboring a left posterior insular LGG is reported, by detailing a transcorticosubcortical approach. Method: The five surgeries were achieved in awake patients using cortical and axonal electrostimulation mapping. The glioma was removed through the left rolandic and/or parietal opercula, with preservation of the subcortical connectivity. Results: The cortical mapping was positive in the five patients, enabling the selection of an optimal transcortical approach, via the anterolateral supramarginal gyrus in four patients and/or via the lateral retrocentral gyrus in three cases (plus through the left superior temporal gyrus in one
case). Moreover, the white matter tracts were identified in all cases, i.e., the lateral part of the superior longitudinal fasciculus (five cases), the arcuate fasciculus (four cases), the thalamocortical somatosensory pathways (four cases), the motor pathway (one
case), the semantic pathway (three cases), and the optic tract (one
case). Complete resection of the LGG was achieved in two patients and near-total resection in three patients. There were no postoperative permanent sensorimotor, language, or visual deficits. Conclusion: A transcortical approach through the parietorolandic operculum in awake patients represents safe and effective access to the left posterior insular LGG. Detection and preservation of the functional connectivity using direct electrostimulation of the white matter bundles are needed in this cross-road brain region to prevent otherwise predictable postsurgical impairments.