Giant insular gliomas, a surgical management approach
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Abstract
Introduction: Giant insular gliomas (GIG) are defined as those that cover the 4 zones of the Berger/Sanai classification. Objective: To present a case series of 7 giant insular gliomas to determine the percentage of tumor resection and the morbidity of the intervention and to propose a surgical management strategy. Method: We performed a retrospective observational analysis of patients with giant insular gliomas undergoing surgical treatment over a period of 3 years. Results: 7 patients with GIG were operated on between July 2019 and November 2023. The average volume was 126.4 ± 36.6 cm3. Tractography (DTI) and fMRI were used in 100% of patients. The majority were operated on in 2 stages, with a first approach under general anesthesia when the glioma was in the non-dominant hemisphere or zone 3 of the dominant hemisphere and a second awake stage. The average resection was 76.4%, none presented permanent deficit, of the patients who debuted with epileptic seizures, 80% remained seizure-free at 3 months. The presence of DTI with tracts included within the tumor or intra-tumor fMRI activation was a predictor of more limited excision. Discussion: In previous series its volumes average 76.7 cm3 (17.1-144.1), with exeresis that average 72.7% and a morbidity that ranges between 5.3%-20%. Different surgical strategies have been proposed, involving transopercular awake surgery, neurophysiological monitoring and transylvian resection, or combinations. Conclusion: two-stage excision of giant insular gliomas allows for extensive excision, reducing morbidity. The use of awake surgery minimizes the risks of aphasia or motor deficit, and preoperative study with fMRI and DTI can influence surgical planning.
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Glioma, insular glioma, giant insular glioma, transopercular approach, transylvian approach, humans, awake surgery, tractography, extention resection, brain mapping, insula
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