Martino Juan, Mato David, de Lucas Enrique Marco, García-Porrero Juan A, Gabarrós Andreu, Fernández-Coello Alejandro, Vázquez-Barquero Alfonso
Departments of 1 Neurological Surgery and.
Radiology, Hospital Universitario Marqués de Valdecilla and Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL);
J Neurosurg. 2015 Oct;123(4):1081-92. doi: 10.3171/2014.11.JNS141992. Epub 2015 May 8.
Little attention has been given to the functional challenges of the insular approach to the resection of gliomas, despite the potential damage of essential neural networks that underlie the insula. The object of this study is to analyze the subcortical anatomy of the insular region when infiltrated by gliomas, and compare it with the normal anatomy in nontumoral hemispheres.
Ten postmortem human hemispheres were dissected, with isolation of the inferior fronto-occipital fasciculus (IFOF) and the uncinate fasciculus. Probabilistic diffusion tensor imaging (DTI) tractography was used to analyze the subcortical anatomy of the insular region in 10 healthy volunteers and in 22 patients with insular Grade II and Grade III gliomas. The subcortical anatomy of the insular region in these 22 insular gliomas was compared with the normal anatomy in 20 nontumoral hemispheres.
In tumoral hemispheres, the distances between the peri-insular sulci and the lateral surface of the IFOF and uncinate fasciculus were enlarged (p < 0.05). Also in tumoral hemispheres, the IFOF was identified in 10 (90.9%) of 11 patients with an extent of resection less than 80%, and in 4 (36.4%) of 11 patients with an extent of resection equal to or greater than 80% (multivariate analysis: p = 0.03).
Insular gliomas grow in the space between the lateral surface of the IFOF and uncinate fasciculus and the insular surface, displacing and compressing the tracts medially. Moreover, these tracts may be completely infiltrated by the tumor, with a total disruption of the bundles. In the current study, the identification of the IFOF with DTI tractography was significantly associated with the extent of tumor resection. If the IFOF is not identified preoperatively, there is a high probability of achieving a resection greater than 80%.
尽管岛叶下的重要神经网络存在潜在损伤风险，但岛叶入路切除胶质瘤的功能挑战却很少受到关注。本研究的目的是分析胶质瘤浸润时岛叶区域的皮质下解剖结构，并将其与非肿瘤半球的正常解剖结构进行比较。
解剖10个尸检人类半球，分离额枕下束（IFOF）和钩束。使用概率性扩散张量成像（DTI）纤维束成像分析10名健康志愿者和22例岛叶二级和三级胶质瘤患者的岛叶区域皮质下解剖结构。将这22例岛叶胶质瘤的岛叶区域皮质下解剖结构与20个非肿瘤半球的正常解剖结构进行比较。
在肿瘤半球中，岛周沟与IFOF和钩束外侧表面之间的距离增大（p < 0.05）。同样在肿瘤半球中，11例切除范围小于80%的患者中有10例（90.9%）可识别出IFOF，11例切除范围等于或大于80%的患者中有4例（36.4%）可识别出IFOF（多变量分析：p = 0.03）。
岛叶胶质瘤生长于IFOF和钩束外侧表面与岛叶表面之间的间隙，将这些纤维束向内侧移位并压缩。此外，这些纤维束可能被肿瘤完全浸润，导致束的完全中断。在本研究中，通过DTI纤维束成像识别IFOF与肿瘤切除范围显著相关。如果术前未识别出IFOF，则实现大于80%切除率的可能性很高。
