Department of Neurological Surgery and Neuroscience, University of Virginia Health System, Charlottesville, VA, USA.
Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey.
J Clin Neurosci. 2020 Aug;78:376-386. doi: 10.1016/j.jocn.2020.04.091. Epub 2020 May 4.
The insular gliomas were classified based on their locations and extensions to the adjacent areas. The insular and orbitofrontal cortices with underlying fiber tracts were studied on ten (20 sides) human cadaveric brains and two heads. Twenty patients with insular gliomas with the orbitofrontal or septal region extensions were studied on preoperative magnetic resonance imaging (MRI). Insular gliomas can extend to the orbitofrontal area dorsolaterally and/or ventromedially through the subdivision of the uncinate fasciculus. The dorsolateral part of the uncinate fasciculus interconnects the temporopolar area to the lateral orbitofrontal cortex through insula, and the ventromedial part of the uncinate fasciculus interconnects the temporopolar area to the medial orbital cortex, gyrus rectus, and septal region. The gyrus rectus infiltration on MRI indicates a ventromedial involvement by passing through the ventromedial part of the uncinate fasciculus. Diffusion tensor imaging (DTI) MRI demonstration of the UF is difficult due to the interruption of the fiber tracts by tumor. Tumor infiltration extending to the gyrus rectus requires a 15° lateral tilting with vertex toward contralateral side, as well as 70° head rotation to the contralateral side of lesion, for exposure of frontal base, septal region, and lateral border of the anterior perforating substance at the same time with the exposure of whole sylvian fissure via transsylvian approach of the insular tumors. An understanding of the orbitofrontal extension of the insular tumor based on the subdivisions of UF is useful in preoperative surgical planning and can assist for gross total resection.
岛叶胶质瘤根据其位置和向相邻区域的延伸进行分类。在十具（20 侧）人体尸脑和两个头颅上研究了岛叶和眶额皮质及其下纤维束。在术前磁共振成像（MRI）上研究了 20 例岛叶胶质瘤伴眶额或隔区延伸的患者。岛叶胶质瘤可通过扣带束的细分向外侧和/或内侧经岛叶延伸至眶额区。扣带束的背外侧部分通过岛叶将颞极区与外侧眶额皮质连接，扣带束的腹侧部分将颞极区与内侧眶皮质、直回和隔区连接。直回在 MRI 上的浸润表明通过扣带束的腹侧部分有内侧受累。由于肿瘤中断，弥散张量成像（DTI）MRI 对 UF 的显示较为困难。肿瘤浸润延伸至直回需要 15°的外侧倾斜，顶点朝向对侧，以及 70°的头部向病变对侧旋转，以同时暴露额底、隔区和前穿质的外侧边界，以及通过岛叶肿瘤的经外侧裂入路暴露整个外侧裂。了解基于 UF 细分的岛叶肿瘤的眶额延伸有助于术前手术计划，并有助于实现大体全切除。
