Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Neurol India. 2021 Nov-Dec;69(6):1560-1564. doi: 10.4103/0028-3886.333450.
Insular glioma was considered a nonsurgical entity due to resection-associated morbidities. The advancement in neurosurgical techniques and adjuncts used in the last two decades made the resection of insular gliomas simpler for neurosurgeons with the maximum extent of resection and acceptable morbidity rates. The complex anatomy of this region remains a challenge for neurosurgeons and requires expertise. The key factors to achieve complete resection in the insular region are the thorough knowledge of surgical anatomy and meticulous microsurgical techniques. Intraoperative adjuncts such as image guidance along with cortical and subcortical mapping assist in excellent outcomes.
In this study, we describe the operative technique and application of trans-Sylvian approach to do the compartmental dissection done by the senior author, along with challenges faced, with the hope to highlight the efficacy of the approach to achieve maximal resection of this entity without compromising patient's safety.
A 32-year-old right-handed gentleman presented with episodes of excessive salivation, tingling sensation on the right side of the body along with nausea that lasted for 15-20 s for the last 8 months and one episode of speech arrest without any loss of consciousness and motor or sensory deficit. CEMRI of the brain was suggestive of left insular glioma. The patient underwent left pterional craniotomy, and gross total resection of the tumor was done using compartmental dissection.
At follow-up after 1 month, the patient is seizure-free without any speech difficulty and motor or sensory deficit.
Compartmental dissection of insular glioma is a safe and efficacious technique to achieve gross total resection of the tumor in this complex region without morbidity.
由于与切除相关的发病率，岛叶胶质瘤曾被认为是一种不可手术的实体瘤。在过去二十年中，神经外科技术和辅助手段的进步使得神经外科医生能够更简单地切除岛叶胶质瘤，实现最大限度的切除并获得可接受的发病率。该区域复杂的解剖结构仍然是神经外科医生面临的挑战，需要具备专业技能。在岛叶区域实现完全切除的关键因素是对手术解剖结构的透彻了解和精细的显微外科技术。术中辅助手段，如影像引导以及皮质和皮质下定位，有助于获得良好的结果。
在本研究中，我们描述了由资深作者应用经外侧裂入路进行的隔室分离的手术技术和应用，以及所面临的挑战，希望强调该方法在不影响患者安全的情况下实现最大程度切除该实体瘤的功效。
一名 32 岁的右利手男性，出现了 8 个月的右侧过度流涎、刺痛感和恶心，持续 15-20 秒，以及一次无意识丧失、运动或感觉障碍的言语中断。脑部 CEMRI 提示左侧岛叶胶质瘤。患者接受了左翼点开颅术，并使用隔室分离术进行了肿瘤的大体全切除。
术后 1 个月随访时，患者无癫痫发作，无言语困难，无运动或感觉障碍。
岛叶胶质瘤的隔室分离是一种安全有效的技术，可在不增加发病率的情况下，在这个复杂区域实现肿瘤的大体全切除。
