Leavitt Lydia, Baohan Amy, Heller Howard, Kozanno Liana, Frosch Matthew P, Dunn Gavin
Department of Neurosurgery, University of Illinois College of Medicine, Rockford, Illinois.
Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States.
Surg Neurol Int. 2022 Dec 23;13:591. doi: 10.25259/SNI_871_2022. eCollection 2022.
Mass lesions within the insular are diagnostically and surgically challenging due to the numerous critical cortical, subcortical, and vascular structures surrounding the region. Two main surgical techniques - the transsylvian approach and the transcortical approach - provide access to the insular cortex. Of the range of pathologies encountered, abscesses in the insula are surprisingly rare.
A 34-year-old patient was admitted for surgical resection of a suspected high-grade glioma in the insula of the dominant hemisphere. A rapid clinical decline prompted emergent neurosurgical intervention using a transsylvian approach. Surprisingly, abundant purulent material was encountered on entering the insular fossa. Pathological analysis confirmed an insular abscess, although a source of infection could not be identified. The patient required a second evacuation for reaccumulation of the abscess and adjuvant corticosteroids for extensive cerebral edema.
An abscess located in the insular cortex is an incredibly rare occurrence. Surgical management using the transsylvian approach is one option to approach this region. Familiarity with this approach is thus extremely beneficial in situations requiring emergent access to the dominant insula when awake mapping is not feasible. In addition, treatment of abscesses with adjuvant corticosteroids is indicated when extensive, life-threatening cerebral edema is present.
岛叶内的占位性病变在诊断和手术方面具有挑战性，因为该区域周围有众多重要的皮质、皮质下和血管结构。两种主要的手术技术——经侧裂入路和经皮质入路——可用于进入岛叶皮质。在遇到的一系列病变中，岛叶脓肿出奇地罕见。
一名34岁患者因疑似优势半球岛叶高级别胶质瘤入院接受手术切除。临床状况迅速恶化促使采用经侧裂入路进行紧急神经外科干预。令人惊讶的是，进入岛叶窝时发现大量脓性物质。病理分析证实为岛叶脓肿，尽管未确定感染源。患者因脓肿再次积聚需要进行第二次引流，并因广泛脑水肿接受辅助性皮质类固醇治疗。
位于岛叶皮质的脓肿极为罕见。采用经侧裂入路进行手术治疗是进入该区域的一种选择。因此，在无法进行清醒脑图谱定位且需要紧急进入优势岛叶的情况下，熟悉这种入路非常有益。此外，当出现广泛的、危及生命的脑水肿时，应使用辅助性皮质类固醇治疗脓肿。
