Surgery of insular nonenhancing gliomas: Volumetric analysis of tumoral resection, clinical outcome, and survival in a consecutive series of 66 cases

Miran Skrap, Massimo Mondani, Barbara Tomasino, Luca Weis, Riccardo Budai, Giada Pauletto, Roberto Eleopra, Luciano Fadiga, Tamara Ius

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Despite intraoperative technical improvements, the insula remains a challenging area for surgery because of its critical relationships with vascular and neurophysiological functional structures. OBJECTIVE: To retrospectively investigate the morbidity profile in insular nonenhancing gliomas, with special emphasis on volumetric analysis of tumoral resection. METHODS: From 2000 to 2010, 66 patients underwent surgery. All surgical procedures were conducted under cortical-subcortical stimulation and neurophysiological monitoring. Volumetric scan analysis was applied on T2-weighted magnetic resonance images (MRIs) to establish preoperative and postoperative tumoral volume. RESULTS: The median preoperative tumor volume was 108 cm. The median extent of resection was 80%. The median follow-up was 4.3 years. An immediate postoperative worsening was detected in 33.4% of cases; a definitive worsening resulted in 6% of cases. Patients with extent of resection of > 90% had an estimated 5-year overall survival rate of 92%, whereas those with extent of resection between 70% and 90% had a 5-year overall survival rate of 82% (P 30 cm had a 5-year overall survival rate of 57% (P =.02). CONCLUSION: With intraoperative cortico-subcortical mapping and neurophysiological monitoring, a major resection is possible with an acceptable risk and a significant result in the follow-up.

Original languageEnglish
Pages (from-to)1081-1093
Number of pages13
JournalNeurosurgery
Volume70
Issue number5
DOIs
Publication statusPublished - May 2012

Keywords

  • Brain mapping
  • Direct electrical stimulation
  • Extent of resection
  • Functional outcome
  • Insular gliomas surger

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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