Insular glioma surgery complications
The insula’s proximity to middle cerebral artery and lenticulostriate arteries, primary motor areas, and perisylvian language areas makes accessing and resecting gliomas in this region challenging 1). A good understanding of the surgical anatomy and an awareness of potential pitfalls can help reduce neurological complications and maximize surgical resection of insular tumors 2) 3).
There are still three major concerns about lesions that can impact the quality of life of patients in the postoperative period of insular glioma surgery. The first is the damage to the internal capsule and corona radiata by direct manipulation, which can cause motor and sensory deficits in the contralateral hemibody. The second is the lesion of bundles and fascicles of white fibers surrounding the tumor, such as the inferior fronto-occipital fascicle (IFOF) and superior longitudinal fasciculus (SLF). And finally, there is a risk of arterial and venous vascular lesions 4).
A meta-analysis of 890 insular glioma patients found the pooled incidences of new permanent motor and speech deficits following surgery to be 4% and 2%, respectively 5).