Advertisement

Journal of Neuro-Oncology

, Volume 130, Issue 2, pp 283–287 | Cite as

The transsylvian approach for resection of insular gliomas: technical nuances of splitting the Sylvian fissure

  • Michael M. SafaeeEmail author
  • Dario J. Englot
  • Seunggu J. Han
  • Michael T. Lawton
  • Mitchel S. Berger
Topic Review

Abstract

Insular gliomas represent a unique surgical challenge due to the complex anatomy and nearby vascular elements associated within the Sylvian fissure. For certain tumors, the transsylvian approach provides an effective technique for achieving maximal safe resection. The goal of this manuscript and video are to present and discuss the surgical nuances and appropriate application of splitting the Sylvian fissure. Our hope is that this video highlights the safety and efficacy of the transsylvian approach for appropriately selected insular gliomas.

Keywords

Insula Glioma Sylvian fissure Transsylvian approach 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 (MP4 396970 KB)

References

  1. 1.
    Ostrom QT, Bauchet L, Davis FG, Deltour I, Fisher JL, Langer CE, Pekmezci M, Schwartzbaum JA, Turner MC, Walsh KM, Wrensch MR, Barnholtz-Sloan JS (2014) The epidemiology of glioma in adults: a “state of the science” review. Neuro Oncol 16:896–913. doi: 10.1093/neuonc/nou087 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gousias K, Markou M, Voulgaris S, Goussia A, Voulgari P, Bai M, Polyzoidis K, Kyritsis A, Alamanos Y (2009) Descriptive epidemiology of cerebral gliomas in northwest Greece and study of potential predisposing factors, 2005–2007. Neuroepidemiology 33:89–95. doi: 10.1159/000222090 CrossRefPubMedGoogle Scholar
  3. 3.
    Larjavaara S, Mantyla R, Salminen T, Haapasalo H, Raitanen J, Jaaskelainen J, Auvinen A (2007) Incidence of gliomas by anatomic location. Neuro Oncol 9:319–325. doi: 10.1215/15228517-2007-016 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Dubrow R, Darefsky AS (2011) Demographic variation in incidence of adult glioma by subtype, United States, 1992–2007. BMC Cancer 11:325. doi: 10.1186/1471-2407-11-325 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Gigineishvili D, Shengelia N, Shalashvili G, Rohrmann S, Tsiskaridze A, Shakarishvili R (2013) Primary brain tumour epidemiology in Georgia: first-year results of a population-based study. J Neurooncol 112:241–246. doi: 10.1007/s11060-013-1054-1 CrossRefPubMedGoogle Scholar
  6. 6.
    Lee CH, Jung KW, Yoo H, Park S, Lee SH (2010) Epidemiology of primary brain and central nervous system tumors in Korea. J Korean Neurosurg Soc 48:145–152. doi: 10.3340/jkns.2010.48.2.145 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, Stroup NE, Kruchko C, Barnholtz-Sloan JS (2013) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro Oncol 15(Suppl 2):ii1–ii56. doi: 10.1093/neuonc/not151 PubMedPubMedCentralGoogle Scholar
  8. 8.
    Cancer Genome Atlas Research Network, Brat DJ, Verhaak RG, Aldape KD, Yung WK, Salama SR, Cooper LA, Rheinbay E, Miller CR, Vitucci M, Morozova O, Robertson AG, Noushmehr H, Laird PW, Cherniack AD, Akbani R, Huse JT, Ciriello G, Poisson LM, Barnholtz-Sloan JS, Berger MS, Brennan C, Colen RR, Colman H, Flanders AE, Giannini C, Grifford M, Iavarone A, Jain R, Joseph I, Kim J, Kasaian K, Mikkelsen T, Murray BA, O’Neill BP, Pachter L, Parsons DW, Sougnez C, Sulman EP, Vandenberg SR, Van Meir EG, von Deimling A, Zhang H, Crain D, Lau K, Mallery D, Morris S, Paulauskis J, Penny R, Shelton T, Sherman M, Yena P, Black A, Bowen J, Dicostanzo K, Gastier-Foster J, Leraas KM, Lichtenberg TM, Pierson CR, Ramirez NC, Taylor C, Weaver S, Wise L, Zmuda E, Davidsen T, Demchok JA, Eley G, Ferguson ML, Hutter CM, Mills Shaw KR, Ozenberger BA, Sheth M, Sofia HJ, Tarnuzzer R, Wang Z, Yang L, Zenklusen JC, Ayala B, Baboud J, Chudamani S, Jensen MA, Liu J, Pihl T, Raman R, Wan Y, Wu Y, Ally A, Auman JT, Balasundaram M, Balu S, Baylin SB, Beroukhim R, Bootwalla MS, Bowlby R, Bristow CA, Brooks D, Butterfield Y, Carlsen R, Carter S, Chin L, Chu A, Chuah E, Cibulskis K, Clarke A, Coetzee SG, Dhalla N, Fennell T, Fisher S, Gabriel S, Getz G, Gibbs R, Guin R, Hadjipanayis A, Hayes DN, Hinoue T, Hoadley K, Holt RA, Hoyle AP, Jefferys SR, Jones S, Jones CD, Kucherlapati R, Lai PH, Lander E, Lee S, Lichtenstein L, Ma Y, Maglinte DT, Mahadeshwar HS, Marra MA, Mayo M, Meng S, Meyerson ML, Mieczkowski PA, Moore RA, Mose LE, Mungall AJ, Pantazi A, Parfenov M, Park PJ, Parker JS, Perou CM, Protopopov A, Ren X, Roach J, Sabedot TS, Schein J, Schumacher SE, Seidman JG, Seth S, Shen H, Simons JV, Sipahimalani P, Soloway MG, Song X, Sun H, Tabak B, Tam A, Tan D, Tang J, Thiessen N, Triche T Jr, Van Den Berg DJ, Veluvolu U, Waring S, Weisenberger DJ, Wilkerson MD, Wong T, Wu J, Xi L, Xu AW, Yang L, Zack TI, Zhang J, Aksoy BA, Arachchi H, Benz C, Bernard B, Carlin D, Cho J, DiCara D, Frazer S, Fuller GN, Gao J, Gehlenborg N, Haussler D, Heiman DI, Iype L, Jacobsen A, Ju Z, Katzman S, Kim H, Knijnenburg T, Kreisberg RB, Lawrence MS, Lee W, Leinonen K, Lin P, Ling S, Liu W, Liu Y, Liu Y, Lu Y, Mills G, Ng S, Noble MS, Paull E, Rao A, Reynolds S, Saksena G, Sanborn Z, Sander C, Schultz N, Senbabaoglu Y, Shen R, Shmulevich I, Sinha R, Stuart J, Sumer SO, Sun Y, Tasman N, Taylor BS, Voet D, Weinhold N, Weinstein JN, Yang D, Yoshihara K, Zheng S, Zhang W, Zou L, Abel T, Sadeghi S, Cohen ML, Eschbacher J, Hattab EM, Raghunathan A, Schniederjan MJ, Aziz D, Barnett G, Barrett W, Bigner DD, Boice L, Brewer C, Calatozzolo C, Campos B, Carlotti CG Jr, Chan TA, Cuppini L, Curley E, Cuzzubbo S, Devine K, DiMeco F, Duell R, Elder JB, Fehrenbach A, Finocchiaro G, Friedman W, Fulop J, Gardner J, Hermes B, Herold-Mende C, Jungk C, Kendler A, Lehman NL, Lipp E, Liu O, Mandt R, McGraw M, McLendon R, McPherson C, Neder L, Nguyen P, Noss A, Nunziata R, Ostrom QT, Palmer C, Perin A, Pollo B, Potapov A, Potapova O, Rathmell WK, Rotin D, Scarpace L, Schilero C, Senecal K, Shimmel K, Shurkhay V, Sifri S, Singh R, Sloan AE, Smolenski K, Staugaitis SM, Steele R, Thorne L, Tirapelli DP, Unterberg A, Vallurupalli M, Wang Y, Warnick R, Williams F, Wolinsky Y, Bell S, Rosenberg M, Stewart C, Huang F, Grimsby JL, Radenbaugh AJ, Zhang J (2015) Comprehensive, integrative genomic analysis of diffuse lower-grade gliomas. N Engl J Med 372:2481–2498. doi: 10.1056/NEJMoa1402121 CrossRefPubMedGoogle Scholar
  9. 9.
    Eckel-Passow JE, Lachance DH, Molinaro AM, Walsh KM, Decker PA, Sicotte H, Pekmezci M, Rice T, Kosel ML, Smirnov IV, Sarkar G, Caron AA, Kollmeyer TM, Praska CE, Chada AR, Halder C, Hansen HM, McCoy LS, Bracci PM, Marshall R, Zheng S, Reis GF, Pico AR, O’Neill BP, Buckner JC, Giannini C, Huse JT, Perry A, Tihan T, Berger MS, Chang SM, Prados MD, Wiemels J, Wiencke JK, Wrensch MR, Jenkins RB (2015) Glioma groups based on 1p/19q, IDH, and TERT promoter mutations in tumors. N Engl J Med 372:2499–2508. doi: 10.1056/NEJMoa1407279 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Duffau H, Capelle L (2004) Preferential brain locations of low-grade gliomas. Cancer 100:2622–2626. doi: 10.1002/cncr.20297 CrossRefPubMedGoogle Scholar
  11. 11.
    Tanriover N, Rhoton AL Jr, Kawashima M, Ulm AJ, Yasuda A (2004) Microsurgical anatomy of the insula and the sylvian fissure. J Neurosurg 100:891–922. doi: 10.3171/jns.2004.100.5.0891 CrossRefPubMedGoogle Scholar
  12. 12.
    Ture U, Yasargil MG, Al-Mefty O, Yasargil DC (2000) Arteries of the insula. J Neurosurg 92:676–687. doi: 10.3171/jns.2000.92.4.0676 CrossRefPubMedGoogle Scholar
  13. 13.
    Shelley BP, Trimble MR (2004) The insular lobe of Reil: its anatamico-functional, behavioural and neuropsychiatric attributes in humans—a review. World J Biol Psychiatry 5:176–200CrossRefPubMedGoogle Scholar
  14. 14.
    Ture U, Yasargil DC, Al-Mefty O, Yasargil MG (1999) Topographic anatomy of the insular region. J Neurosurg 90:720–733CrossRefPubMedGoogle Scholar
  15. 15.
    Rey-Dios R, Cohen-Gadol AA (2013) Technical nuances for surgery of insular gliomas: lessons learned. Neurosurg Focus 34:E6. doi: 10.3171/2012.12.FOCUS12342 CrossRefPubMedGoogle Scholar
  16. 16.
    Varnavas GG, Grand W (1999) The insular cortex: morphological and vascular anatomic characteristics. Neurosurgery 44:127–136 (discussion 136–128)CrossRefPubMedGoogle Scholar
  17. 17.
    Hentschel SJ, Lang FF (2005) Surgical resection of intrinsic insular tumors. Neurosurgery 57:176–183 (discussion 176–183)PubMedGoogle Scholar
  18. 18.
    Yasargil MG, von Ammon K, Cavazos E, Doczi T, Reeves JD, Roth P (1992) Tumours of the limbic and paralimbic systems. Acta Neurochir (Wien) 118:40–52CrossRefGoogle Scholar
  19. 19.
    Sanai N, Berger MS (2008) Glioma extent of resection and its impact on patient outcome. Neurosurgery 62: 753–764. doi: 10.1227/01.neu.0000318159.21731.cf (discussion 264–756)CrossRefPubMedGoogle Scholar
  20. 20.
    Sanai N, Berger MS (2011) Extent of resection influences outcomes for patients with gliomas. Rev Neurol (Paris) 167:648–654. doi: 10.1016/j.neurol.2011.07.004 CrossRefGoogle Scholar
  21. 21.
    Sanai N, Polley MY, McDermott MW, Parsa AT, Berger MS (2011) An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 115:3–8. doi: 10.3171/2011.2.JNS10998 CrossRefPubMedGoogle Scholar
  22. 22.
    Simon M, Neuloh G, von Lehe M, Meyer B, Schramm J (2009) Insular gliomas: the case for surgical management. J Neurosurg 110:685–695. doi: 10.3171/2008.7.JNS17639 CrossRefPubMedGoogle Scholar
  23. 23.
    Duffau H (2009) A personal consecutive series of surgically treated 51 cases of insular WHO grade II glioma: advances and limitations. J Neurosurg 110:696–708. doi: 10.3171/2008.8.JNS08741 CrossRefPubMedGoogle Scholar
  24. 24.
    Ius T, Pauletto G, Isola M, Gregoraci G, Budai R, Lettieri C, Eleopra R, Fadiga L, Skrap M (2014) Surgery for insular low-grade glioma: predictors of postoperative seizure outcome. J Neurosurg 120:12–23. doi: 10.3171/2013.9.JNS13728 CrossRefPubMedGoogle Scholar
  25. 25.
    Sanai N, Polley MY, Berger MS (2010) Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. J Neurosurg 112:1–9. doi: 10.3171/2009.6.JNS0952 CrossRefPubMedGoogle Scholar
  26. 26.
    Skrap M, Mondani M, Tomasino B, Weis L, Budai R, Pauletto G, Eleopra R, Fadiga L, Ius T (2012) Surgery of insular nonenhancing gliomas: volumetric analysis of tumoral resection, clinical outcome, and survival in a consecutive series of 66 cases. Neurosurgery 70: 1081–1093. doi: 10.1227/NEU.0b013e31823f5be5 (discussion 1093–1084)CrossRefPubMedGoogle Scholar
  27. 27.
    Hervey-Jumper SL, Li J, Osorio JA, Lau D, Molinaro AM, Benet A, Berger MS (2016) Surgical assessment of the insula. Part 2: validation of the Berger–Sanai zone classification system for predicting extent of glioma resection. J Neurosurg 124:482–488. doi: 10.3171/2015.4.JNS1521 CrossRefPubMedGoogle Scholar
  28. 28.
    Duffau H, Capelle L, Lopes M, Faillot T, Sichez JP, Fohanno D (2000) The insular lobe: physiopathological and surgical considerations. Neurosurgery 47:801–810 (discussion 810–801)CrossRefPubMedGoogle Scholar
  29. 29.
    Sanai N, Mirzadeh Z, Berger MS (2008) Functional outcome after language mapping for glioma resection. N Engl J Med 358:18–27. doi: 10.1056/NEJMoa067819 CrossRefPubMedGoogle Scholar
  30. 30.
    Lang FF, Olansen NE, DeMonte F, Gokaslan ZL, Holland EC, Kalhorn C, Sawaya R (2001) Surgical resection of intrinsic insular tumors: complication avoidance. J Neurosurg 95:638–650. doi: 10.3171/jns.2001.95.4.0638 CrossRefPubMedGoogle Scholar
  31. 31.
    Wang P, Wu MC, Chen SJ, Xu XP, Yang Y, Cai J (2012) Microsurgery resection of intrinsic insular tumors via transsylvian surgical approach in 12 cases. Cancer Biol Med 9:44–47. doi: 10.3969/j.issn.2095-3941.2012.01.008 PubMedPubMedCentralGoogle Scholar
  32. 32.
    Benet A, Hervey-Jumper SL, Sanchez JJ, Lawton MT, Berger MS (2016) Surgical assessment of the insula. Part 1: surgical anatomy and morphometric analysis of the transsylvian and transcortical approaches to the insula. J Neurosurg 124:469–481. doi: 10.3171/2014.12.JNS142182 CrossRefPubMedGoogle Scholar
  33. 33.
    Seeger W (2000) Microsurgery of cerebral veins. Springer, ViennaGoogle Scholar
  34. 34.
    Zhong J, Dujovny M, Perlin AR, Perez-Arjona E, Park HK, Diaz FG (2003) Brain retraction injury. Neurol Res 25:831–838. doi: 10.1179/016164103771953925 CrossRefPubMedGoogle Scholar
  35. 35.
    Andrews RJ, Bringas JR (1993) A review of brain retraction and recommendations for minimizing intraoperative brain injury. Neurosurgery 33:1052–1063 (discussion 1063–1054)CrossRefPubMedGoogle Scholar
  36. 36.
    Schramm J, Aliashkevich AF (2007) Surgery for temporal mediobasal tumors: experience based on a series of 235 patients. Neurosurgery 60: 285–294. doi: 10.1227/01.NEU.0000249281.69384.D7 (discussion 294–285)CrossRefPubMedGoogle Scholar
  37. 37.
    Rolston JD, Englot DJ, Benet A, Li J, Cha S, Berger MS (2015) Frontal operculum gliomas: language outcome following resection. J Neurosurg 122:725–734. doi: 10.3171/2014.11.JNS132172 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Michael M. Safaee
    • 1
    Email author
  • Dario J. Englot
    • 1
  • Seunggu J. Han
    • 1
  • Michael T. Lawton
    • 1
  • Mitchel S. Berger
    • 1
  1. 1.Department of Neurological SurgeryUniversity of CaliforniaSan FranciscoUSA

Personalised recommendations