Abstract
Background
The function-based resection using trans-cortical approach for removing insular diffuse glioma shares a positive benefit-to-risk ratio with a low rate of permanent morbidity.
Method
The technique requires intraoperative functional brain mapping to be performed under awake condition using direct electrical stimulations at both cortical and subcortical levels to identify brain connectivity supporting neurocognition.
Conclusion
The trans-cortical approach is a safe and efficient technique to remove insular diffuse glioma. Intraoperative functional brain mapping under awake condition allows preserving brain connectivity and tailoring the resection. Great care must be taken in preventing vascular damages, and particularly the lenticulostriate arteries.
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The authors declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Key points
- Awake condition optimizes the benefit-to-risk ratio.
- Preoperative neurocognitive evaluation and patient’s preparation are keys to successful awake surgery.
- The positive cortical mapping tailors the trans-cortical approach.
- The positive subcortical mapping tailors the deep limits of resection.
- Subpial dissection avoids damaging the sylvian vascularization, and vascular boundaries have to be respected.
- Transient postoperative neurological and neurocognitive worsening requires rehabilitation.
- Permanent postoperative neurological deficit related to vascular injury occurs < 5%.
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Video 1
Illustration of the key steps of a function-based resection under awake condition of an insular diffuse glioma using the trans-cortical approach (MOV 36979 kb)
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Roux, A., Dezamis, E., Trancart, B. et al. How I do it: trans-cortical approach for insular diffuse glioma. Acta Neurochir 162, 3025–3030 (2020). https://doi.org/10.1007/s00701-020-04553-w
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DOI: https://doi.org/10.1007/s00701-020-04553-w