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Complication avoidance: resection of the insular glioma complicated by iatrogenic injury to the lenticulostriate artery

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Abstract

Background

Neurosurgical resection of insular gliomas is complicated by the risk of iatrogenic injury to lenticulostriate arteries (LSAs).

Method

We provide a description, figures, and a video to illustrate the clinical case in which the LSA was damaged during the resection of insular glioma. Cadaveric dissection from our anatomical laboratory and our 3D anatomical model provided relevant surgical anatomy of the insula.

Conclusion

Proximal dissection of the Sylvian fissure up to the most lateral LSA, the emergence of the beige putamen, and the lenticulostriate veins are anatomic landmarks that allow reducing the risk of damaging the intraparenchymatous segment of the LSAs.

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Author information

Authors and Affiliations

  1. 7th Department of Neuro-oncology, N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, 125047, Russia

    David I. Pitskhelauri

  2. Moscow, Russia

    Andrey E. Bykanov

Authors
  1. David I. Pitskhelauri
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  2. Andrey E. Bykanov
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Additional information

Key Points

1. Understanding the anatomy of the insular region.

2. Preoperative visualization of the course of LSAs and their relation to the medial border of the tumor by 3D TOF MRA.

3. In the cases when glial tumors involve the LSAs, the feasibility of radical tumor removal without neurological deficit is significantly reduced.

4. Dissection of the proximal M1 segment to the most lateral LSA.

5. Neuronavigation and Doppler ultrasonography are useless for determining the location of the intraparenchymatous segment of the LSA.

6. The main hazard of insular glioma surgery is the intraparenchymatous segment of the LSA.

7. An ultrasonic aspirator should not be used during resection of the most medial portion of the tumor.

8. When detecting the brown-beige-colored putamen, tumor resection in the medial direction must be stopped.

9. The lenticulostriate veins and hemorrhage from these veins are indicative of the proximity of the LSA.

10. In 70–85% of cases, hemiparesis caused by LSA damage resolves within 3 months.

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This article is part of the Topical Collection on Complications

Supplementary Information

Video

. This video demonstrates the removal of the tumor of the left insula via the transsylvian approach (MP4 179517 kb)

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Pitskhelauri, D.I., Bykanov, A.E. Complication avoidance: resection of the insular glioma complicated by iatrogenic injury to the lenticulostriate artery. Acta Neurochir 163, 3093–3096 (2021). https://doi.org/10.1007/s00701-021-04806-2

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  • DOI: https://doi.org/10.1007/s00701-021-04806-2

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