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

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.

[1]  Prof. Dr. med. Wolfgang Seeger.  Microsurgery of Cerebral Veins , 2000, Springer Vienna.

[2]  R J Andrews,et al.  A review of brain retraction and recommendations for minimizing intraoperative brain injury. , 1993, Neurosurgery.

[3]  M. Yașargil,et al.  Topographic anatomy of the insular region. , 1999, Journal of neurosurgery.

[4]  M. Gazi Yasargil,et al.  The Insular Cortex: Morphological and Vascular Anatomic Characteristics , 1999 .

[5]  M. Yașargil,et al.  Arteries of the insula. , 2000, Journal of neurosurgery.

[6]  Manuel Lopes,et al.  The Insular Lobe: Physiopathological and Surgical Considerations , 2000, Neurosurgery.

[7]  Z. Gokaslan,et al.  Surgical resection of intrinsic insular tumors: complication avoidance. , 2001, Journal of neurosurgery.

[8]  Manuel Dujovny,et al.  Brain retraction injury , 2003, Neurological research.

[9]  M. Trimble,et al.  The insular Lobe of Reil–its Anatamico-Functional, behavioural and Neuropsychiatric attributes in humans–a review , 2004, The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry.

[10]  Laurent Capelle,et al.  Preferential brain locations of low‐grade gliomas , 2004, Cancer.

[11]  Alexandre Yasuda,et al.  Microsurgical anatomy of the insula and the sylvian fissure. , 2004, Journal of neurosurgery.

[12]  F. Lang,et al.  Surgical Resection of Intrinsic Insular Tumors , 2005, Neurosurgery.

[13]  T. Dóczi,et al.  Tumours of the limbic and paralimbic systems , 2005, Acta Neurochirurgica.

[14]  Anssi Auvinen,et al.  Incidence of gliomas by anatomic location. , 2007, Neuro-oncology.

[15]  Mitchel S Berger,et al.  Functional outcome after language mapping for glioma resection. , 2008, The New England journal of medicine.

[16]  SURGERY FOR TEMPORAL MEDIOBASAL TUMORS: EXPERIENCE BASED ON A SERIES OF 235 PATIENTS , 2008, Neurosurgery.

[17]  M. Berger,et al.  GLIOMA EXTENT OF RESECTION AND ITS IMPACT ON PATIENT OUTCOME , 2008, Neurosurgery.

[18]  H. Duffau,et al.  A personal consecutive series of surgically treated 51 cases of insular WHO Grade II glioma: advances and limitations. , 2009, Journal of neurosurgery.

[19]  A. Kyritsis,et al.  Descriptive Epidemiology of Cerebral Gliomas in Northwest Greece and Study of Potential Predisposing Factors, 2005–2007 , 2009, Neuroepidemiology.

[20]  G. Neuloh,et al.  Insular gliomas: the case for surgical management. , 2009, Journal of neurosurgery.

[21]  M. Berger,et al.  Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. , 2010, Journal of neurosurgery.

[22]  Chang-Hyun Lee,et al.  Epidemiology of primary brain and central nervous system tumors in Korea. , 2010, Journal of Korean Neurosurgical Society.

[23]  M. Berger,et al.  Extent of resection influences outcomes for patients with gliomas. , 2011, Revue neurologique.

[24]  Mitchel S Berger,et al.  An extent of resection threshold for newly diagnosed glioblastomas. , 2011, Journal of neurosurgery.

[25]  R. Dubrow,et al.  Demographic variation in incidence of adult glioma by subtype, United States, 1992-2007 , 2011, BMC Cancer.

[26]  Luciano Fadiga,et al.  Surgery of insular nonenhancing gliomas: volumetric analysis of tumoral resection, clinical outcome, and survival in a consecutive series of 66 cases. , 2012, Neurosurgery.

[27]  Jie Cai,et al.  Microsurgery Resection of Intrinsic Insular Tumors via Transsylvian Surgical Approach in 12 Cases , 2012, Cancer biology & medicine.

[28]  A. Cohen-Gadol,et al.  Technical nuances for surgery of insular gliomas: lessons learned. , 2013, Neurosurgical focus.

[29]  J. Barnholtz-Sloan,et al.  CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006-2010. , 2013, Neuro-oncology.

[30]  S. Rohrmann,et al.  Primary brain tumour epidemiology in Georgia: first-year results of a population-based study , 2013, Journal of Neuro-Oncology.

[31]  L. Fadiga,et al.  Surgery for insular low-grade glioma: predictors of postoperative seizure outcome. , 2014, Journal of neurosurgery.

[32]  J. Barnholtz-Sloan,et al.  CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. , 2012, Neuro-oncology.

[33]  J. Barnholtz-Sloan,et al.  The epidemiology of glioma in adults: a "state of the science" review. , 2014, Neuro-oncology.

[34]  Alexander R. Pico,et al.  Glioma Groups Based on 1p/19q, IDH, and TERT Promoter Mutations in Tumors. , 2015, The New England journal of medicine.

[35]  L. Morgan,et al.  The epidemiology of glioma in adults: a "state of the science" review. , 2015, Neuro-oncology.

[36]  Steven J. M. Jones,et al.  Comprehensive, Integrative Genomic Analysis of Diffuse Lower-Grade Gliomas. , 2015, The New England journal of medicine.

[37]  M. Berger,et al.  Frontal operculum gliomas: language outcome following resection. , 2015, Journal of neurosurgery.

[38]  M. Berger,et al.  Surgical assessment of the insula. Part 1: surgical anatomy and morphometric analysis of the transsylvian and transcortical approaches to the insula. , 2016, Journal of neurosurgery.

[39]  M. Berger,et al.  Surgical assessment of the insula. Part 2: validation of the Berger-Sanai zone classification system for predicting extent of glioma resection. , 2016, Journal of Neurosurgery.