Abstract

BACKGROUND

Insular diffuse glioma surgery is challenging, and tools to help surgical planning could improve the benefit-to-risk ratio.

OBJECTIVE

To provide a probabilistic resection map and frequency atlases of critical eloquent regions of insular diffuse gliomas based on our surgical experience.

METHODS

We computed cortico-subcortical “eloquent” anatomic sites identified intraoperatively by direct electrical stimulations during transcortical awake resection of insular diffuse gliomas in adults.

RESULTS

From 61 insular diffuse gliomas (39 left, 22 right; all left hemispheric dominance for language), we provided a frequency atlas of eloquence of the opercula (left/right; pars orbitalis: 0%/5.0%; pars triangularis: l5.6%/4.5%; pars opercularis: 37.8%/27.3%; precentral gyrus: 97.3%/95.4%; postcentral and supramarginal gyri: 75.0%/57.1%; temporal pole and superior temporal gyrus: 13.3%/0%), which tailored the transcortical approach (frontal operculum to reach the antero-superior insula, temporal operculum to reach the inferior insula, parietal operculum to reach the posterior insula). We provided a frequency atlas of eloquence identifying the subcortical functional boundaries (36.1% pyramidal pathways, 50.8% inferior fronto-occipital fasciculus, 13.1% arcuate and superior longitudinal fasciculi complex, 3.3% somatosensory pathways, 8.2% caudate and lentiform nuclei). Vascular boundaries and increasing errors during testing limited the resection in 8.2% and 11.5% of cases, respectively. We provided a probabilistic 3-dimensional atlas of resectability.

CONCLUSION

Functional mapping under awake conditions has to be performed intraoperatively in each patient to guide surgical approach and resection of insular diffuse gliomas in right and left hemispheres. Frequency atlases of opercula eloquence and of subcortical eloquent anatomic boundaries, and probabilistic 3-dimensional atlas of resectability could guide neurosurgeons.

中文翻译：

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岛叶弥漫性胶质瘤的手术 - 第 2 部分：在经皮层清醒切除期间，关键雄辩脑结构的概率皮质-皮质下图谱和概率切除图

摘要

背景

岛叶弥漫性胶质瘤手术具有挑战性，帮助手术计划的工具可以提高收益风险比。

客观的

根据我们的手术经验，提供岛叶弥漫性胶质瘤关键区域的概率切除图和频率图谱。

方法

我们计算了在成人岛叶弥漫性胶质瘤经皮层清醒切除术中通过直接电刺激术中确定的皮层-皮层下“雄辩”解剖部位。

结果

从 61 个岛叶弥漫性胶质瘤（左 39 个，右 22 个；所有左半球语言优势）中，我们提供了鳃盖口语的频率图谱（左/右；眶部：0%/5.0%；三角部：l5.6 %/4.5%；鳃盖部：37.8%/27.3%；中央前回：97.3%/95.4%；中央后回和缘上回：75.0%/57.1%；颞极和颞上回：13.3%/0%）经皮层入路（额叶鳃盖到达前上岛叶，颞叶鳃盖到达下岛叶，顶叶鳃盖到达后岛叶）。我们提供了识别皮层下功能边界的口才频率图谱（36.1% 锥体通路，50.8% 下额枕叶束，13.1% 弓状和上纵束复合体，3.3% 体感通路，8. 2% 尾状核和豆状核）。血管边界和测试过程中不断增加的错误分别限制了 8.2% 和 11.5% 的病例的切除。我们提供了可切除性的概率 3 维图谱。

结论

必须在术中对每位患者进行清醒条件下的功能映射，以指导手术入路和切除左右半球的岛叶弥漫性胶质瘤。鳃盖口语和皮层下口语解剖边界的频率图谱，以及可切除性的概率 3 维图谱可以指导神经外科医生。