INSULA GLIOMAS: CORRELATION BETWEEN THE TYPE OF APPROACH (TRANSYLVIAN X TRANSCORTICAL) WITH EXTENT OF RESECTION, MORBIDITY AND SURVIVAL

Abstract

Background: Insula tumors are responsible for up to 25% of low-grade gliomas and 10% of high-grade gliomas. The insula has a complex anatomy, including an eloquent cortex and intimate contact with an arterial vascularization responsible supplying the motor and language systems. Using transsylvian and transcortical corridors for resect insular gliomas remains controversial, and the main concerns behind this are vascular injury during transsylvian dissection and functional impairment in transcortical access. Aim: Observe if there are differences in the extent of lesion resection, postoperative morbidity or survival between the two approaches. Method: 55 patients who underwent resection of insular gliomas by the senior author (GRI) were evaluated, and data related to sex, age at the time of surgical procedure, presence of refractory epilepsy, side of the lesion, pre- and postoperative tumor volumetry, Yasargil and Berger-Sanai classification, encasement of lenticulostriate arteries, neurological examination, and survival were collected. Results: Thirty-one patients (56.4%) underwent a transsylvian approach and 28 patients (43.6%) underwent a transcortical approach. The extent of resection (EOS)> 90% was 61.3% in the transsylvian group and 45.8% in the transcortical group (p = 0.385). The transsylvian approach was chosen for most of the Yasargil type 3 tumors. Late postoperative evaluations of the 2 groups were similar. Conclusions: The transsylvian and transcortical approaches do not present any significant difference in relation to the degree of resection (p = 0.385), survival (p = 0.204), or results in neurological deficits in the late postoperative period.