gms | German Medical Science

Objective: Intrinsic tumors of the insula are frequently excluded from surgical treatment. The authors propose a more extensive approach to these lesions based on the results of this series.

Methods: This series consists of a total of 61 patients (37 males, 24 females, mean age 45 years) harboring benign (34 patients) or malignant (27 patients) tumors involving the insula,all of whom underwent surgical treatment. The dominant hemisphere was affected in 34 patients, and the nondominant hemisphere in 27 cases. Two groups were defined on the basis of preoperative magnetic resonance (MR) imaging: 34 lesions were restricted to the insula and the corresponding opercula; the other 27 lesions involved other mesocortical and/or allocortical areas as well. Most patients displayed only mild preoperative symptoms. The median score according to the Karnofsky performance scale was 90.

Results: Microsurgical removal was achieved via a transsylvian approach in 27 cases and via a frontal and/or temporal approach in 34 cases. According to early postoperative MR imaging, complete tumor removal (100%) was achieved in 18 patients, nearly complete (>80%) in 35 and incomplete resection (50%-80%) in 8 patients. There was no operative mortality. 33 patients (54%) experienced immediate postoperative morbidity including reduced performance. After a mean follow-up review of 8.5 months, 7 of 57 patients (13%) all harboring Grade IV tumors had died of tumor recurrence and 5 of 50 patients suffered permanent deficits, accounting for an overall operative morbidity of 10%.

Conclusions: The authors conclude that low-grade intrinsic insular tumors, as well as Grade III tumors, can be removed with favorable results in the majority of patients. Surgical treatment of glioblastomas should only be considered for patients with good preoperative performance and young age.