Artikel
Microsurgery of insular gliomas: surgical and functional outcomes
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Autoren
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Cristina Goga
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
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Martin Stienen
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
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Shahan Momjian
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
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Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Surgery for insular gliomas remains challenging due to intricate anatomy, including a complex network of white matter fibers and surrounding critical vascular structures. In this report the authors summarize their experience with microsurgical resection of insular gliomas.
Method: The authors analyzed preoperative data, surgical strategies, complications, and functional outcome in a series of 40 patients (mean age 53,6 years, range 17-86 years; 18 females) who underwent microsurgical resection of an insular glioma between February 2007 to November 2015. Microsurgical resection was performed under neurophysiological monitoring.
Results: Tumors were classified as low-grade gliomas (WHO Grade II) in 29% cases. A glioblastoma multiforme (WHO Grade IV, 55% of cases) and oligoastrocytoma (WHO Grade III, 16% of cases) were the most frequent histopathological results. A > 90% resection was achieved in 55%, a 70-90% resection in 19 % and < 70% in another 26% of cases. Among the patients with WHO Grade IV insular gliomas, 75% had a > 70% resection. There was 1 surgery related-death and an immediate postoperative worsening of Karnofsky Performance Scale was seen in 48% of cases. However, at 3 months, good functional outcomes (Karnofsky Performance Scale 80-100) were observed in 77% of cases. After surgery 93% of patients who had presented with epilepsy were seizure free or experienced isolated seizures. Detailed neuropsychological testing showed speech, memory and attention, executive deficits in 83% of patients with insular gliomas. After surgery, worsened neuropsychological deficits were recorded in 27% of patients while in 14% of cases there was an improvement in neuropsychological function.
Conclusions: Extensive resection of insular gliomas can often be accomplished and is acceptably safe even in patients with WHO Grade IV tumors with a good preoperative performance. Neuropsychological deficits are a common finding in patients with insular gliomas and detailed testing should be part of the standard pre-operative assessment. With detailed clinical and neuropsychological testing, postoperative deficits are often detected but most of these deficits are transitory.
