gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Microsurgery of insular gliomas: surgical and functional outcomes

Meeting Abstract

  • Cristina Goga - Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
  • Martin Stienen - Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
  • Shahan Momjian - Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
  • Karl Schaller - Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.01.03

doi: 10.3205/16dgnc084, urn:nbn:de:0183-16dgnc0840

Published: June 8, 2016

© 2016 Goga et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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.