Postcentral gyrus resection of opercular gliomas is a risk factor for motor deficits caused by damaging the radiologically invisible arteries supplying the descending motor pathway

Shibahara, Ichiyo; Sato, Sumito; Hide, Takuichiro; Saito, Ryuta; Kanamori, Masayuki; Sonoda, Yukihiko; Tominaga, Teiji; Kumabe, Toshihiro

doi:10.1007/s00701-021-04737-y

Cited by 7 publications

(15 citation statements)

References 45 publications

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“…In addition, parietal operculum and posterior insular resections trended toward an association with postoperative motor impairment and hemiparesis, respectively. In this regard, the vascularization pattern overlying the frontoparietal operculum and the posterior insula may explain motor deficits following surgery within the operculo‐insular region 33,98–100 . Penetrating vessels arising from posterior M2 and M3 MCA branches supply portions of the corticospinal tract 33,98–100 .…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, the vascularization pattern overlying the frontoparietal operculum and the posterior insula may explain motor deficits following surgery within the operculo‐insular region. 33 , 98 , 99 , 100 Penetrating vessels arising from posterior M2 and M3 MCA branches supply portions of the corticospinal tract. 33 , 98 , 99 , 100 More specifically, long insular arteries (LIA) arising from M2 branches over the posterior–superior insula 33 , 98 , 99 , 100 and the long medullary arteries (LMA) originating from M3 branches covering the frontal and parietal opercula supply the corona radiata.…”

Section: Discussionmentioning

confidence: 99%

“… 33 , 98 , 99 , 100 Penetrating vessels arising from posterior M2 and M3 MCA branches supply portions of the corticospinal tract. 33 , 98 , 99 , 100 More specifically, long insular arteries (LIA) arising from M2 branches over the posterior–superior insula 33 , 98 , 99 , 100 and the long medullary arteries (LMA) originating from M3 branches covering the frontal and parietal opercula supply the corona radiata. 33 , 98 , 99 , 100 These branches (LIA, LMA) do not harbor anastomoses, and their sacrifice during insular or opercular resection can result in subcortical ischemia.…”

Section: Discussionmentioning

confidence: 99%

“… 33 , 98 , 99 , 100 More specifically, long insular arteries (LIA) arising from M2 branches over the posterior–superior insula 33 , 98 , 99 , 100 and the long medullary arteries (LMA) originating from M3 branches covering the frontal and parietal opercula supply the corona radiata. 33 , 98 , 99 , 100 These branches (LIA, LMA) do not harbor anastomoses, and their sacrifice during insular or opercular resection can result in subcortical ischemia. 101 Moreover, injury to LIAs arising from M2 branches overlying the posterior insula specifically has been identified as a risk factor for corona radiata strokes and postoperative motor deficits in epilepsy 37 , 38 and glioma surgery.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

et al. 2022

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Insular epilepsy (IE) is an increasingly recognized cause of drug-resistant epilepsy amenable to surgery. However, concerns of suboptimal seizure control and permanent neurological morbidity hamper widespread adoption of surgery for IE.We performed a systematic review and individual participant data meta-analysis to determine the efficacy and safety profile of surgery for IE and identify predictors of outcomes. Of 2483 unique citations, 24 retrospective studies reporting on 312 participants were eligible for inclusion. The median follow-up duration was 2.58 years (range, 0-17 years), and 206 (66.7%) patients were seizure-free at last follow-up. Younger age at surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

et al. 2022

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“…However, the detailed anatomy of arteries in the vicinity of the SLS remains unclear. [20][21][22][23][24][25] Taken together, elucidating the detailed anatomy of the LIAs and LMAs around the SLS may lead to a reduction in the risks of ischemic motor complications.…”

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confidence: 99%

Arteries Around the Superior Limiting Sulcus: Motor Complication Avoidance in Insular and Insulo-Opercular Surgery

Ikegaya,

Hayashi,

Higashijima

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Insulo-opercular surgery can cause ischemic motor complications. A source of this is the arteries around the superior limiting sulcus (SLS), which reach the corona radiata, but the detailed anatomy remains unclear. To characterize arteries around the SLS including the long insular arteries (LIAs) and long medullary arteries, we classified them and examined their distribution in relation to the SLS, which helps reduce the risk of ischemia. METHODS: Twenty adult cadaveric hemispheres were studied. Coronal brain slices were created perpendicular to the SLS representing insular gyri (anterior short, middle short, posterior short, anterior long, and posterior long). The arteries within 10-mm proximity of the SLS that reached the corona radiata were excavated and classified by the entry point. RESULTS: A total of 122 arteries were identified. Sixty-three (52%), 20 (16%), and 39 (32%) arteries penetrated the insula (LIAs), peak of the SLS, and operculum (long medullary arteries), respectively. 100 and six (87%) arteries penetrated within 5 mm of the peak of the SLS. The arteries were distributed in the anterior short gyrus (19%), middle short gyrus (17%), posterior short gyrus (20%), anterior long gyrus (19%), and posterior long gyrus (25%). Seven arteries (5.7%) had anastomoses after they penetrated the parenchyma. CONCLUSION: Approximately 90% of the arteries that entered the parenchyma and reached the corona radiata were within a 5-mm radius of the SLS in both the insula and operculum side. This suggests that using the SLS as a landmark during insulo-opercular surgery can decrease the chance of ischemia.

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Visualization of the lenticulostriate arteries, long insular arteries, and long medullary arteries on intra-arterial computed tomography angiography with ultrahigh resolution in patients with glioma

Osada,

Kanamori,

Osawa

et al. 2023

Acta Neurochir

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Purpose The anatomical association between the lesion and the perforating arteries supplying the pyramidal tract in insulo-opercular glioma resection should be evaluated. This study reported a novel method combining the intra-arterial administration of contrast medium and ultrahigh-resolution computed tomography angiography (UHR-IA-CTA) for visualizing the lenticulostriate arteries (LSAs), long insular arteries (LIAs), and long medullary arteries (LMAs) that supply the pyramidal tract in two patients with insulo-opercular glioma. Methods This method was performed by introducing a catheter to the cervical segment of the internal carotid artery. The infusion rate was set at 3 mL/s for 3 s, and the delay time from injection to scanning was determined based on the time-to-peak on angiography. On 2- and 20-mm-thick UHR-IA-CTA slab images and fusion with magnetic resonance images, the anatomical associations between the perforating arteries and the tumor and pyramidal tract were evaluated. Results This novel method clearly showed the relationship between the perforators that supply the pyramidal tract and tumor. It showed that LIAs and LMAs were far from the lesion but that the proximal LSAs were involved in both cases. Based on these results, subtotal resection was achieved without complications caused by injury of perforators. Conclusion UHR-IA-CTA can be used to visualize the LSAs, LIAs, and LMAs clearly and provide useful preoperative information for insulo-opercular glioma resection.

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Postcentral gyrus resection of opercular gliomas is a risk factor for motor deficits caused by damaging the radiologically invisible arteries supplying the descending motor pathway

Cited by 7 publications

References 45 publications

Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

Arteries Around the Superior Limiting Sulcus: Motor Complication Avoidance in Insular and Insulo-Opercular Surgery

Visualization of the lenticulostriate arteries, long insular arteries, and long medullary arteries on intra-arterial computed tomography angiography with ultrahigh resolution in patients with glioma

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