Surgical anatomy of the peri-insular association tracts. Part I.The superior longitudinal fascicle system

Bykanov, Andrey; Pitskhelauri, D I; Баталов, А И; Pronin, Igor; Shkarubo, M A; Dobrovol'sky, G F; Kobyakov, G L; Буклина, С Б; Пучков, В. Л.; Захарова, Н. Е.; As, Smirnov; Sanikidze, Alexander; Gol'bin, D A; Pogosbekyan, E L; Kudieva, Elina; Shkatova, A M; Потапов, А А

doi:10.17116/neiro201780726-38

Cited by 8 publications

(2 citation statements)

References 37 publications

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“…6,10,27,28 The main advantage of transcortical approach is a larger operating window and space for manipulation, which was also confirmed by the results of anatomical investigation, in which these 2 approaches were compared. [29][30][31] This advantage is provided by resection of the functionally "nonsignificant" brain tissue under the control of electrophysiological methods. 8 However, in white matter of the fronto-parietal operculum, the associative fibers of the superior longitudinal fasciculus III are located, 30 Broca's area in the dominant hemisphere and the motor area of the facial muscles (temporary central facial paresis reaches up to 9.3% 8 after transcortical approach).…”

Section: Surgical Approaches To the Insular Lobe And Clinical Outcomementioning

confidence: 99%

“…[29][30][31] This advantage is provided by resection of the functionally "nonsignificant" brain tissue under the control of electrophysiological methods. 8 However, in white matter of the fronto-parietal operculum, the associative fibers of the superior longitudinal fasciculus III are located, 30 Broca's area in the dominant hemisphere and the motor area of the facial muscles (temporary central facial paresis reaches up to 9.3% 8 after transcortical approach).…”

Section: Surgical Approaches To the Insular Lobe And Clinical Outcomementioning

confidence: 99%

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Transsylvian Insular Glioma Surgery: New Classification System, Clinical Outcome in a Consecutive Series of 79 Cases

Pitskhelauri¹,

Bykanov²,

Konovalov³

et al. 2021

Operative Surg.

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BACKGROUND Surgery of insular glial tumors remains a challenge because of high incidence of postoperative neurological deterioration and the complex anatomy of the insular region. OBJECTIVE To explore the prognostic role of our and Berger-Sanai classifications on the extent of resection (EOR) and clinical outcome. METHODS From 2012 to 2017, a transsylvian removal of insular glial tumors was performed in 79 patients. The EOR was assessed depending on magnetic resonance imaging scans performed in the first 48 h after surgery. RESULTS The EOR ≥90% was achieved in 30 (38%) cases and <90% in 49 (62.0%) cases. In the early postoperative period, the new neurological deficit was observed in 31 (39.2%) patients, and in 5 patients (6.3%), it persisted up to 3 mo. We proposed a classification of insular gliomas based on its volumetric and anatomical characteristics. A statistically significant differences were found between proposed classes in tumor volume before and after surgery (P < .001), EOR (P = .02), rate of epileptic seizures before the surgical treatment (P = .04), and the incidence of persistent postoperative complications (P = .03). In the logistic regression model, tumor location in zone II (Berger-Sanai classification) was the predictor significantly related to less likely EOR of ≥90% and the maximum rate of residual tumor detection (P = .02). CONCLUSION The proposed classification of the insular gliomas was an independent predictor of the EOR and persistent postoperative neurological deficit. According to Berger-Sanai classification, zone II was a predictor of less EOR through the transsylvian approach.

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Section: Surgical Approaches To the Insular Lobe And Clinical Outcomementioning

confidence: 99%

Section: Surgical Approaches To the Insular Lobe And Clinical Outcomementioning

confidence: 99%

Transsylvian Insular Glioma Surgery: New Classification System, Clinical Outcome in a Consecutive Series of 79 Cases

Pitskhelauri¹,

Bykanov²,

Konovalov³

et al. 2021

Operative Surg.

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Anatomical and Technical Preparations of the Human Brain for White Matter Fibers Dissection with Electromagnetic Neuronavigation Assistance Technical Nuances for Application

et al. 2022

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Intraoperative mapping of long association fibers in surgery of gliomas of the speech-dominant frontal lobe

et al. 2018

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Surgery of intracerebral tumors involving long association fibers is a challenge. In this study, we analyze the results of intraoperative mapping of the superior longitudinal, arcuate, and frontal aslant tracts in surgery of brain gliomas. Purpose. The study purpose was to compare the results of intraoperative mapping and the postoperative speech function in patients with gliomas of the premotor area of the speech-dominant frontal lobe, which involved the superior longitudinal, arcuate, and frontal aslant tracts, who were operated on using awake craniotomy. Material and methods. Twelve patients with left frontal lobe gliomas were operated on: 11 patients were right-handed, and one patient was a left-hander retrained at an early age. Histological types of tumors were represented by Grade II diffuse astrocytomas (6 patients), Grade III anaplastic astrocytomas (1 patient), Grade IV glioblastoma (1 patient), Grade II oligodendroglioma (1 patient), and Grade III anaplastic oligodendrogliomas (3 patients). The mean age of patients was 45 (29-67) years; there were 6 males and 6 females. All patients underwent preoperative and postoperative MRI with reconstruction of the long association fibers and determination of the topographic anatomical relationships between the fibers and the tumor. Surgery was performed using the asleep-awake-asleep protocol with intraoperative awakening of patients. All patients underwent cortical and subcortical electrophysiological stimulation to control the localization of eloquent structures and to clarify the safe limits of resection. For intraoperative speech monitoring, a computerized naming test was used with naming of nouns or verbs, and automatic speech was evaluated (counting from 1 to 10, enumeration of months and days of the week), which was complemented by a talk with the patient. Speech disorders before, during, and after surgery were evaluated by a neuropsychologist. The mean current strength during direct electrical stimulation was 3 (1.9-6.5) mA. Results. The association fibers were intraoperatively identified in all patients (SLF/AF in 11 patients; FAT in one patient). In 4 patients, the cortical motor speech area was intraoperatively mapped; in three cases, tumor resection was accompanied by speech disturbances outside the stimulation. During direct electrical stimulation, speech disturbances developed in 7 of 12 cases. All patients underwent control MRI within the first 48-72 h: total resection (more than 90% of the tumor) was performed in 7 cases; subtotal resection was achieved in two patients; partial resection was performed in two cases. According to postoperative MR tractography, the resected tumor bed was adjacent to the SLF/AF complex in 7 cases, located near the SLF/AF complex in three cases, and adjacent to the FAT in two cases. Postoperatively, 11 out of 12 patients had worsening of neurological symptoms in the form of various speech disturbances. In one patient, speech disturbances developed 2 days after surgery, which was associated with an increase in edema. On e...

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Surgical anatomy of the peri-insular association tracts. Part I.The superior longitudinal fascicle system

Cited by 8 publications

References 37 publications

Transsylvian Insular Glioma Surgery: New Classification System, Clinical Outcome in a Consecutive Series of 79 Cases

Transsylvian Insular Glioma Surgery: New Classification System, Clinical Outcome in a Consecutive Series of 79 Cases

Anatomical and Technical Preparations of the Human Brain for White Matter Fibers Dissection with Electromagnetic Neuronavigation Assistance Technical Nuances for Application

Intraoperative mapping of long association fibers in surgery of gliomas of the speech-dominant frontal lobe

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