Awake Craniotomy | Dominant Insular Glioma (Trans-Sylvian &Transcortical) | Language & Motor Mapping скачать в хорошем качестве

Awake Craniotomy | Dominant Insular Glioma (Trans-Sylvian &Transcortical) | Language & Motor Mapping

🔬 Insular gliomas are covered by eloquent cortical and subcortical areas essential for language, and motor control. They are intimately related to major white matter tracts including the inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus, and uncinate fasciculus, as well as descending motor pathways and critical vascular structures such as branches of the middle cerebral artery and the lenticulostriate arteries. This complex environment demands surgical strategies that balance oncological goals with maximum functional preservation. In this case, we utilized: 🔹 Preoperative fMRI and tractography, integrated into neuronavigation 🔹 5-ALA fluorescence-guided surgery 🔹 Awake craniotomy with cortical and subcortical language and motor mapping 📌 Surgical approach: We initially employed a trans-sylvian route to access the tumor. Thanks to awake cortical mapping, we were able to safely create three transcortical windows to optimize tumor exposure and resection: – A pars orbitalis/pars triangularis window – A pars opercularis window – A temporal operculum window Anteroinferior resection boundaries were limited by stimulation-induced semantic paraphasia involving the IFOF, while posterior-superior depth was determined using asleep subcortical motor mapping to preserve descending motor tracts. ✅ Outcome: We achieved a gross total resection of the enhancing tumor. 🗣️ The patient developed an expected transient phonemic paraphasia, which fully resolved within two weeks.