Surgical Resection of Insular Gliomas and the Role of Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging Tractography - Single Surgeon Experience.

Surgical Resection of Insular Gliomas and the Role of Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging Tractography - Single Surgeon Experience.

World Neurosurg. 2016 Nov 9;:

Authors: Panigrahi M, Chandrasekhar YB, Vooturi S, Ram GA, Rammohan VS

Abstract
OBJECTIVE: In gliomas located in proximity to eloquent areas, near total resection and subsequent radiotherapy is often preferred to avoid post-operative neurological complications. Pre-operative functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI)tractography provide new insights into surgeries of insular gliomas. The current study reports our experience of surgical management of insular gliomasand the role of functional magnetic resonance imaging (fMRI) and Diffuse Tensor Imaging (DTI) tractography in planning the resection.
METHODS: We retrospectively compared the clinical and outcome variables of 61 patients who underwent surgical resection of insular gliomas. The study population was divided into two groups based on the utilization of fMRI and DTI tractographyin planning the resection.
RESULTS: The average age of the study population was44.1 ± 12.6 years with 21 (34.4 %) of them women. Nearly two thirds 40 (65.6%) patients had WHO Grade II tumours and 16 (26.2%) had Grade IV tumours. The most common tumour was glioblastoma, observed in 16 (26.2%) patients. In 10 (16.4%) patients, fMRI and DTI tractography were utilized.The overall mortality in the study population was 15 (24.6%). None of the patients where fMRI and DTI were utilized for planning the surgery died (29.4% vs 0.0%; p=0.05) and all of them had normal functioning (70.5 % vs 100.0%; p=0.05) at three months follow up.
CONCLUSION: Surgical resection of insular gliomas remains a challenge to the neurosurgeon and demands good knowledge of the anatomical landmarks. Use fMRI and DTI tractography may help achieve good outcome.

PMID: 27838429 [PubMed - as supplied by publisher]

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