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Preservation of the Lenticulostriate Arteries During Insular Glioma Resection

Insular gliomas represent 25% and 10% of low- and high-grade gliomas, respectively. Their resection proves challenging due to the intimate involvement of eloquent parenchyma and the lenticulostriate arteries (LSAs), limiting facility of achieving maximal safe resection. The majority of postoperative...

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Autor principal: Ghali, Michael George Zaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057893/
https://www.ncbi.nlm.nih.gov/pubmed/32181167
http://dx.doi.org/10.4103/ajns.AJNS_146_18
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author Ghali, Michael George Zaki
author_facet Ghali, Michael George Zaki
author_sort Ghali, Michael George Zaki
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description Insular gliomas represent 25% and 10% of low- and high-grade gliomas, respectively. Their resection proves challenging due to the intimate involvement of eloquent parenchyma and the lenticulostriate arteries (LSAs), limiting facility of achieving maximal safe resection. The majority of postoperative deficits following insular glioma resection is attributed to compromise of the LSAs. It is contemporaneously critical and challenging to preserve these vessels, given they are numerous and small, with an intraparenchymal course hidden from direct visualization during the operative intervention. A lesser degree of medially directed displacement of the LSAs predicts tumoral encasement of these vessels, which portends a decreased likelihood for achieving a gross total resection and increased probability of postoperative morbidity. Preservation of these vessels thus requires knowledge of their location during the entirety of the insular glioma resection and is facilitated by pre- and intra-operative imaging. Intraoperative real-time tracking, however, may prove rather challenging, especially with transcortical access. Conventional catheter digital subtraction angiography, computed tomographic angiography, magnetic resonance imaging and angiography, and three-dimensional ultrasound powered Doppler have proven effective modalities in assessing lenticulostriate position, and their use facilitates a greater extent of resection while minimizing the attendant morbidity consequent to LSA injury.
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spelling pubmed-70578932020-03-16 Preservation of the Lenticulostriate Arteries During Insular Glioma Resection Ghali, Michael George Zaki Asian J Neurosurg Review Article Insular gliomas represent 25% and 10% of low- and high-grade gliomas, respectively. Their resection proves challenging due to the intimate involvement of eloquent parenchyma and the lenticulostriate arteries (LSAs), limiting facility of achieving maximal safe resection. The majority of postoperative deficits following insular glioma resection is attributed to compromise of the LSAs. It is contemporaneously critical and challenging to preserve these vessels, given they are numerous and small, with an intraparenchymal course hidden from direct visualization during the operative intervention. A lesser degree of medially directed displacement of the LSAs predicts tumoral encasement of these vessels, which portends a decreased likelihood for achieving a gross total resection and increased probability of postoperative morbidity. Preservation of these vessels thus requires knowledge of their location during the entirety of the insular glioma resection and is facilitated by pre- and intra-operative imaging. Intraoperative real-time tracking, however, may prove rather challenging, especially with transcortical access. Conventional catheter digital subtraction angiography, computed tomographic angiography, magnetic resonance imaging and angiography, and three-dimensional ultrasound powered Doppler have proven effective modalities in assessing lenticulostriate position, and their use facilitates a greater extent of resection while minimizing the attendant morbidity consequent to LSA injury. Wolters Kluwer - Medknow 2020-02-25 /pmc/articles/PMC7057893/ /pubmed/32181167 http://dx.doi.org/10.4103/ajns.AJNS_146_18 Text en Copyright: © 2020 Asian Journal of Neurosurgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Review Article
Ghali, Michael George Zaki
Preservation of the Lenticulostriate Arteries During Insular Glioma Resection
title Preservation of the Lenticulostriate Arteries During Insular Glioma Resection
title_full Preservation of the Lenticulostriate Arteries During Insular Glioma Resection
title_fullStr Preservation of the Lenticulostriate Arteries During Insular Glioma Resection
title_full_unstemmed Preservation of the Lenticulostriate Arteries During Insular Glioma Resection
title_short Preservation of the Lenticulostriate Arteries During Insular Glioma Resection
title_sort preservation of the lenticulostriate arteries during insular glioma resection
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057893/
https://www.ncbi.nlm.nih.gov/pubmed/32181167
http://dx.doi.org/10.4103/ajns.AJNS_146_18
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