The Analysis Of Clinical Features And Treatment Of Insula Glioma: 10 Case Report

ObjectiveTo summarize the clinical manifestation and radiological features of insular glioma and to discuss how to improve the skill of microsurgery with the help of radiological data. MethodsThe clinical manifestation, radiological features and pathological characters of 10 cases of insula gliomas which were operated transpterion transsylvian approach in our hospital between May 2004 and November 2006 were retrospectively studied. ResultThe average age of patients was 39.4 year-old, and the average diameter of tumor was 5.0 centimeter. According to the classification of limbic and paralimbic tumors posited by Yasargil, two cases were restricted to insula or to part of it (type 3A); three cases include the lesion in insula and the corresponding opercula (type 3B); three cases include lesion in insula, the corresponding opercula, and one or both other paralimbic-Frontoobital, temporopolar area (type 5A); the rest cases include lesion in insula, the corresponding opercula, and parts of the limbic system (type 5B). Seizure occurred in seven cases of insula glioma. Most of the tumors in T1-weighted image were hypo-signal, in T2-weighted image were hyper-signal andwere no contrast enhancement with gadolinium infusion with sharp border and no edema. Eight cases were astrocytoma (Grade I—II WHO), one case was mixed glioma (Grade II WHO) and the rest case was anaplastic astrocytoma (Grade III WHO). All tumors were resected through microsurgery. Three cases were resected subtotally and the others were partially. All patients had no neurological deficit after surgery. ConclusionThe insular tumor mostly happened in young people. The chief complaint is seizure. Most insular gliomas are of low grade with big volume. Resecting tumor under microscope is the efficient treatment. With the help of knowledge of the microanatomy of insula, preoperative diffusion tensor imaging and intra-operative direct cerebral stimulation, neurosurgeon could resect tumor as possible as one can and keep the intact neurological function.