The Research On Insular Glioma Growth

Objective:Anatomy of the insula is complex, middle cerebral artery and its branches prostrate in the insular surface. When insula affected glioma, middle cerebral artery and its branches shifted. It is difficult to removal of the tumor in the vascular space. Currently, there is a greater limitations for surgery mostly based on personal understanding of the spatial configuration with MRI images of the lesion. In order to display the track of the vessel vividly and help the operators adjust surgical approach and avoid to damage the important artery, all the insular glioma patients take MRI(magnetic resonance imaging) and CTA examinations before the operation routinely, then reconstruct into three-dimensional visualization. And it is also beneficial for the physicians with no sufficient experience to understand and learn the complicated anatomy of insular lobe and the operation process. Meanwhile, we will combine our research of insular glioma type with previous operation experience, and establish(modify) new insular glioma classification according to the growth direction of insular glioma so as to formulate standard surgical approach suitable for Chinese people individually.Methods:Retrospective analysis 127 insular glioma surgeries for eight years in Beijing Tiantan Hospital Ward 10. All patients underwent conventional MRI before and after surgery. The tumor location was categorized using the classification of Saito et al. Frontal-temporal incision was undertaken, using lateral fissure approach as the basic approach, adjusting surgical path accordance with the tumor involvement of the limiting sulcus. All surgeries were performed by the same neurosurgeon(XIE J).New clinical records and neuroradiological data of patients with insular gliomas(8 cases) received and operated in from June of 2015 to January 2016were collected and analyzed retrospectively. All the 8 insular gliomas patients take MRI(magnetic resonance imaging) and CTA examinations before the operation routinely, then reconstruct into three-dimensional visualization. According to the growth direction of insular glioma and the results of the image, modify the standard surgical approach.Results: The old series included 80 men and 47 women, mean age 41.1±11.2 years. The main symptoms leading to diagnosis were seizures. Preoperative MRI showed that, according to Saito’s classification system, C-type(30.7%)and B(26.8%) was the most common site with insula, followed by type B + C(20.5%),type A(15.7%), D-type(3.9%) and B + C + D-type(2.4%). According to the early postoperative MR image, complete resection in was seen in 51 cases(40.2%), nearly complete resection in 71 cases(55.9%), incomplete resection in 5 case(3.9%). After surgery 55 patients have different degrees of movement disorders, 33 patients returned to normal after two weeks; three months of follow-up review, partial recovery with mild impairment still in 14 cases(11.0%), severe limb movement disorder in 8 cases(6.3%). The most common pathological grade was gradeⅡ(65.4%).The new research series included 3 men and 5 women, ranging in age from 21-58(mean age 34.9 ± 12.9 years). The main symptoms leading to diagnosis were seizures(5patients).Preoperative MRI showed that, according to Saito’s classification system, 6 cases which the tumor progressing via the inferior limiting sulcus, at the same time encasing MCA and LSA. According to the early postoperative MR image, complete resection in was seen in 1cases, nearly complete resection in 7 cases After surgery 1 patient have movement disorders, 1 patient have mild aphasia.Conclusion: According insular glioma type, combined with insular gliomathree-dimensional visualization, analyze tumor growth direction, guide the surgeon to choose rational surgical approach to avoid serious complications.