CASE REPORT

Insular Gliomas Involving the 4 Regions of Berger-Sanai: 2 case reports and technical discussion

Gliomas Insulares Envolvendo as 4 Regiões de Berger-Sanai: 2 relatos de casos e discussão técnica

  • Breno Nery 1    Breno Nery 1
  • Cláudio Brandão dos Santos Filho 2    Cláudio Brandão dos Santos Filho 2
  • Raívson Diogo Felix Fernandes 2    Raívson Diogo Felix Fernandes 2
  • Rafael de Almeida Rabello 2    Rafael de Almeida Rabello 2
  • Arsenor Antônio Pinheiro Filho 2    Arsenor Antônio Pinheiro Filho 2
  • Victoria Rodrigues Durand 2    Victoria Rodrigues Durand 2
  • Ana Carolina Brandão Paganini 2    Ana Carolina Brandão Paganini 2
  • Anna Carolyne Mendes de Oliveira 2    Anna Carolyne Mendes de Oliveira 2
  • Isabel de Souza Rodrigues Deocleciano 2    Isabel de Souza Rodrigues Deocleciano 2
  • Eduardo Quaggio 1    Eduardo Quaggio 1
  • José Alencar de Sousa Segundo 1    José Alencar de Sousa Segundo 1
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Resumo

O córtex insular, às vezes chamado de “lobo oculto” do cérebro, é uma área crítica, porém desafiadora na neurocirurgia, especialmente no que diz respeito à remoção de gliomas. Esta revisão explora detalhadamente sua complexa anatomia, incluindo a vascularização sanguínea e os tratos de substância branca que atravessam essa região. A partir de dois relatos de casos, destacamos as características diagnósticas e as nuances cirúrgicas dos gliomas insulares. O primeiro caso envolve um paciente de 65 anos com glioma de alto grau, em tratamento hospitalar, e o segundo, um paciente ambulatorial de 34 anos com tumor de grau mais baixo. Em ambos os casos, esses exemplos ilustram a importância de cirurgias tecnicamente complexas, como a craniotomia com paciente acordado e o mapeamento em tempo real, para alcançar a máxima ressecção enquanto se preservam áreas eloqüentes do cérebro. O sistema de classificação Berger-Sanai, relevante para a identificação da localização do tumor e abordagem cirúrgica, também é mencionado. Nossos achados sugerem que, com um planejamento meticuloso e o uso de tecnologias inovadoras, é possível obter melhorias consideráveis na sobrevida e nos desfechos funcionais da população tratada com malignidades insulares, especialmente gliomas insulares. Este artigo destaca o potencial da neurocirurgia moderna para melhorar amplamente os resultados em pacientes afetados por esses tumores desafiadores.

Palavras-chave

Córtex insular; Neoplasias cerebrais; Glioma; Neurocirurgia; Neuroanatomia

Abstract

The insular cortex, sometimes called the “hidden lobe” of the brain, is a critical yet challenging area in neurosurgery, especially when it comes to removing gliomas. This paper of the following review explores in detail its complex anatomy, including blood vasculature and white matter tracts passing through this region. From two case reports, we highlight the diagnostic features and surgical nuances of insular gliomas. The initial case was in a theater-bound 65-year-old patient with high-grade glioma and the following in a 34-year-old out-patient with lower-grade tumor. In either case, these examples illustrate the key utility of technically complicated surgeries such as awake craniotomy and real-time mapping to achieve maximal resection while sparing eloquent brain areas. The Berger-Sanai classification system relevant to identifying tumor location and surgical approach is also mentioned. Our findings suggest that with meticulous planning and the use of innovative technologies, we can lead to considerable improvements of survival and functional outcomes for the population being treated at insular malignancies, especially insular gliomas. This paper highlights the potential of modern neurosurgery to vastly improve outcomes in patients with those affected by these challenging tumors.

Keywords

Insular cortex; Brain neoplasms; Glioma; Neurosurgery; Neuroanatomy

References

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1Neurosurgery Department, Hospital Beneficência Portuguesa de Ribeirão Preto, Ribeirão Preto, SP, Brazil.

2Centro Universitário Unifacisa, Medicine Departament, Campina Grande, PB, Brazil.

 

Received Aug 8, 2024

Accepted Sept 5, 2024

JBNC  Brazilian Journal of Neurosurgery

JBNC
  •   ISSN (print version): 0103-5118
  •   e-ISSN (online version): 2446-6786
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