Dominant Insular GBM
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Removal of Lateral Insular GBMs in the dominant hemisphere can be quite challenging. Let's go ahead and review the operative events for maximizing the safety of the operation. This is a 47 year-old male who presented with mild speech difficulty. MRI evaluation revealed high-grade glioma in the lateral aspect of insular infiltrating the Inferior Frontal Gyrus, as well as part of the temporal lobe. Obviously, the location of the MCA branches is quite critical for aggressive resection of this tumor and awake craniotomy was undertaken. So, appropriate cortical corridors can be selected for accessing the tumor. Here's a Left Frontal Temporal Craniotomy, Sylvian Fissure. Part of the fissure as you can see affected by the tumor. Here's the Broca's area, they're noted by S tags and also the face area. Despite maximum super stimulation in this area, knowingness of speech or language was detected and therefore Wernicke's area was excluded from this portion of the superior temporal gyrus. I entered the part of the superior temporal gyrus infiltrated by the tumor and use this as an operative trajectory to enter the tumor and work between the MCA branches. Obviously the location of the Broca's area within the inferior posterior frontal gyrus prohibited the use of a posterior frontal Craniotomy to reach the tumor. So I continued to remove the discolored tumor as aggressively as possible. Here, you can see the discolored tumor. I undermined the inferior frontal gyrus to remove the tumor. Tumor is quite discolored. working between the MC branches, Obviously, Some tumor was left behind over the surface of the insula or the M2 branches traveled on. Part of the superior temporal gyrus affected by the tumor was resected. Preparing soaked gel foam pledges were used to bathe the vessels intermittently and relieve their vasospasm. Obviously, most to remove this mass is not possible due to its location. Patient's speech and language was continuously monitored during the resection. Here's the frontal view. The undermining necessary to remove the edges of the tumor marked by the lack suture. Postoperative MRI revealed the reasonal resection of the mass. This is a three months MRI, T2 scan appeared relatively clean, and the pattern of enhancement at this location was suspected to be consistent with scarring rather than recurrence of tumor. Obviously, some of it nodular enhancement more immediately is consistent with residual tumor. This patient did suffer from speech difficulty after surgery, which was relatively mild to moderate. However, these deficits resolved within a month after surgery. Thank you.
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