GBM of the Posterior Insula
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Let's review methodologies for resection of a posterior dominant insular GBM. This is a 45 year-old female who suffered from subtle right-sided hemiparesis. MRI evaluation revealed, a relatively heterogeneous ring enhancing mass with a dominant nodule facing the posterior aspect of the dominant insula. There was minimal edema associated with this lesion. The patient underwent resection of this mass. The procedure was conducted under general anesthesia. The Sylvian Fissure was dissected using standard techniques and using the inside to outside method. Superior or economic bands. are widely dissected. Here's the surface of the insula that appears expanded. You can see the inferior and superior pre insular cell site were exposed. Here is DMC bifurcation. The posterior aspect of the Sylvian Fissure was further dissected and the posterior insula was entered. Small corticotomy was completed. I did not feel any transcortical corridors through the posterior inferior funnel or superior temporal gyri were necessary for removal of the tumor. And therefore an awake craniotomy was not deemed necessary. Resection was completed using standard techniques. Thrombin solution was used to achieve hemostasis. Here's a final view of the resection cavity. And post-operative MRI revealed grow store removal of the mess without any complicating features. You can see again, the operative trajectory through the posterior insula, the transsylvian-transinsular approach using the anterior to posterior operative trajectory. Again, the microscope has to be angled very far anteriorly to the far posteriorly, to be able to reach the posterior pole of the tumor without necessarily requiring a transcortical corridor within the lateral temporal lobe. Thank you.
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