Insular GBM Encasing the MCA

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Let's review the operative events for resection of an insular GBM encasing the middle cerebral artery. This is a 45-year-old female who suffered from a single seizure. MRI evaluation revealed, a relatively heterogeneously enhancing mass centered over the right insula, encasing one of the branches of the middle cerebral artery. There is significant edema associated with this mass. A CT angiogram demonstrated dilation of proximal branches of one of the M2 trunks. Obviously, encasement of the entire distal MCA by the tumor. Patient underwent a right frontotemporal craniotomy. The STA was harvested just in case it was emergently necessary for revascularization of one of the trunks. I planned subtotal tumor removal with per reservation of all the MCA branches. It's Temporal lobe Sylvian fissure. The Sylvian fissure was widely dissected. Motor evoked potentials are monitored using direct cortical microstimulation. Here's the tumor exposed through the transsylvian approach. The MCA branches were carefully dissected and isolated from the tumor per pavin soak gel foam pledges were used to pave the vessels and relieve their vasospasm because the MCA branch was engulfed in the tumor. I investigated the center of the tumor and you can see this dilatation at the level of this M2 trunk, and the bleeding was controlled with gentle tamponade and a piece of cotton. I removed the tumor piecemeal, I expecting that a piece of tumor will be left behind at the periphery of the M2 trunk. Here you can see the majority of the tumor has been removed small piece of the tumor in casing the dilated of the M2 trunk was left behind postoperative MRI revealed reasonable resection of the mass the edema has resolved. And the patient did very well after surgery. Thank you.

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