May 12, 2015
Let's talk about another simple case of an insular GBM. This is a 65 year old male with a single episode of confusion. MRI evaluation revealed a relatively small heterogeneously enhancing mass within the right insula. There is amount of edema. This tumor eventually proved to be a high grade glioma. Patient underwent resection. Sylvian fissure was widely split. Neuronavigation was used so that the corticotomy can be performed over the area of the tumor. On the insular, MCA branches were carefully mobilized and protected. Pituitary rongeurs were used to evacuate the tumor. Tumor relatively fibrous. Bipolar forceps were also used to disintegrate the tumor. Here you can see relatively normal margins anteriorly, but there is some residual tumor posteriorly. This portion of the tumor was also removed. I carefully watch for lenticulostriate arteries. Ring curettes may be used within the operative blind spots, underneath the arteries, and the peel edges. Here, you can see one of the lenticulostriate arteries that was carefully protected. Following immaculate hemostasis. Closure was performed standard fashion for achieving hemostasis in this area, I avoid aggressive coagulation and use thrombin solution and gentle tamponade so that the force of the electrocautery and the thermal effect of the bipolar forceps would not injure the lenticulostriate arteries that are nearby. Here's the final result through the transsylvian route. And here's the postoperative MRI which demonstrated satisfactory resection of this tumor. Thank you.
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