April 29, 2016
Here's another video discussing resection of a giant Nondominant Insular Glioma. This is a 32 year old male with intractable headaches, and my evaluation revealed a relatively heterogeneous mass within the area of the right insula extending into the temporal lobe. Therefore, this is an insular glioma with a significant temporal component. My operative strategy involves a temporal lobectomy removing the part of the tumor within the temporal lobe, and then also using the trans-insular approach for maximizing removal of the tumor. In this case, sleep mapping and subcortical stimulation was utilized since the patient was too anxious to undergo an awake craniotomy. The incision is illustrated, you can see the craniotomy Sylvian Fissure, no navigation was used to mark the boundaries of the tumor. Relatively large generous temporal lobectomy will be necessary in this case here's the final map of the tumor. He was using cortical stimulation to determine our threshold for subcortical mapping. Temporal lobectomy in this case was completed. The tumor was extruding through this Sylvian Fissure and therefore the extent of lobectomy is somewhat superior than in normal lobectomy technique. The Sylvian Fissure are carefully protected during the resection of the temporal lobe. Tumor is somewhat discolored compared to the normal brain and is immediately encountered during our quarter academy. After completion of the temporal lobectomy, I'll go ahead and find the medial edge of the tentorium, make sure the medial structures that are affected by the tumor are removed and then next through the different operative working channels between the M two branches to remove the tumor within the insula. Here's another MCA branch that has been carefully protected and the tumors discolored compared to the normal white matter, and is relatively easily recognizable. Additional tumor is removed, here's the operative cavity. Next I undermine the posterior temporal lobe resection and remove the tumor that is advancing more posteriorly along the axis of the temporal lobe, and I come back to the trans insular corridor and remove more tumor. The motor cortex can be in-term militantly stimulated to assure preservation of the descending motor fiber tracks, and here are the M two branches, working between them to remove the tumor, tumor has a heterogeneous appearance to it in this area as a moving toward the striatum, subcortical mapping will be used, micro-Doppler ultrasonography is also used to assure the patency of their vasculature in this area. Here is some of the normal appearing brain that shows that I'm reaching the medial aspect of the tumor. The lenticular straight arteries are carefully protected, and here's the discolored tumor. I continue to on the mind, a frontal operculum to further advance my resection corridor. One more time working between them MCA branches through the insula preparing soak gel foam is used as necessary to relieve the basal spasm of these vessels. Here's one of the funnel views of our operative corridor again the MCA vessels, all appear relatively healthy, preparing soak gel foam for relieving the vasospasm and the post operative MRI revealed really the cinnabar resection of the tumor small amount of potential tumor was left behind at the area of the internal capsule to minimize postoperative deficits, and this patient made an excellent recovery. Thank you.
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