SURGICAL-TREATMENT INSULAR GLIOMAS

Surgical treatment of glial tumours arising in the Insula is specially challenging due to the proximity of the internal capsule. Although sm all insular gliomas have been removed safely by a transylvian approach , in large dominant insular tumours only biopsy has been recommended t o avoid postoperative deficits. Unfortunately that is a suboptimal for m of treatment as low grade supratentorial gliomas should be removed r adically to prevent tumour progression, malignization and to increase the recurrence-free-interval. Addition of radiotherapy to partial remo val is associated with a much higher incidence of recurrences and earl y malignizations compared to radical removal and no radiotherapy. Betw een Ist October 1989 and Ist September 1996 we treated twenty-three pa tients harbouring insular gliomas. To increase the radicality of the r esection the surgical procedure was performed under local anaesthesia whenever possible, as general anaesthesia usually leads to more conser vative resections, In 20/23 (86.9%) patients complete resection was ac complished, and subtotal in three (13.1%). The removed tumours were: t wo oligodendrogliomas, five grade I astrocytomas, nine grade II, four grade III and three grade IV. Postoperative neurological deficits occu rred in five patients. Four suffered a hemiparesis (that recovered in an average of 6 months) and one a motor dysphasia which took a week to recover. Two of the seventeen patients operated on for low grade insu lar gliomas underwent malignant change. We conclude that complete surg ical removal of insular gliomas should be considered and at least atte mpted in all cases.