title: Image-guided transsylvian, transinsular approach for insular cavernous angiomas.
abstract: OBJECTIVE
  Surgical treatment of cavernomas arising in the insula is especially challenging because of the proximity to the internal capsule and lenticulostriate arteries. We present our technique of image guidance for operations on insular cavernomas and assess its clinical usefulness.
  
  
  METHODS
  Between 1997 and 2003, with the guidance of a frameless stereotactic system (BrainLab AG, Munich, Germany), we operated on eight patients who harbored an insular cavernoma. Neuronavigation was used for 1) accurate planning of the craniotomy, 2) identification of the distal sylvian fissure, and, finally, 3) finding the exact site for insular corticotomy. Postoperative clinical and neuroradiological evaluations were performed in each patient.
  
  
  RESULTS
  The navigation system worked properly in all eight neurosurgical patients. Exact planning of the approach and determination of the ideal trajectory of dissection toward the cavernoma was possible in every patient. All cavernomas were readily identified and completely removed by use of microsurgical techniques. No surgical complications occurred, and the postoperative course was uneventful in all patients.
  
  
  CONCLUSIONS
  Image guidance during surgery for insular cavernomas provides high accuracy for lesion targeting and permits excellent anatomic orientation. Accordingly, safe exposure can be obtained because of a tailored dissection of the sylvian fissure and minimal insular corticotomy.
authors.affiliation: Department of Neurosurgery, Philipps University, Marburg, Germany. sure@med.uni-marburg.de
authors.forename: Wuttipong
authors.initials: W
authors.lastname: Tirakotai
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.forename: Ludwig
authors.initials: L
authors.lastname: Benes
authors.forename: Boris
authors.initials: B
authors.lastname: Krischek
authors.forename: Siegfried
authors.initials: S
authors.lastname: Bien
authors.forename: Helmut
authors.initials: H
authors.lastname: Bertalanffy