title: Intraoperative Multi-Information-Guided Resection of Dominant-Sided Insular Gliomas in a 3-T Intraoperative Magnetic Resonance Imaging Integrated Neurosurgical Suite.
abstract: To evaluate the clinical application of 3-T intraoperative magnetic resonance imaging (iMRI), awake craniotomy, multimodal functional mapping, and intraoperative neurophysiologic monitoring (IONM) for resection of dominant-sided insular gliomas.
  
  
  
  From March 2011 to June 2013, 30 gliomas involving the dominant insular lobe were resected in the IMRIS 3.0-T iMRI integrated neurosurgical suite. For 20 patients, awake craniotomy with cortical electrical stimulation mapping was performed to locate the language areas. For 10 patients who were not suitable for awake surgery, general anesthesia and functional navigation were performed. Diffusion tensor imaging tractography-based navigation, continuous motor evoked potential monitoring, and subcortical electrical stimulation mapping were applied to localize and monitor the motor pathway in all cases. iMRI was used to assess the extent of resection. The results of intraoperative imaging, IONM, and the surgical consequences were analyzed.
  
  
  
  Intraoperative imaging revealed residual tumor in 26 cases and led to further resection in 9 cases. As a result, the median extent of resection was increased from 90% to 93% (P = 0.008) in all cases, and from 88% to 92% (P = 0.018) in low-grade gliomas. The use of iMRI also resulted in an increase in the percentage of gross and near total resection from 53% to 77% (P = 0.016). The rates of permanent language and motor deficits resulting from tumor removal were 11% and 7.1%, respectively.
  
  
  
  The combination of iMRI, awake craniotomy, multimodal brain mapping, and IONM tailored for each patient permits the maximal safe resection of dominant-sided insular glioma.
authors: Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China.
authors: Dong-Xiao
authors: DX
authors: Zhuang
authors: Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China. Electronic address: wjsongc@126.com.
authors: Jin-Song
authors: JS
authors: Wu
authors: Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China.
authors: Cheng-Jun
authors: CJ
authors: Yao
authors: Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China.
authors: Tian-Ming
authors: TM
authors: Qiu
authors: Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China.
authors: Jun-Feng
authors: JF
authors: Lu
authors: Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China.
authors: Feng-Ping
authors: FP
authors: Zhu
authors: Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China.
authors: Geng
authors: G
authors: Xu
authors: Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China.
authors: Wei
authors: W
authors: Zhu
authors: Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai Neurosurgical Center, Shanghai, P.R. China.
authors: Liang-Fu
authors: LF
authors: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D056324:Diffusion Tensor Imaging; D004558:Electric Stimulation / Q000379:methods; D019054:Evoked Potentials, Motor; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D005910:Glioma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D016896:Treatment Outcome; D014851:Wakefulness
keywords: Electric stimulation; Glioma; Insula; Intraoperative magnetic resonance imaging; Neuronavigation