title: Clinical considerations and surgical approaches for low-grade gliomas in deep hemispheric locations: insular lesions.
abstract: Insula and paralimbic region represent a common location for gliomas in adulthood. However, limbic and paralimbic tumors are rare in children. Reports of pediatric insular tumors are scarce in literature, and most of them are included in adult's series, so their management and outcome can be outlined only after extracting data from these reports. Due to their predominantly low grade, they usually have a benign course for some time, what make them ideal candidates for total resection. However, their intricate location and spread to key areas, including the temporal lobe, make them a surgical challenge. The transsylvian route, with or without resection of the frontal and/or temporal operculae, which requires exposure of part or all of the insula is commonly selected for insular tumor approaches. Intraoperative functional mapping is a standard procedure for resection of central region tumors in adults. In children and young individuals, awake craniotomy is not always possible and surgical planning usually relay on functional and anatomical preoperative studies. The main goal when approaching an insular tumor is to achieve the largest extent of resection to increase overall patient survival while preserving the functional status, minimizing postoperative morbidity and increasing the quality of life. The extent of resection seems to be correlated also with the control of associated (and usually intractable) epilepsy.
authors.affiliation: Servicio de Neurocirugía Pediátrica, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041, Madrid, Spain. jose.hinojosa@salud.madrid.org.|Servicio de Neurocirugía, Hospital Universitario Quirón, C/Diego Velázquez 1, 28223, Pozuelo de Alarcón Madrid, Spain. jose.hinojosa@salud.madrid.org.
authors.forename: J
authors.initials: J
authors.lastname: Hinojosa
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Quirón, C/Diego Velázquez 1, 28223, Pozuelo de Alarcón Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Gil-Robles
authors.affiliation: Servicio de Neurocirugía Pediátrica, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Pascual
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D007839:Functional Laterality / Q000502:physiology*; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods*
keywords: Astrocytoma; Epilepsy; Insula; Low grade glioma