title: Neuronavigated Fiber Dissection with Pial Preservation: Laboratory Model to Simulate Opercular Approaches to Insular Tumors.
abstract: BACKGROUND
  Advances in the oncologic and functional results of insular surgery have been reported recently. Such successes have been made possible by the advent of the transopercular approach under awake monitoring and by improved anatomic and functional knowledge of white matter pathways surrounding the insula. Nonetheless, given the rarity of insular tumors, it is difficult to get familiar with the complex 3-dimensional anatomy of the different neuronal and vascular structures encountered during a transopercular insular resection. We thus propose to develop a laboratory model allowing to train transopercular approaches of the insula.
  
  
  METHODS
  Two hemispheres prepared with Klinger's technique were dissected under light microscope, preserving all pial membranes. The different steps of the dissection were video recorded.
  
  
  RESULTS
  Preservation of pial membranes enabled us to simulate subpial resection, both during operculum removal and during insular cortex resection. The medial wall of the resection was defined by the inferior-fronto-occipital fasciculus, protecting from the lenticulostriate arteries.
  
  
  CONCLUSIONS
  In this paper, we show that Klinger dissection with preservation of pial membranes provides a realistic model of insular surgery, allowing surgeons to learn and train on this highly specialized surgery.
authors.affiliation: Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; University Paris 7, Paris, France; IMNC UMR8165, Orsay, France. Electronic address: mandonnet@mac.com.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mandonnet
authors.affiliation: Department of Neurological Surgery, Hospital Universitario Marques de Valdecilla and Fundacion Instituto de Investigacion Marques de Valdecilla (IDIVAL), Trento APSS, Italy.
authors.forename: Juan
authors.initials: J
authors.lastname: Martino
authors.affiliation: Department of Neurosciences, Division of Neurosurgery, Structural and Functional Connectivity Lab Project, 'S. Chiara' Hospital, Trento APSS, Italy; Structural and Functional Connectivity Lab Project, Division of Neurosurgery, 'S. Chiara' Hospital, Trento APSS, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Sarubbo
authors.affiliation: Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; Department of Neurosurgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Corrivetti
authors.affiliation: Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France.
authors.forename: Schahrazed
authors.initials: S
authors.lastname: Bouazza
authors.affiliation: Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bresson
authors.affiliation: Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier Medical University Center, Montpellier, France; Institute of Neuroscience of Montpellier, INSERM U1051, Montpellier, France.
authors.forename: Hugues
authors.initials: H
authors.lastname: Duffau
authors.affiliation: Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; University Paris 7, Paris, France; Laboratory of Experimental Neurosurgery, Paris, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Froelich
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D006801:Humans; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods; D010841:Pia Mater / Q000473:pathology / Q000601:surgery*
keywords: Anatomy; Fiber dissection; Insula; Neuronavigation; Subpial dissection; Surgery