title: Surgical Resection of Insular Gliomas and Roles of Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging Tractography-Single Surgeon Experience.
abstract: OBJECTIVE
  In gliomas located in proximity to eloquent areas, near total resection and subsequent radiotherapy is often preferred to avoid postoperative neurologic complications. Preoperative functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) tractography provide new insights into surgeries of insular gliomas. In this study we report our experience of surgical management of insular gliomas and the role of fMRI and DTI tractography in planning the resection.
  
  
  METHODS
  We retrospectively compared the clinical and outcome variables of 61 patients who underwent surgical resection of insular gliomas. The study population was divided into 2 groups according to the use of fMRI and DTI tractography in planning the resection.
  
  
  RESULTS
  The average age of the study population was 44.1 ± 12.6 years with 21 (34.4%) of the patients women. Nearly two thirds of them (40, or 65.6%) had World Health Organization grade II tumors, and 16 patients (26.2%) had grade IV tumors. The most common tumor was glioblastoma, observed in 16 patients (26.2%). In 10 (16.4%) patients, fMRI and DTI tractography were used. The overall mortality in the study population was 15 (24.6%). None of the patients where fMRI and DTI were used for planning the surgery died (29.4% vs. 0.0%; P = 0.05), and all of them had normal functioning (70.5% vs. 100.0%; P = 0.05) at 3 months' follow-up.
  
  
  CONCLUSIONS
  Surgical resection of insular gliomas remains a challenge to the neurosurgeon and demands good knowledge of anatomic landmarks. Use of fMRI and DTI tractography may help achieve a good outcome.
authors.affiliation: Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India. Electronic address: manaspanigrahi@live.com.
authors.forename: Manas
authors.initials: M
authors.lastname: Panigrahi
authors.affiliation: Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
authors.forename: Y B V K
authors.initials: YB
authors.lastname: Chandrasekhar
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
authors.forename: Sudhindra
authors.initials: S
authors.lastname: Vooturi
authors.affiliation: Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
authors.forename: G Ananta
authors.initials: GA
authors.lastname: Ram
authors.affiliation: Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
authors.forename: V S V
authors.initials: VS
authors.lastname: Rammohan
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002540:Cerebral Cortex; D056324:Diffusion Tensor Imaging; D005260:Female; D005909:Glioblastoma / Q000473:pathology / Q000601:surgery; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: DTI tractography; Functional MRI; Insular gliomas; Outcome; Surgical resection