Surgery for insular low-grade glioma: predictors of postoperative seizure outcome Clinical article

For a long time, the insula has fascinated anatomists, physiologists, and surgeons because of its complex role and technically challenging access.3,13,35,38,50,53–55,67 Following the publication of Yaşargil et al., thanks to technical developments and a better understanding of insular functional anatomy, some experiences of insular surgery have recently been reported.13,20,33,50,53,55,64,67,69 However, to date, there are few data in the literature concerning the epileptological outcome of surgery in patients with insular low-grade gliomas (LGGs).10,13,17,19,29,45,62,67 Drug-resistant tumor-related epilepsy is observed in approximately 15% of patients with insular LGG, producing a significant impact on patients’ quality of life and possibly causing cognitive impairment.13,24,30 Moreover, seizure control has been reported to be achieved in a percentage ranging between 76% and 90% of cases after insular glioma surgery with perilesional cortical resection.13,25,45,54,69 The role of the insula in epilepsy has been a matter of debate for several decades because of its multiple connections with the amygdala, the hippocampus, the olfactory cortex, the entorhinal cortex, and the cingulate gyrus.35 Recent data appear to confirm the involvement of the insular Surgery for insular low-grade glioma: predictors of postoperative seizure outcome