Surgical Removal of Opercular Gliomas with attention to Preservation of Subcortical Function(<SPECIAL ISSUE>Complication Avoidance: Anatomical Practice as Operative Training (2))

Abstract

Surgical resection of opercular gliomas imposes a major challenge for neurosurgeons due to their close vicinity to functionaly important language and motor areas. Recent advances in intraoperative functional brain mapping and neuronavigation systems can help reduce neurological complications and maximize surgical resection of tumors located in the frontoparietal opercular region. The authors report their experience with opercular gliomas, with an emphasis on preservation of the subcortical function. Potential methods used to avoid damaging the subcortical motor pathway include widely splitting the sylvian fissure and identifying early the upper limiting sulcus of insula and the middle cerebral artery-M2 branches to define the inferior resection plane, removing the tumor by "en bloc" fashion through the preparation of the sulci, and dissecting the medial aspect of the tumor in a superior to inferior direction along the corticospinal fiber tract.