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2013
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| Online Access: | https://doi.org/10.5281/zenodo.18722413 |
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| author | González-López, Pablo Ture, Ugur |
| author_facet | González-López, Pablo Ture, Ugur |
| contents | <p>In this chapter, included in the book <em>Controversies in Neurosurgery II</em> (Thieme Medical Publishers, 2013), we systematically address one of the classic dilemmas in oncological neurosurgery: the resection of gliomas located in eloquent brain areas, with particular emphasis on the insula and perisylvian regions. The text combines conceptual discussion, detailed anatomical foundations, and step-by-step surgical strategy, integrating microsurgical neuroanatomy, diffusion tensor imaging (DTI) tractography, three-dimensional reconstructions, and advanced preoperative planning.</p> <p>The chapter analyzes the anatomical foundations of the insular region—the lateral sulcus, frontal, parietal, and temporal opercula, internal capsule, and M2 branches of the middle cerebral artery—highlighting the vascular and functional complexity that determines surgical risk. The anatomical boundaries of so-called “eloquent tumors” are reviewed, and the balance between maximal safe resection and functional preservation is discussed, incorporating available evidence regarding survival, tumor control, and neurological morbidity. Special attention is given to the role of DTI tractography in identifying critical white matter tracts and to the importance of three-dimensional anatomical reconstruction in understanding the relationship between the tumor, vascular structures, and deep brain anatomy.</p> <p>From a technical standpoint, the chapter provides a detailed description of the transsylvian approach, progressive opening of the Sylvian fissure, identification of cortical and perforating branches, tumor devascularization strategy, and subpial resection aimed at preserving the internal capsule and adjacent eloquent structures. The need for individualized planning, precise microanatomical knowledge, and appropriate selection of the surgical corridor is emphasized, as well as the complementary use of neuronavigation and advanced imaging techniques.</p> <p>The clinical relevance of the chapter lies in its systematization of anatomical and strategic criteria for addressing lesions traditionally considered high-risk from a surgical perspective, promoting the concept of maximal safe resection as the therapeutic standard in insular and perisylvian gliomas. Its contribution is particularly significant in the context of the evolution of oncological neurosurgery toward increasingly precise techniques focused on functional preservation. By integrating evidence, applied anatomy, and surgical experience, the chapter constitutes both a practical and educational resource for neurosurgeons managing tumors in eloquent areas, contributing to improved decision-making and functional outcomes in complex neuro-oncological pathology.</p> |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_5281_zenodo_18722413 |
| institution | Zenodo |
| language | |
| publishDate | 2013 |
| publisher | Zenodo |
| record_format | zenodo |
| spellingShingle | Resection of Gliomas in Eloquent Areas of the Brain González-López, Pablo Ture, Ugur <p>In this chapter, included in the book <em>Controversies in Neurosurgery II</em> (Thieme Medical Publishers, 2013), we systematically address one of the classic dilemmas in oncological neurosurgery: the resection of gliomas located in eloquent brain areas, with particular emphasis on the insula and perisylvian regions. The text combines conceptual discussion, detailed anatomical foundations, and step-by-step surgical strategy, integrating microsurgical neuroanatomy, diffusion tensor imaging (DTI) tractography, three-dimensional reconstructions, and advanced preoperative planning.</p> <p>The chapter analyzes the anatomical foundations of the insular region—the lateral sulcus, frontal, parietal, and temporal opercula, internal capsule, and M2 branches of the middle cerebral artery—highlighting the vascular and functional complexity that determines surgical risk. The anatomical boundaries of so-called “eloquent tumors” are reviewed, and the balance between maximal safe resection and functional preservation is discussed, incorporating available evidence regarding survival, tumor control, and neurological morbidity. Special attention is given to the role of DTI tractography in identifying critical white matter tracts and to the importance of three-dimensional anatomical reconstruction in understanding the relationship between the tumor, vascular structures, and deep brain anatomy.</p> <p>From a technical standpoint, the chapter provides a detailed description of the transsylvian approach, progressive opening of the Sylvian fissure, identification of cortical and perforating branches, tumor devascularization strategy, and subpial resection aimed at preserving the internal capsule and adjacent eloquent structures. The need for individualized planning, precise microanatomical knowledge, and appropriate selection of the surgical corridor is emphasized, as well as the complementary use of neuronavigation and advanced imaging techniques.</p> <p>The clinical relevance of the chapter lies in its systematization of anatomical and strategic criteria for addressing lesions traditionally considered high-risk from a surgical perspective, promoting the concept of maximal safe resection as the therapeutic standard in insular and perisylvian gliomas. Its contribution is particularly significant in the context of the evolution of oncological neurosurgery toward increasingly precise techniques focused on functional preservation. By integrating evidence, applied anatomy, and surgical experience, the chapter constitutes both a practical and educational resource for neurosurgeons managing tumors in eloquent areas, contributing to improved decision-making and functional outcomes in complex neuro-oncological pathology.</p> |
| title | Resection of Gliomas in Eloquent Areas of the Brain |
| url | https://doi.org/10.5281/zenodo.18722413 |