Emrah AKÇAY, Hakan YILMAZ, Hüseyin Berk BENEK, Alper TABANLI, Alaettin YURT

SURGICAL RESECTION OF TUMORS LOCATED IN THE INSULAR REGION

Introduction: Only a few published surgical results of tumors in the insular region exist. The authors report their experience with tumors of the insula together with the surgical procedure and outcomes. Material and methods: The authors studied 32 intrinsic insular tumor cases that underwent tumor resection in their department. Opercular retraction and the manipulation of the middle cerebral artery (MCA) and its segments were avoided by widely splitting the Sylvian fissure, dissecting the MCA, and identifying the important landmarks of the periinsular sulci. Tumor molecular pathology, location, achievable extent of resection, postoperative complications, postoperative neurological outcome, and overall survival were evaluated to determine the value of this surgical approach. Results: 12 tumors (37%) were purely insular, 11 (34%) extended into the temporal pole, and 9 (28%) extended into the frontal operculum. A transsylvian approach combined with a frontal operculum resection or temporal lobectomy was used. There were 17 patients with a tumor diameter larger than 5 cm. Gross total resection of the tumor was possible in 30 patients (93.7%). There was no postoperative death. Tumor recurrence developed in a single patient, after 5 years 2 months. The neurological condition improved after surgery in 15 patients but was unchanged in 12. Postoperatively, 1 patient had long-term dysphasia, 1 had aphasia, 1 had transient dysphasia and 2 had hemiparesis. Conclusion: Widely splitting the Sylvian fissure and dissecting the MCA and lateral lenticulostriate artery (LLA) seems to be enviable method for total insular tumor resection without any deficit.

İNSULAR BÖLGE YERLEŞİMLİ KİTLELERİN CERRAHİ REZEKSİYONU

Giriş: İnsular bölgedeki tümörlerin cerrahi sonuçları ile ilgili sadece birkaç yayın mevcuttur. Yazarlar, cerrahi prosedür ve sonuçlar ile birlikte insula tümörleri ile ilgili deneyimlerini bildirmişlerdir. Gereç ve Yöntem: Yazarlar bölümlerinde tümör rezeksiyonu yapılan 32 intrinsik insular tümör vakasını incelediler. Sylvian fissürün genişçe açılması, orta serebral arter (MCA)’ in diseke edilmesi ve periinsular sulkusun önemli lendmarklarının ortaya konulmasıyla operküler retraksiyon ve MCA ve segmentlerinin manipülasyonu önlendi. Bu cerrahi yaklaşımın değerini belirlemek için tümör moleküler patolojisi, yerleşim yeri, ulaşılabilir rezeksiyon derecesi, ameliyat sonrası komplikasyonlar, ameliyat sonrası nörolojik sonuç ve genel sağkalım değerlendirildi. Bulgular: 12 tümör (% 37) tamamen insülerdi, 11 (% 34)’i temporal pole ve 9 (% 28)’ u frontal operculuma uzanıyordu. Frontal operculum rezeksiyonu veya temporal lobektomi ile kombine transsilvian yaklaşım kullanıldı. Tümör çapı 5 cm'den büyük 17 hasta vardı. 30 hastada (% 93.7) tümör gross total rezeke edildi. Ameliyat sonrası exitus olmadı. 5 yıl 2 ay sonra tek bir hastada tümör nüksü gelişti. Ameliyat sonrası 15 hastada nörolojik durum düzeldi ancak 12 hastada değişmedi. Postoperatif 1 hastada uzun süreli disfazi, 1 hastada afazi, 1 hastada geçici disfazi ve 2 hastada hemiparezi görüldü. Sonuç: Sylvian fissürünün geniş açılması ve MCA ve lateral lentrikülostriat arterin (LLA) diseksiyonu, defisit geliştirmeden total insular tümör rezeksiyonu için en iyi yöntem gibi görünmektedir.

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