Insular lobe surgery and cognitive impairment in gliomas operated with intraoperative neurophysiological monitoring
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ORIGINAL ARTICLE - TUMOR - GLIOMA
Insular lobe surgery and cognitive impairment in gliomas operated with intraoperative neurophysiological monitoring Barbara Zarino 1 & Martina Andrea Sirtori 1,2 & Tommaso Meschini 3 & Giulio Andrea Bertani 1 & Manuela Caroli 1 & Cristina Bana 4 & Linda Borellini 4 & Marco Locatelli 1,2,3 & Giorgio Carrabba 1 Received: 22 May 2020 / Accepted: 3 November 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background For a long time, surgery of insular gliomas was considered at high risk for postoperative cognitive deficits, but recent studies highlighted the feasibility of the surgical approach. The aims of our study were to investigate the presence of language impairment before and after surgery and the relationship between language impairment and tumor volume preoperatively and extent of resection (EOR) 3 months after surgery. Methods Thirty-five patients with insular gliomas underwent an extensive language assessment before and few days after surgery, and after 3 months. Intraoperative neurophysiological monitoring (IOM) and brain mapping with direct electrical stimulation (DES) were used in all the cases; 8 patients underwent awake craniotomy. Statistical analysis was performed on the language tests administered. Results Patients with pure left insular lesion showed language impairment before and after surgery. Overall, patients with a left lesion showed a drop of performance after surgery followed by a partial recovery. Moreover, when the tumor involved the insula and adjacent networks, we observed a more severe deficit. No correlations were found between tumor volume, EOR, and language impairment. Conclusions Left insular lobe is an important hub in language networks; its involvement determines pre- and postsurgical deficits, together with the involvement of white matter connections. Tumor volume and EOR are not risk factors per se directly related to language functioning. Surgery of insular gliomas is possible with a pre- and intraoperative extensive study of the patient with IOM and awake surgery, and encouraged by the trend of cognitive recovery highlighted. Keywords Insular lobe surgery . Cognitive impairment . Neurosurgery . Neuropsychology . Language . Insular glioma
Barbara Zarino and Martina Andrea Sirtori contributed equally to the study and should therefore be considered as first co-authors. This article is part of the Topical Collection on Tumor - Glioma * Barbara Zarino [email protected] 1
Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Padiglione Monteggia, 20122 Milan, Italy
2
Department of Psychology, University of Milano-Bicocca, Milan, Italy
3
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
4
Neuropathophysilogy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Abbreviations DES Direct electrical stimulation EOR Extent of resection F Female FI Fronto-insular FR Face Recognition FTI Fronto-temporo-insul
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