Surgery of Insular Diffuse Low-Grade Gliomas

Diffuse low-grade glioma represents a premalignant neoplasm that has a propensity to involve the insula/paralimbic region for molecular, anatomical, and functional reasons. This tumor tends to affect young patients that present typically with few symptoms, most often epilepsy, but that exhibit neurocognitive deficits when screened appropriately by objective neuropsychological assessment. Because the natural history of this disease and the functional connectivity of this brain area are increasingly known, it has become clear that early and safe maximal surgical treatment is the best management in order to optimize not only survival but also quality of life of affected patients. We will here discuss insular gliomas as a specific pathologic entity; we will detail surgical techniques, by emphasizing the role of awake mapping; and we will report oncological as well as functional results of this therapeutic approach.