El lóbulo de la ínsula: Parte 2 - Anatomía microquirúrgica y correlación clínico-quirúrgica / The lobe of the insula: Part 2 - Microsurgical anatomy and clinical-surgical correlation

Introducción: El conocimiento profundo de la anatomía microquirúrgica del lóbulo de la ínsula es crucial para operar pacientes con tumores en esta región. Objetivo: El objetivo de la segunda parte de este estudio es correlacionar la anatomía microquirúrgica con casos ilustrativos retirados de nuestra casuística de 35 pacientes en los cuales fueron realizados 44 cirugías de tumores en relación con el lóbulo de la ínsula. Material y Métodos: A lo largo de marzo de 2007 y agosto de 2014, 44 microcirugías fueron realizadas en 35 pacientes portadores de tumores insulares y los hallazgos de las cirugías y mapeo cerebral se correlacionaron con la anatomía microquirúrgica. Resultados: De una serie de 44 pacientes con tumores de la ínsula, la mayoría de los casos eran gliomas de bajo grado de malignidad (29 casos). El inicio de los síntomas en 34 pacientes fue epilepsia, siendo esta refractaria al tratamiento medicamentoso en 12 casos. El grado de resección fue subtotal o total en la mayoría de los casos de la serie. La mejoría en la calidad de vida (epilepsia, etc.) estuvo presente en más de la mitad de los pacientes. El déficit neurológico permanente estuvo presente en tres pacientes. Conclusión: En los tumores insulares, es tan importante el conocimiento profundo de la anatomía, como el saber utilizar e interpretar en tiempo real las observaciones de la monitorización neurofisiológica intraoperatoria.

Introduction: The deep knowledge of the microsurgical anatomy of the insular lobe is crucial to operate patients with tumors in this region. Objectives: Our purpose in this second part is to correlate insular surgical anatomy with illustrative cases from 4 surgeries performed on 35 patients with insular tumors. Materials and Methods: From March 2007 to August 2014, 44 microsurgeries were performed on 35 patients with insular glioma tumors. Of these, 29 cases were low-grade gliomas. Seizures were the first symptom in most cases. Total, or near total tumor resection was achieved in most of the patients. Improvement in quality of life was achieved in more than half of the patients after surgery. Moderate and permanent neurological deficits were present in 3 patients. Results: The majority of cases were low grade malignancy gliomas (29 cases). The onset of symptoms in 34 patients was epilepsy, being refractory to drug treatment in 12 cases. The degree of resection was subtotal or total in most cases of this series. The improvement in the quality of life (epilepsy, etc.) was present in more than half of the patients. Permanent neurological deficit was present in three patients. Conclusion: For insular tumors, microsurgical anatomy knowledge is as important as cortical and subcortical mapping

Unveiling the Insular Lobe of Reil: Neurophysiological and Anatomical Features

The insular lobe has long been investigated, from its anatomical descriptions to its neurophysiological activity. Located in a central location, the insular lobe participates in several afferent and efferent pathways, forming part of the eloquent and fundamental structures that make up the central core of the brain. The lobe of the insula has participation in language function, such as speech, sensory (e.g., taste), limbic, autonomic (visceral), also forming part of complex associative circuits, including part of the circuits of mirror neurons. Several functional descriptions attributed to the insular lobe have beenmade in patients suffering fromcerebrovascular diseases, as well as in those with epilepsy. Much progress and many descriptions have also been made in patients with tumors. Despite much information already available about the insular lobe, it is likely that much will be discovered in the coming years.

Application of intraoperative MRI combined with neuronavigation in microsurgical resection for insular glioma / 中南大学学报(医学版)

Objective:To evaluate the value of intraoperative magnetic resonance imaging (iMRI) combined with neuronavigation for the resection of insular gliomas.Methods:From August 2014 to October 2017 in the First Hospital Affiliated to Sun Yat-sen University,clinical data of 41 patients with insular glioma,who underwent the surgery assisted with 3.0T iMRI and neuronavigation,were analyzed retrospectively,and the resection extent,complications and prognosis were evaluated.Results:Subtotal tumor resection was achieved in 21 patients and partial resection was done in 20 after iMRI scanning.After further resection,total tumor resection was achieved in 16 patients,subtotal resection in 18 and partial resection in 7.There was a statistical significant difference in tumor resection between pre-iMRI and post-iMRI according to the Fisher test (P＜0.05).In the follow-up from 3 months to 3 years,the symptoms of the 41 patients had improved.Conclusion:iMRI corrected the shift of brain.Neuronavigation can accurately and timely assess the degree of resecting tumor.The combination of neuronavigation with surgery can maximally and safely resect insular glioma.

Changes in the functional activity and connectivity of the insular cortex in patients with low back pain / 中华物理医学与康复杂志

Objective To investigate the functional activity and connectivity of the insular cortex at rest in persons with low back pain (LBP).Methods Twelve healthy subjects (male 6,female 6 ; age 24.8 ± 3.3 years) were given fMRI 3.0T scans at rest.Back muscle pain was then induced with an intramuscular injection of 3％ hypertonic saline solution and a second scan was performed.The pain-free and in-pain fMRI data were compared using paired t-tests to highlight any changes in the functional connectivity of the anterior and posterior insular cortex on both sides.Pain severity was quantified using a visual analogue scale (VAS).Results Ratings of LBP severity peaked at 6.02 ± 1.96 on the VAS.The functional connectivity of the inferior insular cortex with the frontal cortex,the thalamus and the parahippocampal gyrus was enhanced when the subjects were in pain,but connectivity with the posterior cingulate cortex,the precuneus,the temporal cortex,the paracentral lobule and the cerebellar tonsil was reduced.The inferior parietal lobule exhibited significantly enhanced connectivity with the anterior insular cortex,but reduced connectivity with the posterior insular cortex.In addition,the medial cingulate cortex displayed decreased functional connectivity with the anterior insular cortex,but increased functional connectivity with the posterior insular cortex when the subjects were in pain.Conclusion This study has revealed impeded functional connectivity of the insular cortex when experiencing LBP at rest.This may possibly be related to pain's disruption of cognition and emotion.

Insular Infarction Presenting With Transient Global Amnesia

The pathophysiology of transient global amnesia is uncertain. Several studies have suggested that the anatomical substrates of transient global amnesia are the limbic areas, including the hippocampus, caudate nucleus, cingulate area, and thalamus. We examined a patient who presented with transient global amnesia with left insular infarction. We believe that the insular lobe may be an important area of episodic memory formation, and infarction of this brain area may be the mechanism underlying the amnesia experienced in this case.

Ictal Focus on the Bialateral Claustrum in a Case of Insular Seizure Manifesting as Status Epilepticus

Insular lobe seizure (ILS) is very rare and ictal focus has not been documented by neuroimaging studies. Clinical characteristics consist of clearly preserved consciousness, visceral sensation, somatomotor symptoms, and dysphonic or dysarthric speech. We report a 34-year-old female with ILS, manifesting as first onset status epilepticus. SISCOM and SPM analysis through brain MRI and 18F FDG PET-CT reveals ictal focus on the bilateral claustrum, which has a close relationship with insula anatomically. This is the first case report in Korea.