Transopercular Approach to Resection of Dominant Hemisphere Diffuse Insular Glioma Using Multimodal Intraoperative Strategy with Awake Mapping

Background: Deep location as well as relation to major vascular structures and eloquent brain areas make insular glioma resection challenging. Transsylvian and transopercular approaches have been described for resection of these tumors. Objective: We illustrate the anatomical relations of a dominant hemisphere insular glioma and present the video demonstrating the step-wise resection of the same via frontal transopercular approach. Surgical Procedure: A 27-year-old lady with dominant hemisphere insular glioma underwent awake surgery through a transopercular approach with cortical and subcortical mapping using direct electrical stimulation for resection of the same. Result: Gross total resection of left insular glioma was achieved without any fresh postoperative deficits. Conclusion: Awake transopercular approach with intraoperative motor, language, and neuropsychological monitoring helps achieve maximum safe resection of insular glioma in the dominant cerebral hemisphere.