Second Surgery in Insular Low-Grade Gliomas

Figure 1

A case of vast left fronto-temporo-insular LGG. Functional MRI/DTI data were overlapped on T2-weighted MRIs and loaded into the Neuro-Navigation system, allowing a better evaluation of the preoperative surgical planning. In the 3D rendering the lesion is represented in red, and the arcuate fasciculus (AF) is in blue, while the orange fMRI spots represent the Broca (anterior spot) and Wernicke area (posterior spot). The functional analysis highlights the cortical areas activated by counting, object naming, and verb generation tasks. The eloquent cortical regions, displaced by the tumor, were easily detected with cortical mapping during surgical procedure. The tumor mass displaces the AF upwards (ACHIEVA 3 T MRI, Philips, Netherlands).