Awake Craniotomy with Intraoperative Language Mapping for Left Insular Gliomas
DOI:
https://doi.org/10.5281/zenodo.22310343Keywords:
Insular glioma, Awake craniotomy, Language mapping, Direct electrical stimulation, Extent of resectionAbstract
Background: Gliomas of the dominant insula are encased by perisylvian language cortex, subcortical language tracts, and
lenticulostriate perforators. Awake craniotomy with direct electrical stimulation (DES) mapping is the principal strategy for
maximising resection while preserving language. Objective: To synthesise published literature on awake language mapping for left insular glioma. Methods: Narrative review of anatomical/classification, technique, mapping-methodology, resection/survival, complication, and comparative awake-versus-asleep studies. Findings: The Berger-Sanai classification predicts resectability and morbidity; Zone I tumours achieve the highest median resection (86%). Resection near 90% corresponds to 5-year survival of 100% versus 84% (grade II) and 2-year survival of 91% versus 75% (grade III/IV). Stimulation mapping raises gross-total resection from 58% to 75% and lowers late deficits from 8.2% to 3.4%. Dedicated series report 73-100% resection with minimal permanent morbidity.
Conclusions: Awake DES mapping enables aggressive, function-sparing resection of dominant insular gliomas and should be
standard practice where feasible.
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