Magnetic resonance imaging for preoperative identification of the lenticulostriate arteries in insular glioma surgery

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Abstract
Aggressive resection of insular tumors is possible using a meticulous surgical approach based on the regional insular anatomy, with high rates of gross-total resection and low rates of permanent neurological deficits. However, the risk of postoperative morbidities remains high, often caused by disruption of the vascular supply to the surrounding eloquent structures, especially the lenticulostriate arteries (LSAs) that supply the internal capsule. Three-dimensional 3-T time-of-flight (TOF) MR imaging was performed pre- and postoperatively in patients with insuloopercular gliomas. This 3D 3-T TOF MR imaging clearly visualized the LSAs and the relationships with the tumor margins. These findings were confirmed intraoperatively. Three-dimensional 3-T TOF MR imaging of the LSAs in patients with insuloopercular gliomas can help to maximize the extent of resection without neurological complications, preserve the LSAs during surgery, and assist in patient selection.