Gliomas of the Limbic and Paralimbic System, Technique and Results of Resections

Czech version

Authors: R. Bartoš ^1,2; V. Němcová ²; T. Radovnický ¹; A. Sejkorová ^1,3; A. Malucelli ¹; M. Orlický ¹; F. Třebický ⁴; M. Sameš ¹
Authors‘ workplace: Neurochirurgická klinika UJEP a Krajská zdravotní, a. s., Masarykova nemocnice v Ústí nad Labem, o. z. ¹; Anatomický ústav, 1. LF UK v Praze ²; Department of Neurologic Surgery, Mayo Clinic, Rochester, USA ³; Ústav radiační onkologie, Nemocnice Na Bulovce, Praha ⁴
Published in: Cesk Slov Neurol N 2016; 79/112(2): 131-147
Category: Minimonography
doi: https://doi.org/10.14735/amcsnn2016131

Overview

Limbic and paralimbic gliomas represent a unique group of brain tumors both from an anatomic and surgical point of view. Microsurgery, together with modern perioperative procedures, enables a wider extent of resection of these gliomas. Based on localization, we divide gliomas into three basic groups: 1. insular, 2. amygdalohippocampal complex and 3. cingulum gliomas. In our review, we describe the anatomy and function of the limbic and paralimbic system and in relation to that, we present a description of the specific neurosurgical approaches to these regions. Maximal resection with brain function preservation represents the basis for subsequent oncologic therapy. We also present the surgical results of our department in the last seven years with regard to morbidity and radicality.

Key words:
limbic system – insula – hippocampus – cingulum – glioma – resection

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Reil J. Die sylvische Grube. Arch Physiol (Halle) 1809;9:195– 208.

2. Türe U, Yaşargil MG, Al-Mefty O, et al. Topographic anatomy of the insular region. J Neurosurg 1999;90(4):720– 33.

3. Tűre U, Yaşargil MG, Al-Mefty O, et al. Arteries of the insula. J Neurosurg 2000;92(4):676– 87.

4. Chang LJ, Yarkoni T, Khaw MW, et al. Decoding the role of the insula in human cognition: functional parcellation and large-scale reverse inference. Cereb Cortex 2013;23(3):739– 49. doi: 10.1093/ cercor/ bhs065.

5. Stephani C, Fernandez-Baca Vaca G, Maciunas R,et al. Functional neuroanatomy of the insular lobe. Brain Struct Funct 2011;216(2):137– 49. doi: 10.1007/ s00429-010-0296-3.

6. Ibañez A, Gleichgerrcht E, Manes F. Clinical effects of insular damage in humans. Brain Struct Funct 2010;214(5– 6):397– 410. doi: 10.1007/ s00429-010-0256-y.

7. Yaşargil MG. Microneurosurgery. Vol. 4. New York, Thieme Medical 1996.

8. Lang FF, Olansen NE, DeMonte F, et al. Surgical resection of intrinsic insular tumors: complication avoidance. J Neurosurg 2001;95(4):638– 50.

9. Hentschel SJ, Lang FF. Surgical resection of intrinsic insular tumors. Neurosurgery 2005;57(Suppl 1):176– 83.

10. Neuloh G, Pechstein U, Schramm J. Motor tract monitoring during insular glioma surgery. J Neurosurg 2007;106(4):582– 92.

11. Simon M, Neuloh G, von Lehe M, et al. Insular gliomas: the case for surgical management. J Neurosurg 2009;110(4):685– 95. doi: 10.3171/ 2008.7.JNS17639.

12. Bartoš R, Sameš M, Zolal A, et al. Resekce insulárních gliomů – volumetrické hodnocení radikality. Cesk Slov Neurol N 2009;72/ 105(6):534– 41.

13. Fernandez-Miranda JC, Rhoton AL, Álvarez-Linera J, et al. Three-dimensional microsurgical and tractographic anatomy of the white matter of the human brain. Neurosurgery 2008;62(Suppl 6):989– 1028. doi: 10.1227/ 01.neu.0000333767.05328.49.

14. Türe U, Yaşargil MG, Friedman AH, et al. Fiber dissection technique: lateral aspect of the brain. Neurosurgery 2000;47(2):417– 26.

15. Bartoš R, Hejčl A, Zolal A, et al. Laboratorní disekce drah laterálního aspektu mozkové hemisféry. Cesk Slov Neurol N 2012;75/ 108(1):30– 7.

16. Tűre U, Harupt MV, Kaya AH, et al. The paramedian supracerebellar-transtentorial approach to the entire lenght of the mediobasal temporal region: an anatomical and clinical study. J Neurosurg 2012;116(4):773– 91. doi: 10.3171/ 2011.12.JNS11791.

17. Duvernoy H, Cattin F, Risold PY. The human hippocampus. functional anatomy, vascularization and serial sections with MRI. 4th ed. Springer-Verlag Berlin Heidelberg 2013.

18. Smahmann J, Pandya D. Fiber pathways of the brain. Oxford University Press. New York 2006.

19. Figueiredo EG, Deshmukh P, Nakaji P, et al. Anterior selective amygdalohippocampectomy: technical description and microsurgical anatomy. Neurosurgery 2010;66(Suppl 3):45– 53. doi: 10.1227/ 01.NEU.0000350981.36623.8B.

20. Wen HT, Rhoton AL jr, de Oliveira E, et al. Microsurgical anatomy of the temporal lobe: part 1: mesial temporal lobe anatomy and its vascular relationships as applied to amygdalohippocampectomy. Neurosurgery 1999;45(3):549– 91.

21. Yaşargil MG, von Ammon K, Cavazos E, et al. Tumours of the limbic and paralimbic systems. Acta Neurochir 1992;118(1– 2):40– 52.

22. Wheatley BM. Selective amygdalohippocampectomy: the trans-middle temporal gyrus approach. Neurosurg Focus 2008;25(3):E4. doi: 10.3171/ FOC/ 2008/ 25/ 9/ E4.

23. Mengesha T, Abu-Ata M, Haas KF, et at. Visual field defects after selective amygdalohippocampectomy and standard temporal lobectomy. J Neuroophthalmol 2009; 9(3):208– 13. doi: 10.1097/ WNO.0b013e3181b41262.

24. Jittapiromask P, Deshomukh P, Nakaji P, et al. Comparative analysis of the posterior approaches to the medial temporal region: supracerebellar transtentorial versus occipital transtentorial. Neurosurgery 2009;64(Suppl 1):ons35– 43. doi: 10.1227/ 01.NEU.0000334048.96772.A7.

25. Ozek MM, Tűre U. Surgical approach to thalamic tumors. Childs Nerv Syst 2002;18(8):450– 6.

26. Bartoš R, Malucelli A, Provazníková E, et al. Zadní interhemisferický prekuneální/ transspleniální přístup k intrinsickým mozkovým lézím. Cesk Slov Neurol N 2012;75/ 108(3):354– 8.

27. de Oliveira JG, Párraga RG, Chaddad-Neto F, et al. Supracerebellar transtentorial approach-resection of the tentorium instead of an opening-to provide broad exposure of the mediobasal temporal lobe: anatomical aspects and surgical applications. J Neurosurg 2012;116(4):764– 72. doi: 10.3171/ 2011.12.JNS111256.

28. Bartoš R, Radovnický T, Orlický M, et al. Kombinovaný paramediánní supracerebellární-transtentoriální a miniinvazivní suboccipitální přístup při resekci gliomu celé délky mediobazální temporální oblasti: anatomická studie, technické poznámky a kazuistika. Cesk Slov Neurol N 2014;77/ 110(3):353– 8.

29. Vogt BA. Cingulate neurobiology and disease. 1. ed. Oxford University Press. New York 2009.

30. Vogt BA, Hof PR, Vogt L. Cingulate gyrus. In: Paxinos G, Mai JK (eds). The human nervous system. 1. ed.New York: Academic Press 2003:915– 49.

31. Palomero-Gallagher N, Mohlberg H, Zilles K, et al. Cytology and receptor architecture of anterior human cingulate cortex. J Comp Neurol 2008;508(6):906– 26.

32. Leech R, Sharp DJ. The role of the posterior cingulate cortex in cognition and disease. Brain 2013;137(1):12– 32. doi: 10.1093/ brain/ awt162.

33. Moshel YA, Marcus JD, Parker EC, et al. Resection of insular gliomas: the importance of lenticulostriate artery position. J Neurosurg 2008;109(5):825– 34. doi: 10.3171/ JNS/ 2008/ 109/ 11/ 0825.

34. Saito R, Kumabe T, Inoue T, et al. Magnetic resonance imaging for preoperative identification of the lenticulostriate arteries in insular glioma surgery. Technical note. J Neurosurg 2009;111(2):278– 81. doi: 10.3171/ 2008.11.NS08858.

35. Skrap M, Mondani M, Tomasino B, et al. Surgery of insular nonenhancing gliomas: volumetric analysis of tumoral resection, clinical outcome, and survival in a consecutive series of 66 cases. Neurosurgery 2012;70(5):1081– 93. doi: 10.1227/ NEU.0b013e31823f5be5.