Resection of a large left opercular cavernoma in a child using neuronavigation

Abstract

The insular lobe is a complex structure constituting anatomic, cytoarchitectonic, and functional interface between the allocortex and the neocortex. This area is a part of a larger system that includes the orbitofrontal, temporopolar, and insular regions, constituting the paralimbic system or mesocortex. For a long time, the issue in studying this entity accounted for the poor understanding of its precise functionality. Because of the technical complexity in approaching and dissecting this region, very few neurosurgeons attempted surgery of the insula. Particularly on the dominant side, the natural history of these lesions must be carefully balanced with the surgical morbidity involved in their resection. Surgical treatment of cavernomas arising around the insula (especially in dominant cerebral hemisphere) is challenging in reason of the proximity to the internal capsule and lenticulostriate arteries. The advent of image guidance systems and intraoperative mapping of the subcortical language pathways has broadened the surgical indications for these lesions. In the case reported here we removed a cavernous angioma of the left dominant operculum in a child with the aid of a neuronavigation system guidance.