{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:24:07Z","timestamp":1790853847259,"version":"4.1.0"},"reference-count":108,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2009,8]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Despite the report of recent experiences of insular surgery in the past decade, there has been no series specifically dedicated to studying functional outcome following resection of insular WHO Grade II gliomas involving the dominant hemisphere, in patients with no or only mild preoperative language deficit. In this article, the authors analyze the contribution of awake mapping for preservation of brain function, especially language, in a homogeneous series of 24 patients who underwent surgery for insular Grade II gliomas within the dominant insular lobe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-four patients underwent surgery for an insular Grade II glioma involving the dominant hemisphere (22 left, 2 right), revealed by seizures in all but 1 case. The preoperative neurological examination result was normal in 17 patients (71%), whereas 7 patients presented with language disorders detected using an accurate language assessment performed by a speech therapist. All surgeries were performed on awake patients utilizing intra-operative language mapping involving cortical and subcortical stimulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were no intrasurgical complications or postsurgical sensorimotor deficits. Despite an immediate postoperative language worsening in 12 cases (50%), all patients recovered to a normal status within 3 months, and 6 cases even improved in comparison with their preoperative examination results. The 24 patients returned to normal social and professional lives. Moreover, the surgery had a favorable impact on epilepsy in all but 4 cases (83%). On control MR imaging, 62.5% of resections were total or subtotal. Three patients underwent a second or third awake surgery, with no additional deficit. All but 2 patients (92%) are alive after a mean follow-up of 3 years (range 3\u2013133 months).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although insular surgery was long believed to be too risky, the present results show that the rate of permanent deficit, especially dysphasia, following resection of Grade II gliomas involving the dominant insula has been dramatically reduced (none in this patient series), thanks to the systematic use of intraoperative awake mapping, even in cases of repeated operations. Furthermore, patient quality of life may be improved due to a decrease of epilepsy after surgery. Thus, the authors suggest systematically considering resection when an insular Grade II glioma is diagnosed after seizures in a patient with no or mild deficit, even a glioma invading the dominant hemisphere.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2009.5.focus0938","type":"journal-article","created":{"date-parts":[[2009,7,31]],"date-time":"2009-07-31T09:13:53Z","timestamp":1249031633000},"page":"E7","source":"Crossref","is-referenced-by-count":136,"title":["Functional outcome after language mapping for insular World Health Organization Grade II gliomas in the dominant hemisphere: experience with 24 patients"],"prefix":"10.3171","volume":"27","author":[{"given":"Hugues","family":"Duffau","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, H\u00f4pital Gui de Chauliac, and"},{"name":"Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale U888, H\u00f4pital de la Colombi\u00e8re, Centre Hospitalier Universitaire de Montpellier; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Moritz-Gasser","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, H\u00f4pital Gui de Chauliac, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peggy","family":"Gatignol","sequence":"additional","affiliation":[{"name":"Laboratoire de Psychologie et de Neurosciences Cognitives, Centre National de Recherche Scientifique, Universit\u00e9 de Paris V Ren\u00e9 Descartes, Boulogne Billancourt, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0270007","series-title":"Brain Lang","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/S0093-934X(03)00347-X","article-title":"The contribution of the insula to motor aspects of speech production: a review and a hypothesis","volume":"89","author":"Ackermann","year":"2004"},{"key":"b2-0270007","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1227\/01.NEU.0000298902.69473.77","article-title":"Resection of World Health Organization Grade II gliomas involving Broca's area: methodological and functional considerations","volume":"61","author":"Benzagmout","year":"2007"},{"key":"b3-0270007","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"1784","DOI":"10.1002\/1097-0142(19940915)74:6<1784::AID-CNCR2820740622>3.0.CO;2-D","article-title":"The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas","volume":"74","author":"Berger","year":"1994"},{"key":"b4-0270007","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1002\/cncr.20867","article-title":"Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance","volume":"103","author":"Claus","year":"2005"},{"key":"b5-0270007","series-title":"Nat Rev Neurosci","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1038\/nrn894","article-title":"How do you feel? 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