Microsurgical preservation of lenticulostriate artery perforators in insular glioma: the two point antegrade skeletonization technique.

Abstract

Reaching parenchymal segments of the lateral lenticulostriate artery (LSA) perforators, which represent the medial resection limit in insular gliomas (IG), remains a challenge. The currently described methods are indirect and sometimes, imprecise. We report an antegrade direct skeletonization technique to identify these tiny arteries at the medial end of IGs with an illustrative case of grade 2 astrocytoma. The patient recovered uneventfully following a near total tumor resection without any postoperative radiological ischemia in the LSA territory. Our microsurgical technique of antegrade LSA skeletonization may be useful in insular gliomas with a sharp medial border.