Neurosurgical anatomy of the insula and Sylvian fissure in gliomas: literature review and personal experience. The second report. Veins

Abstract

Insular gliomas account for 25% of all low-grade and 10% of high-grade gliomas. Neurosurgical treatment of insular gliomas involves achieving the maximum possible volume of tumor removal while ensuring high quality of life. The anatomical proximity of functionally important brain structures and the involvement of important insular arteries and veins limits the possibility of radical removal of tumors. The key to the effectiveness of surgical intervention in insular gliomas is the selection and implementation of adequate surgical access surgical access. The most commonly used approach to insular gliomas is transsylvian-transinsular. The implementation of this approach is largely determined by the individual characteristics of the venous system of the sylvian fissure, since it is characterized by extreme anatomical variability in particular, the type of outflow direction dominance, the number of veins, their size, type of branching, drainage, collateral connections. The review presents data on the informativeness of modern methods of instrumental research in the assessment of the venous system of the sylvian fissure and insula with the aim of planning surgery for insular gliomas. Methods of preserving venous collectors of the sylvian fissure and possible complications associated with the exclusion of draining veins from the circulation are described.