Neuronavigated fiber dissection with pial preservation: a laboratory model to simulate opercular approaches to insular tumors

Abstract

Background Advances in the oncological and functional results of insular surgery have been reported recently. Such successes have been made possible by the advent of the transopercular approach under awake monitoring and by the improved anatomical and functional knowledge of the white matter pathways surrounding the insula. Nonetheless, given the rarity of insular tumors, it is difficult to get familiar with the complex 3D anatomy of the different neuronal and vascular structures encountered during a transopercular insular resection. We thus propose to develop a laboratory model allowing to train transopercular approaches of the insula Methods Two hemispheres prepared with Klinger's technique were dissected under light microscope, preserving all pial membranes. The different steps of the dissection were video recorded. Results The preservation of pial membranes enabled to simulate subpial resection, both during operculum removal and during insular cortex resection. The medial wall of the resection was defined by the inferior-fronto-occipital fasiculus, protecting from the lenticulostriate arteries. Conclusion In this paper, we show that Klinger dissection with preservation of pial membranes provides a realistic model of insular surgery, allowing to learn and train this highly-specialized surgery.