Porto Alegre Line predicts lenticulostriate arteries encasement and extent of resection in insular gliomas. A preliminary study
ObjectIn insular glioma surgery, lenticulostriate arteries (LSTa) tumoral encasement increases neurological deficits risk despite intensive efforts to preserve the internal capsule's integrity. In this study, we focus on the LSTa relationships with the medial aspect of the insular tumors. We pr...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1414302/full |
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| author | Gustavo Rassier Isolan Gustavo Rassier Isolan Gustavo Rassier Isolan Samir Ale Bark Samir Ale Bark Jander Moreira Monteiro Jander Moreira Monteiro Tobias A. Mattei Kaan Yağmurlu Rafaela Fernandes Gonçalves Rafaela Fernandes Gonçalves Osvaldo Malafaia Rafael Roesler Rafael Roesler Rafael Roesler Jurandir Marcondes Ribas Filho |
| author_facet | Gustavo Rassier Isolan Gustavo Rassier Isolan Gustavo Rassier Isolan Samir Ale Bark Samir Ale Bark Jander Moreira Monteiro Jander Moreira Monteiro Tobias A. Mattei Kaan Yağmurlu Rafaela Fernandes Gonçalves Rafaela Fernandes Gonçalves Osvaldo Malafaia Rafael Roesler Rafael Roesler Rafael Roesler Jurandir Marcondes Ribas Filho |
| author_sort | Gustavo Rassier Isolan |
| collection | DOAJ |
| description | ObjectIn insular glioma surgery, lenticulostriate arteries (LSTa) tumoral encasement increases neurological deficits risk despite intensive efforts to preserve the internal capsule's integrity. In this study, we focus on the LSTa relationships with the medial aspect of the insular tumors. We propose a new non-invasive method for LSTa involvement prediction in preoperative MRI (Porto Alegre Line). We compare it with direct intraoperative encased LSTa visualization.MethodsA retrospective review of our database of 52 patients of insular glioma was performed. In cases with no tumor located medial to Porto Alegre line, our medial resection limit, mainly for the tumor part located next to the limen insula, was the inferior fronto-occipital fasciculus (IFOF), identified through altered speech patterns during electric subcortical stimulation. In cases with no assumed LSTa involvement, the parameter used to stop resection was the confirmation of the corticospinal tract with 10-mA stimulus. The resection limit of tumors placed medially to the Porto Alegre line was intraoperative direct LSTa visualization.ResultsThe LSTa involvement was the most critical medial limiting factor in more aggressive tumor resection and an excellent overall survival (P = 0.022). In cases in which there were direct intraoperative LSTa encasement visualization, Porto Alegre Line was employed as an MRI preoperative landmark for prediction of LSTa involvement in those patients with Sensitivity, Specificity, Positive Predictive Values of 1, 0.975 and 0.923, respectively.ConclusionWe have found that LSTa encasement is a limiting factor to reach a satisfactory extent of resection and that Porto Alegre Line can predict it. |
| format | Article |
| id | doaj-art-08d594f2aaa94ff494a5e73e1800d672 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj-art-08d594f2aaa94ff494a5e73e1800d6722025-02-10T06:48:39ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2025-02-011210.3389/fsurg.2025.14143021414302Porto Alegre Line predicts lenticulostriate arteries encasement and extent of resection in insular gliomas. A preliminary studyGustavo Rassier Isolan0Gustavo Rassier Isolan1Gustavo Rassier Isolan2Samir Ale Bark3Samir Ale Bark4Jander Moreira Monteiro5Jander Moreira Monteiro6Tobias A. Mattei7Kaan Yağmurlu8Rafaela Fernandes Gonçalves9Rafaela Fernandes Gonçalves10Osvaldo Malafaia11Rafael Roesler12Rafael Roesler13Rafael Roesler14Jurandir Marcondes Ribas Filho15Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Curitiba, BrazilNational Science and Technology Institute for Children's Cancer Biology and Pediatric Oncology—INCT BioOncoPed, Porto Alegre, BrazilThe Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BrazilGraduate Program in Principles of Surgery, Mackenzie Evangelical University, Curitiba, BrazilThe Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BrazilGraduate Program in Principles of Surgery, Mackenzie Evangelical University, Curitiba, BrazilThe Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BrazilDivision of Neurological Surgery, St. Louis University, St. Louis, MO, United StatesDepartment of Neurosurgery, University of Virginia, Charlottesville, VA, United StatesGraduate Program in Principles of Surgery, Mackenzie Evangelical University, Curitiba, BrazilThe Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BrazilThe Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BrazilNational Science and Technology Institute for Children's Cancer Biology and Pediatric Oncology—INCT BioOncoPed, Porto Alegre, BrazilDepartment of Pharmacology, Institute for Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, BrazilCancer and Neurobiology Laboratory, Experimental Research Center, Clinical Hospital (CPE-HCPA), Federal University of Rio Grande do Sul, Porto Alegre, BrazilThe Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, BrazilObjectIn insular glioma surgery, lenticulostriate arteries (LSTa) tumoral encasement increases neurological deficits risk despite intensive efforts to preserve the internal capsule's integrity. In this study, we focus on the LSTa relationships with the medial aspect of the insular tumors. We propose a new non-invasive method for LSTa involvement prediction in preoperative MRI (Porto Alegre Line). We compare it with direct intraoperative encased LSTa visualization.MethodsA retrospective review of our database of 52 patients of insular glioma was performed. In cases with no tumor located medial to Porto Alegre line, our medial resection limit, mainly for the tumor part located next to the limen insula, was the inferior fronto-occipital fasciculus (IFOF), identified through altered speech patterns during electric subcortical stimulation. In cases with no assumed LSTa involvement, the parameter used to stop resection was the confirmation of the corticospinal tract with 10-mA stimulus. The resection limit of tumors placed medially to the Porto Alegre line was intraoperative direct LSTa visualization.ResultsThe LSTa involvement was the most critical medial limiting factor in more aggressive tumor resection and an excellent overall survival (P = 0.022). In cases in which there were direct intraoperative LSTa encasement visualization, Porto Alegre Line was employed as an MRI preoperative landmark for prediction of LSTa involvement in those patients with Sensitivity, Specificity, Positive Predictive Values of 1, 0.975 and 0.923, respectively.ConclusionWe have found that LSTa encasement is a limiting factor to reach a satisfactory extent of resection and that Porto Alegre Line can predict it.https://www.frontiersin.org/articles/10.3389/fsurg.2025.1414302/fullinsular tumorslenticulostriate arteriesOptic Chiasm - Insular Recess linePorto Alegre Linetumor resection |
| spellingShingle | Gustavo Rassier Isolan Gustavo Rassier Isolan Gustavo Rassier Isolan Samir Ale Bark Samir Ale Bark Jander Moreira Monteiro Jander Moreira Monteiro Tobias A. Mattei Kaan Yağmurlu Rafaela Fernandes Gonçalves Rafaela Fernandes Gonçalves Osvaldo Malafaia Rafael Roesler Rafael Roesler Rafael Roesler Jurandir Marcondes Ribas Filho Porto Alegre Line predicts lenticulostriate arteries encasement and extent of resection in insular gliomas. A preliminary study Frontiers in Surgery insular tumors lenticulostriate arteries Optic Chiasm - Insular Recess line Porto Alegre Line tumor resection |
| title | Porto Alegre Line predicts lenticulostriate arteries encasement and extent of resection in insular gliomas. A preliminary study |
| title_full | Porto Alegre Line predicts lenticulostriate arteries encasement and extent of resection in insular gliomas. A preliminary study |
| title_fullStr | Porto Alegre Line predicts lenticulostriate arteries encasement and extent of resection in insular gliomas. A preliminary study |
| title_full_unstemmed | Porto Alegre Line predicts lenticulostriate arteries encasement and extent of resection in insular gliomas. A preliminary study |
| title_short | Porto Alegre Line predicts lenticulostriate arteries encasement and extent of resection in insular gliomas. A preliminary study |
| title_sort | porto alegre line predicts lenticulostriate arteries encasement and extent of resection in insular gliomas a preliminary study |
| topic | insular tumors lenticulostriate arteries Optic Chiasm - Insular Recess line Porto Alegre Line tumor resection |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1414302/full |
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