Clinical Utility Of Multimodal Imaging And Neuro-Monitoring In Awake Craniotomy For Low-Grade Glioma: A Case Report And Literature Review

Abstract

Insular gliomas pose a therapeutic challenge due to their intricate anatomy and proximity to eloquent brain regions. Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) tractography are useful ways to learn about the insular region's neuronal connections and how they work before surgery. The purpose of this case report is to show how awake craniotomy, with intraoperative neuromonitoring (IONM), can be used to remove low-grade gliomas, especially from the insular region. By carefully drawing functional boundaries using fMRI and DTI data collected before surgery, surgical methods were created to protect important brain areas as much as possible while removing as much of the tumor as possible. A 31-year-old male presented with a 5-month history of headaches, seizures, and right-sided numbness. Neurological examination revealed difficulty with word finding and organization but no overt speech deficits. An MRI revealed a non-enhancing lesion in the left frontotemporal region. An awake craniotomy was conducted to protect language centres and brain function during surgical resection, with guidance from DTI, fMRI, and IONM.The study underscores the importance of integrating advanced imaging modalities with intraoperative techniques to optimize surgical outcomes for insular gliomas. To maximize success and minimize postoperative complications, a comprehensive understanding of tumor biology, neuroanatomy, and patient-specific factors is imperative. Incorporating preoperative fMRI and DTI into surgical planning enhances the accuracy and efficacy of awake craniotomy procedures. Further research is warranted to validate these findings and refine treatment strategies for insular gliomas.