Left insular high-grade glioma

Surgery within the insula is associated with significant morbidity because it is adjacent to and involves critical cortical structures, white matter tracts, and cerebral vasculature. The incidence of subtotal resections for insular gliomas ranges from 62% to 100% in several series. Despite this high rate of subtotal resection, the risk of temporary and permanent deficits remains high with insular tumors; however, they are far from uniform, as some extend to the opercular surface and involve eloquent cortical and subcortical structures. In this chapter, we present a case of a large, dominant-hemisphere high-grade glioma that involves the insula and extends to the opercular surfaces.