case_images: PMC10810732_01
case_images: Initial MRI demonstrating a non-contrast enhancing left frontotemporal insular lesion. (A) T1-weighted post contrast; (B) T2-weighted.
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case_images: PMC10810732_01_rjae004f1.jpg
case_images: f1
case_images: The imaging revealed a left frontotemporal insular lesion without contrast enhancement (Fig. 1).
case_images: (A and B) Pre-operative planning. Tractography (A):green: corticospinal tract; orange = Aacuate fasciculus; yellow = FST; blue = FAT) and visualization of perforator arteries and Virchow-Robin spaces (B). (C and D) Comparison between functional mapping between August 2022 (C) and March 2023 (D) (green box:stability of language eloquence in inferior frontal gyrus; yellow box:neuroplasticity at temporal level). (E and F) Surgical resection with origin of perforators from M1 [1], tumour surrounding perforators [2] and perforators [3]. Phonemic errors with high frequency stimulation [5], perforator's territory [6] and 5-ALA enhancement (F).
case_images: rjae004f2.jpg
case_images: PMC10810732_01_rjae004f2.jpg
case_images: f2
case_images: Surgery was performed using 5-ALA, IONM and preoperative mapping (Fig. 2). Contrast enhancing tumour that was 5-ALA positive was resected and sent separately for analysis (Fig. 2). A comparison between the functional mappings between August 2022 and March 2023 was performed, revealing neuroplasticity at temporal level (Fig. 2).
case_images: Bone flap with coronal suture diastases.
case_images: rjae004f3.jpg
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case_images: f3
case_images: Postoperative (second surgery) MRI demonstrating residual tumour at the posterior margin of the insula.
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case_images: f4
case_images: Post-operative MRI revealed removal of the contrast enhancing portion of the tumour and intentional residual tumour at the posterior margin of the insula (Fig. 4).