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ORIGINAL RESEARCH article

Front. Surg.
Sec. Neurosurgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1414302
This article is part of the Research Topic Microsurgical Anatomy of the Central Nervous System and Skull Base Volume II View all 6 articles

Porto Alegre Line predicts lenticulostriate arteries encasement upon the extent of resection in insular gliomas. A preliminary study

Provisionally accepted
Gustavo Rassier Isolan Gustavo Rassier Isolan 1,2*SAMIR ALE BARK SAMIR ALE BARK 1,2Jander Moreira Monteiro Jander Moreira Monteiro 1,2Tobias Alecio Mattei Tobias Alecio Mattei 3Kaan Yağmurlu Kaan Yağmurlu 4Rafaela Fernandes Gonçalves Rafaela Fernandes Gonçalves 1,2Osvaldo Malafaia Osvaldo Malafaia 1Rafael Roesler Rafael Roesler 5Jurandir Marcondes Ribas Filho Jurandir Marcondes Ribas Filho 1
  • 1 Centro Avançado de Neurologia e Neurocirurgia (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil
  • 2 Faculdade Evangélica do Paraná, Curitiba, Brazil
  • 3 Department of Neurological Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, United States
  • 4 Department of Neurosurgery, School of Medicine, University of Virginia, Charlottesville, Virginia, United States
  • 5 Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

The final, formatted version of the article will be published soon.

    Object: In 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. Methods: A 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. Results:The 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.We have found that LSTa encasement is a limiting factor to reach a satisfactory extent of resection and that Porto Alegre Line can predict it.

    Keywords: LSTa, Lenticulostriate arteries, MRI, magnetic resonance imaging, OC-IR line, Optic Chiasm -Insular Recess line, GRI, Gustavo Rassier Isolan (author), WHO, World Health Organization, DRE, drug-resistant epilepsy, KPS, Karnofsky performance status, LGG, low-grade glioma

    Received: 08 Apr 2024; Accepted: 07 Jan 2025.

    Copyright: © 2025 Isolan, BARK, Monteiro, Mattei, Yağmurlu, Gonçalves, Malafaia, Roesler and Filho. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Gustavo Rassier Isolan, Centro Avançado de Neurologia e Neurocirurgia (CEANNE), Porto Alegre, Rio Grande do Sul, Brazil

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.