Recovery of major cognitive deficits following awake surgery for insular glioma: a case report

Research output: Contribution to journalArticlepeer-review

Electronic versions

  • Daniel J. O’Hara
    Leeds Teaching Hospitals NHS Trust
  • John Goodden
    Leeds Teaching Hospitals NHS Trust
  • Ryan Mathew
    Leeds Teaching Hospitals NHS Trust
  • Rebecca Chan
  • Paul Chumas
    Leeds Teaching Hospitals NHS Trust
Background
Resection of insular tumours utilising modern neurosurgical techniques has become commonplace since its safety and reduced morbidity was first established. Interest has grown in the cognitive consequences of insula neurosurgery and studies have largely shown postoperative stability or minor decline. Major or widespread improvements in cognitive functioning following resection of insular tumours have not previously been reported.

Case description
A 34-year-old, left-handed man with a right insular low-grade glioma (LGG) presented with seizures, nausea, altered sensation, poor balance and extensive cognitive decline. Comprehensive neuropsychological assessment highlighted a striking left hemispatial neglect and impairments in attention, working memory, verbal learning and fluency. During an awake craniotomy with functional cortical mapping, he reported intraoperative improvements in hand function and processing speed. Resolution of the neglect and significant improvements in cognition, mood and functioning were observed at follow-up and sustained over several years.

Conclusions
This case highlights that right insular LGGs can cause significant cognitive and functional deficits and that neurosurgery has the potential to alleviate these difficulties to an extent beyond those documented in the extant literature.

Keywords

  • Surgery, Clinical Neurology, General Medicine
Original languageEnglish
Pages (from-to)236-240
Number of pages5
JournalBritish Journal of Neurosurgery
Volume38
Issue number2
Early online date29 Sept 2020
DOIs
Publication statusPublished - 2024
View graph of relations