Abstract
BACKGROUND: Reaching parenchymal segments of the lateral lenticulostriate artery (LSA) perforators, which represent the medial resection limit in insular gliomas (IG), remains a challenge. The currently described methods are indirect and sometimes, imprecise. METHODS: We report an antegrade direct skeletonization technique to identify these tiny arteries at the medial end of IGs with an illustrative case of grade 2 astrocytoma. The patient recovered uneventfully following a near total tumor resection without any postoperative radiological ischemia in the LSA territory. CONCLUSIONS: Our microsurgical technique of antegrade LSA skeletonization may be useful in insular gliomas with a sharp medial border.