Introduction: and Importance: Adult Pilocytic Astrocytomas (APA) are infrequent low grade tumors. While supratentorial APA is considered rare, insular APA is extremely rare.
Case presentation: We present a case of pure insular APA along with surgical outcomes. Tractography and functional MRI were obtained pre-operatively. The patient underwent neuro-navigation guided microsurgical resection with sub-cortical white matter mapping, utilizing Intra-operative MRI guidance. The Sylvain fissure was opened to secure the M3 branches, and near total resection was achieved.
Clinical discussion: APA in the insula is a very rare presentation and is considered challenging. Its proximity to the middle cerebral and lenticulostriate arteries, motor areas, and language areas makes accessing and resecting the tumor challenging. A multidisciplinary approach by an experienced team is needed to plan the management of young adult patients and reach the best outcomes.
Conclusion: Implementing microsurgical techniques, modern imaging modalities and intraoperative mapping helps to achieve maximal safe resection without risking functions.
Keywords: Adult; Insular; KPS, Karnofsky scale; LSA, lenticulostriate arteries; MCA, middle cerebral artery; Microsurgery; Outcomes; Pilocytic Astrocytoma.
© 2021 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.