Improving the extent of resection and reducing the risk of neurological complications are important goals in the treatment of insulo-opercular gliomas [1-5, 10-13]. Aggressive surgical resection of intrinsic insular gliomas is associated with high rates of gross total resection and low rates of permanent neurological deficits and requires meticulous surgical approach based on the regional insular anatomy [1-5, 8-13]. Interruption of the perforating lenticulostriate arteries (LSA) and long insular arteries that arise from the M2  can damage the descending motor pathways  and cause postoperative hemiplegia . Therefore, preservation of the perforating arteries is of utmost importance during surgical resection of insulo-opercular tumors [2, 4, 5, 8].
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