Adult Pilocytic Astrocytoma in the insula: Case report and review of the literature

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.

Highlights • Insular Adult Pilocytic Astrocytomas (APA) are infrequent low grade tumors and are surgically challenging. • Implementing microsurgical techniques by well-trained physicians would lead to a safe resection and preferable outcomes. • Modern imaging modalities and intraoperative mapping helps to achieve maximal safe resection without risking functions.