en Gamma Knife Radiosurgery Case report <p style="text-align: justify;"><strong>Background & Importance:</strong> Insular lobe is located at the depth of sylvian fissure and is hidden by frontal, temporal and parietal&nbsp;lobes in close vicinity of internal capsule and basal ganglia and adjacent to the speech centers in the dominant hemisphere. Thus,&nbsp;radical resection of insular gliomas can be even more difficult. Brain mapping techniques can be used to maximize the extent of&nbsp;tumor removal and minimize postoperative morbidities.<br> <strong>Case Presentation:</strong> Patients with newly diagnosed gliomas of dominant insula were enrolled. The exclusion criteria were severe&nbsp;cognitive and/or psychological disturbances, those with difficulty in communication, older than 65 years, severely obese patients,&nbsp;those with difficult airways for intubation and severe cardiovascular or respiratory diseases. All patients were evaluated by contrast&nbsp;enhanced brain MRI, functional brain MRI and diffusion tensor tractography of language and motor systems preoperatively. All&nbsp;were operated under awake craniotomy with the same anesthesiology protocol. Intraoperative monitoring included continuous&nbsp;motor evoked potential, electromyography, electrocorticography, direct electrical stimulation of cortex and subcortical tracts. They&nbsp;were followed with serial neurological examination and imaging.<br> <strong>Conclusion:</strong> Seven patients were enrolled including 3 man and 4 women with mean age of 44.4 years. 5 patients suffered from&nbsp;low grade and 2 from high grade glioma. The most common clinical presentation was seizure followed by speech disturbance,&nbsp;hemiparesis and memory loss. Extent of tumor resection ranged from 73 to 100%. No mortality or major postoperative neurological&nbsp;deficit was encountered. Seizure control improved in 3/4 of patients with medical refractory epilepsy. One patient suffered from&nbsp;permanent deterioration of speech after surgery.&nbsp;Brain mapping under awake craniotomy may be considered a safe method to maximize the extent of tumor resection, while&nbsp;preserving neurological function in patients with gliomas of the dominant insular lobe.</p> Insular Glioma, Awake Craniotomy, Brain Mapping, Cortical Stimulation 10 14 http://irjns.org/browse.php?a_code=A-10-36-1&slc_lang=en&sid=1 Mohammad Shirani محمد شیرانی 10031947532846003111 10031947532846003111 Yes MD, Assistant Professor of Neurosurgery, Sina Hospital, Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Maysam Alimohamadi میثم علیمحمدی 10031947532846003112 10031947532846003112 No MD, PhD, Assistant Professor of Neurosurgery, Sina Hospital, Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran Reza Shariat Moharari رضا شریعت موحرری 10031947532846003113 10031947532846003113 No MD, Professor of Anesthesiology, Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Koorosh Karimi Yarandi کوروش کریمی یارندی 10031947532846003114 10031947532846003114 No MD, Assistant Professor of Neurosurgery, Sina Hospital, Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran Seyed Ebrahim Ketabchi سیدابراهیم کتابچی 10031947532846003115 10031947532846003115 No MD, Professor of Neurosurgery, Sina Hospital, Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran Abbas Amirjamshidi عباس امیرجمشیدی 10031947532846003116 10031947532846003116 No MD, Professor of Neurosurgery, Sina Hospital, Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran