Insula resection is difficult and challenging because the insula is located deep in the lateral fissure and has a complex surface vascular distribution in close relationship with the surrounding functional areas. Patrice Finet, a neurosurgeon at the University of Montreal Medical Centre, Canada, summarized data from 20 patients with refractory epilepsy after insula resection from 1998 to 2012 to explore the occurrence of cerebral ischemia in patients after insula region surgery and the safety of the procedure, and the article was published in the June 2015 issue of the Journal of Neurosurgery. The insula was removed in 20 patients, some with concomitant insula cap resection; all patients underwent MRI coronal T2Flair within 3 months postoperatively; and neurological function was assessed on the day of surgery, at 2 months, and twice a year thereafter. In the trans-lateral fissure approach, the lateral fissure was opened, preserving the M2, M3, and M4 segments of the middle cerebral artery (MCA) and the main draining vein; navigation techniques were applied to confirm the deep anatomy, and the insula was intermittently retracted using a self-limiting retractor; after exposure of the insula, the branches of M2 were cut by electrocoagulation under the soft meninges, and the soft meninges on the surface of the insula were cut with microscissors, and submural insula resection was performed, which may require sacrificing the penetrating artery of M2. In the transinsular approach, the insula is incised between the insula branches of M4, the insula tissue is continuously aspirated until the circumferential sulcus is exposed, the soft meninges on the surface of the insula are slowly retracted, and submural insula resection is performed. Again, it may be necessary to sacrifice the penetrating artery of M2. Of the 20 patients, only the insula was resected in 2 cases, the insula was combined with the insula cap in 13 cases, the temporal lobe in 3 cases, the frontal lobe in 1 case, and the orbitofrontal lobe in 1 case. of the 13 patients with the insula combined with the insula cap, the frontal cap was resected in 4 cases, the frontoparietal cap in 3 cases, the frontoparietal-temporal cap in 2 cases, the temporal cap in 2 cases, the frontal-temporal cap in 1 case, and the parietal-temporal cap in 1 case. Postoperatively, 12 cases (60%) were found to have ischemic foci on MRI scan, 11 of which (55%) were due to insula resection and one was related to temporal lobe resection. The ischemic area was located in the radial crown from the insula to the lateral ventricular horn and was associated with the resected area. The ischemic foci due to anterior insula resection could extend to the anterior horn of the lateral ventricle, those due to posterior insula resection could extend to the body of the lateral ventricle, and those resected from the lower part of the insula could extend to the temporal horn of the lateral ventricle. There were no ischemic foci associated with the lateral pulsatile artery. Of the 9 patients (45%) who developed neurological deficits, 6 had ischemic foci on postoperative MRI, and all showed mild hemiparesis of the contralateral side and upper extremity, including 1 with isotropic hemianopia in the left upper quadrant after temporal lobectomy; 1 with transient worsening of preoperative hemiparesis; 1 with transient aphasia; and 1 with sensory hypersensitivity of the contralateral hand. Except for hemianopia, all other neurological deficits recovered within 1 week. The causes of transient postoperative dysfunction were: 1, permanent postoperative neurological deficits were associated with lateral lemniscus arteriosus injuries (LLAs), and there were no ischemic foci associated with LLAs in this group of patients. 2, The long perforating artery on the surface of the insula originates from the posterior part of M2 towards the radial crown and supplies only 3%C5 % of the blood flow to the radial crown. When the medium and short perforating arteries of M2 are preserved, the blood supply to the regions of the insula, external capsule and nucleus pulposus accounts for 10% and 85%, respectively, and therefore can be compensated by peripheral vessels after cutting off the long perforating arteries. 3, Spasm of M2 and its major branches may be the cause of transient postoperative neurological dysfunction, which can be prevented by poppy bases, and submural electrocoagulation of vessels is a way to prevent vasospasm. 4, Intraoperative pulling of the insula is also a cause of postoperative dysfunction, and intraoperative wake-up anesthesia can reduce the incidence of postoperative neurological dysfunction caused by insula pulling. 5. Postoperative cerebral edema due to surgical manipulation is also a factor in neurological dysfunction, but recovery is usually faster.