As with all surgical interventions, we must weigh benefits with surgical risk. Unfortunately, early experience with open insular resections resulted in high morbidity and mortality.49 Resection of insular tumors continues to associate with morbidity rates from 20% to 45.5%.50 The insula certainly challenges surgeons with its deep-seated location, hidden by the frontal and temporal opercula, and its intimate relationship with the “candelabra” of the middle cerebral artery (MCA). Surgical risk, therefore, stems primarily from retraction injury and from damage of lenticulostriate arteries or MCA branches.51 An improved understanding of these concerns along with advances in surgical techniques has significantly reduced the risk of insular lobe surgery. In a more recent series, insular lesionectomy was associated with a permanent morbidity of 8% and no mortalities.50