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OBJECT The cerebral isthmus is the white matter area located between the periinsular sulcus and the lateral ventricle. Studies demonstrating the fiber tract and topographic anatomy of this entity are lacking in current neurosurgical literature. Hence, the authors’ primary aim was to describe the microsurgical white matter anatomy of the cerebral isthmus by using the fiber dissection technique, and they discuss its functional significance. In addition, they sought to investigate its possible surgical utility in approaching lesions located in or adjacent to the lateral ventricle. METHODS This study was divided into 2 parts and included 30 formalin-fixed cerebral hemispheres, 5 of which were injected with colored silicone. In the first part, 15 uncolored specimens underwent the Klinger’s procedure and were dissected in a lateromedial direction at the level of the superior, inferior, and anterior isthmuses, and 10 were used for coronal and axial cuts. In the second part, the injected specimens were used to investigate the surgical significance of the superior isthmus in accessing the frontal horn of the lateral ventricle. RESULTS The microsurgical anatomy of the anterior, superior, and inferior cerebral isthmuses was carefully studied and recorded both in terms of topographic and fiber tract anatomy. In addition, the potential role of the proximal part of the superior isthmus as an alternative safe surgical corridor to the anterior part of the lateral ventricle was investigated. CONCLUSIONS Using the fiber dissection technique along with coronal and axial cuts in cadaveric brain specimens remains a cornerstone in the acquisition of thorough anatomical knowledge of narrow white matter areas such as the cerebral isthmus. The surgical significance of the superior isthmus in approaching the frontal horn of the lateral ventricle is stressed, but further studies must be carried out to elucidate its role in ventricular surgery.

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Background/Objective: Carbon nanoparticles (CNs) are a novel injected suspension used during thyroidectomy in order to black stain the thyroid gland and the lymph nodes while maintaining the anatomic color of the parathyroid glands and the laryngeal nerves. The aim of this systematic review is to investigate the benefits of carbon nanoparticles in thyroid surgical procedures and examine their role in lymph node tracing, parathyroid preservation and recurrent laryngeal nerve protection. Methods: A systematic review of the literature in PubMed/Medline database was performed. Articles reporting randomized clinical trials, prospective and retrospective studies that compared the use of carbon nanoparticles in one group of patients with a control-blank group were included. Results: The search strategy retrieved 22 studies of the literature. Fourteen studies calculated a greater number of lymph nodes detected/dissected in the central neck zone to the patients using CN solution and 1 article noted a higher rate of lymp h nodes resected in the lateral neck zone in the same group of patients. A significant increase in the number of metastatic lymph nodes retrieved in the CN group was found in 7 studies. Twenty -one studies suggested that the use of CNs for protection of the parathyroid glands was beneficial. Transient hypoparathyroidism and transient hypocalcemia were presented with a significant lower incidence in the CN group in 13 and in 8 studies respectively. Conclusion: Carbon nanoparticles may improve both central and lateral neck dissection and enhance parathyroid gland.