Relationship between the coronal suture and the central lobe: how important is it and how can we use it in surgical planning?

Abstract

-The surgical treatment of the lesions located in the central lobe is a very difficult task for the neurosurgeon. The overall aim of this study is to verify the correlation of the coronal suture and the structures of the central lobe in 32 cadaver hemisphere brains and the importance of this information in surgical planning. The measurement of the nasion to the coronal suture ranged from 11.5 to 13.5 cm. The distance between the coronal suture in the midline to the central, precentral and paracentral sulcus ranged from 5.0 to 6.6, 2.5 to 4.5 and 1.3 to 4.0 cm respectively. Particularly in the normal cortex these measurements can be used to guide the surgical access. However, the identification of the central sulcus is not easy when the anatomical pattern is distorted or displaced by a lesion or edema. In cases such as these the use of other tools becomes crucial for good surgical planning and cortical mapping or awake craniotomy for a safer resection of the lesion as well.Key words: coronal suture, central lobe, central sulcus, motor cortex, preoperative planning. Relação entre a sutura coronária e o lobo central: qual a sua importância e como podemos usá-la no planejamento cirurgico?Resumo -o tratamento cirúrgico de lesões localizadas no lobo central é difícil para o neurocirurgião. o objetivo deste estudo é verificar a relação da sutura coronária com as estruturas do lobo central utilizandose de dissecção realizada em 32 hemisférios cerebrais de 16 cadáveres, assim como, a importância desta informação no planejamento cirúrgico. A medida da distância entre o nasion e a sutura coronária variou entre 11,5 e 13,5 cm. A distância da sutura coronária na linha média para os sulcos central, pré-central e paracentral variou de 5,0 a 6,6 cm, 2,5 a 4,5 cm e 1,3 a 4,0 cm respectivamente. o conhecimento destas medidas pode ser usado no planejamento cirúrgico principalmente num córtex normal. Porém, a identificação do sulco central é difícil quando as estruturas anatômicas estão deslocadas pela lesão ou quando há edema. Nestes casos a utilização de outros meios diagnósticos para o planejamento cirúrgico torna-se necessária, como também a estimulação cortical ou a craniotomia com o paciente acordado pode proporcionar uma ressecção mais segura da lesão.PAlAvrAs-cHAve: sutura coronal, lobo central, sulco central, córtex motor, planejamento pré-operatório. The central lobe is a site of a wide variety of lesions and sometime surgeons need to approach it directly, for example in the resection of gliomas. However, manipulation in an eloquent area increases the risk of pos surgical complications and deficits. A knowledge of the morphological relationship of this lobe and its relationship to the craniometric points and sutures facilitates the approach to the lesion preserving neurovascular structures [1][2][3][4][5][6] . exact and correct localization of the central sulcus becomes crucial.

Localization of the bregma and its clinical relevance

“…Rivet et al [17] stated that the distance from the coronal suture to the motor cortex was <3 cm in children under 6 years. Sarmento et al [18] stated that the distance between the coronal suture and the central sulcus ranged from 5 to 6.6 cm, in accordance to measurements of Gusmão et al [11] and Ribas et al [12] in the adult. Further, Frigeri et al [19] reported that the precentral gyrus and central sulcus are closest at a point near where the superior temporal line crossed the coronal suture.…”

The Role of the Intraoperative Auxiliary Methods in the Resection of Motor Area Lesions

“…Although technology already offers modern intraoperative localization tools such as MRI and neuronavigation, anatomical knowledge remains an important part of surgical planning. [12][13][14][15] Craniotomy planning is an essential step in approaching motor area lesions. Paul Broca (1824-1880) was the first neurosurgeon to perform a craniotomy based on anatomical localization.…”

“…16 In previous anatomical studies, we verified that the distance between the coronal suture and the central sulcus ranged from 5.6 to 6.6cm in the midline, and that the coronal suture on the pterion region to the central sulcus ranged from 1.5 to 4.0cm. 13 Additionally, the coronal suture was 11.5 to 13.5cm behind the nasium. It is possible to measure these distances by using radiological images, which can then be transferred to the scalp or determined by palpation of the skull.…”

“…[9][10][11] Despite increased use of such techniques, the anatomical knowledge and the use of precise neurosurgical techniques still play a decisive role in the attempt to preserve the full integrity of vascular structures and decrease the risk of functional deficits. [12][13][14][15] The aim of this study was to explore which of the abovementioned methods is best in the resection of motor area lesions. We also investigated the relationship between methods used and the development of postoperative motor deficits.…”

Microsurgical anatomy of the central lobe

“…45 There have been several studies of gyral and sulcal anatomy, craniometrics, and vascular features that included this area. 1,4,10,11,17,19,[21][22][23][24]28,36,[39][40][41][43][44][45][46]51,54,56,57 However, important details are still lacking. The aim of the present study is to define the neural features, craniometric relationships, arterial supply, and venous drainage of the central lobe.…”