The Insular Cortex: Morphological and Vascular Anatomic Characteristics

Varnavas, Gus; Grand, Walter

doi:10.1097/00006123-199901000-00079

Cited by 115 publications

(98 citation statements)

References 23 publications

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“…15) The venous configuration of the insula reflects a mixture of superficial and deep Anatomy of Sylvian Vein connections. 14) We found a significant anastomosis between the SSV and the common trunk of insular veins in 51% of cases. This anastomotic trunk has been called a common vertical trunk, with which the tributaries from the frontal base (FBBVs) can also join.…”

Section: % Of Casesmentioning

confidence: 63%

Operative Anatomy and Classification of the Sylvian Veins for the Distal Transsylvian Approach

Kazumata

Kamiyama

Ishikawa

et al. 2003

Neurol. Med. Chir.(Tokyo)

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Methods for preservation of the sylvian veins in the transsylvian approach have not been established because of the considerable variations. This study attempted to classify the sylvian veins to facilitate systematic dissection of the sylvian fissure for sylvian veins to be preserved. The operative anatomy of the sylvian vein was examined in 82 hemispheres. The type of drainage and the pattern of branching were investigated. The superficial sylvian vein (SSV) was classified into three types according to the number of stems draining into the dural sinus on the inner surface of the sphenoid bone: The SSV was absent or hypoplastic in eight cases, the SSV was single in 38 cases, and the SSV was double in 36 cases. The SSV drained into neither the sphenoparietal sinus nor the cavernous sinus in nine cases. An anastomosis between the SSV and the deep middle cerebral vein (DMCV) was observed in 42 cases. The frontobasal bridging vein (FBBV) drained into the sphenoparietal sinus in 47 cases. The type of connection was further subdivided into four types according to the connections with the DMCV and FBBV. The venous anatomy of sylvian fissure indicates that dissection (skeletonization) of the main stem of sylvian veins from the temporal lobe should be performed to preserve the tributaries from the frontal lobe.

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Section: % Of Casesmentioning

confidence: 63%

Operative Anatomy and Classification of the Sylvian Veins for the Distal Transsylvian Approach

Kazumata

Kamiyama

Ishikawa

et al. 2003

Neurol. Med. Chir.(Tokyo)

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“…Surgery of the insular area is known to be challenging because of its close relationship with vascular structures. 8,15,26,36,[38][39][40] Immediate postoperative deficits have been previously reported with incidence rates between 9.2% and 74% in the literature. Comparison in incidence rate of transient or permanent complications is difficult considering that these series have mostly dealt with patients with tumors or vascular malformations often extending outside the insula both to surrounding lobes and in deeper subcortical structures.…”

Section: Discussionmentioning

confidence: 99%

Vascular consequences of operculoinsular corticectomy for refractory epilepsy

Finet¹,

Nguyen

Bouthillier³

2015

JNS

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OBJECT Surgery in the insular region is considered challenging because of its vascular relationships, the proximity of functional structures, and its deep location in the sylvian fissure. The authors report the incidence and consequences of ischemic lesions after operculoinsular corticectomy for refractory epilepsy. METHODS The authors retrospectively reviewed the data of all patients who underwent an insular resection with or without an opercular resection for refractory epilepsy at their center. All patients underwent postoperative MRI, enabling a radiological analysis of the ischemic lesions as a result of the corticectomies. The resections were classified according to the location and extent of the insular corticectomy and the type of operculectomy. Each patient underwent clinical follow-up. RESULTS Twenty patients underwent surgery. All patients underwent insular corticectomy with or without an operculectomy. Ischemic lesions were identified in 12 patients (60%). In these patients, 11 ischemic lesions (55%) were related to the insular corticectomy, and 1 was related to the associated periinsular resection. The ischemic lesions associated with the insulectomies were typically located in the corona radiata running from the insula to the periventricular region. Nine patients (45%) developed a postoperative neurological deficit, among whom 6 (67%) had an insular corticectomy–related ischemic lesion. All reported neurological deficits were transient. Five patients (25%) had ischemic lesions without neurological deficit. CONCLUSIONS Operculoinsular corticectomies are associated with ischemic lesions in approximately 60% of patients. However, given that no patient had a definitive postoperative deficit, these ischemic lesions have few clinical consequences. Therefore, this surgical procedure can be considered reasonably safe for the treatment of refractory epilepsy.

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“…omy of the insula has only recently been described in detail. [43][44][45]47 The insular lobe is a part of the cerebral cortex covered by the opercula of the frontal, parietal, and temporal lobes. The 3D structure of the insula constitutes a pyramid, and its apex represents the most lateral and superficial point of the structure, located 9-16 mm from the cortical surface.…”

Section: Surgical Anatomymentioning

confidence: 99%

“…The uncinate fasciculus runs medial to the anterior portion of the superior periinsular sulcus. 43,44,47 The course of the MCA along the insular surface poses certain challenges during surgery. The insula receives most of its vascular supply from short perforating vessels originating from the M 2 and M 3 segments of the MCA.…”

Section: Surgical Anatomymentioning

confidence: 99%

Technical nuances for surgery of insular gliomas: lessons learned

Rey‐Dios

Cohen-Gadol

2013

FOC

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Insular gliomas were traditionally considered a nonsurgical entity due to the high morbidity associated with resection. For the past 20 years, advances in microsurgical and brain mapping techniques have allowed neurosurgeons to resect insular gliomas with acceptable morbidity rates. Maximizing the extent of resection is nowadays the goal of surgery since this has proven to be an independent factor contributing to longer survival. Despite much progress, insular tumors remain a challenge for the neurosurgeon due to the complex anatomy of the region and technical expertise required to minimize morbidity during surgery. Herein, the authors describe the current surgical nuances, based on their experience and a literature review, that will allow the surgeon to achieve a thorough resection while ensuring patient safety. The key factors for successful surgery in the insular region include detailed knowledge of the surgical anatomy, mastery of the nuances of cortical and subcortical mapping methods, and meticulous microsurgical technique.

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The Insular Cortex: Morphological and Vascular Anatomic Characteristics

Cited by 115 publications

References 23 publications

Operative Anatomy and Classification of the Sylvian Veins for the Distal Transsylvian Approach

Operative Anatomy and Classification of the Sylvian Veins for the Distal Transsylvian Approach

Vascular consequences of operculoinsular corticectomy for refractory epilepsy

Technical nuances for surgery of insular gliomas: lessons learned

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