Delineation of the Safe Zone in Surgery of Sylvian Insular Triangle

Kaneko, Nobuyuki; Boling, Warren; Shonai, Takaharu; Ohmori, Kazumi; Shiokawa, Yoshiaki; Kurita, Hiroki; Fukushima, Takanori

doi:10.1227/neu.0b013e3182315112

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…They differentiated posterior periinsular sulcus from inferior periinsular sulcus and stated that the 2 sulci have two different axis separated by an angle. 5,6,16 Our study finding concides with presence of 4 periinsular sulci (anterior, superior, inferior, posterior) clarify trapezoid shape of insular cortex. …”

Section: Peripheral Sulci -Trapezoid Shape Insulasupporting

confidence: 65%

“…The posterior periinsular sulcus was differentiated from inferior periinsular sulcus and these two sulci have two different axis separated by an angle. 5 The Insula is a trapezoid shaped cortical structure with its apex directed anteriorly and inferiorly toward the limen insulae. The limen is located at the junction of sphenoidal and operculoinsular compartments of the sylvian fissure.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 There are four periinsular sulci, cited superiorly and posteriorly in a radial manner from the apex at the limen insulae. 5,6 The central insular sulcus, the main and the deepest sulcus of the insula, courses obliquely across the insula, and extends uninterrupted from the limen insula to the superior peripheral sulcus. It divides the insula into two unequal zones: the larger anterior insula, and the smaller posterior insula.…”

Section: Introductionmentioning

confidence: 99%

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Morphological and morphometric study of insular cortex in human cadaveric brains

2020

IJCAP

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Introduction and Aim: The insular cortex is hidden 5 th lobe of brain with variable gross anatomical patterns. Insula is situated in operculoinsular compartment of sylvian cistern. Materials and Methods: 58 human formalin fixed cerebral hemispheres were studied for the gyri and sulci variations of insular cortex and their lengths were recorded using digital vernier caliper. This study was done in department of Anatomy, Gandhi medical college Bhopal. Result: The morphological normal and variable pattern, discontinuous sulci and joined gyri were observed. Out of the (85/406)

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Section: Peripheral Sulci -Trapezoid Shape Insulasupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Morphological and morphometric study of insular cortex in human cadaveric brains

2020

IJCAP

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“…However, performing this procedure requires a detailed anatomical knowledge of the insula and its surroundings, since its location corresponds to the only cortical region of the brain not visible on the dorsolateral surface of the cerebral hemispheres, which justifies its difficult surgical access and the need of excellent preoperative planning and surgical skills. 1 2…”

Section: Introductionmentioning

confidence: 99%

Insulectomy for Refractory Epilepsy: Case Series and Literature Review

Rodrigues

Bernardo

Seba

et al. 2022

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Surgical resection of the insula (insulectomy) is a procedure used for brain lesions and for refractory epilepsy. It has a difficult surgical access and the need of a wide anatomical knowledge and preoperative planning. There are two types of surgical approaches aiming the exposure of the insular cortex: transsylvian and transcortical. The importance of insulectomies is the efficacy in providing a remarkable decrease in seizures. The objective of the present article is to document the results of a series of 10 patients submitted to insulectomies for refractory epilepsies and compare them with the results of other studies reported in the literature, as well as to describe the main nuances of the surgical approaches and their associated risks. In the new case series, all patients corresponded to preoperative Engel classification IV for; after a mean 2-year follow-up period, they corresponded to Engel classification II. A subtotal resection was performed in six patients, and the remaining four underwent a partial resection, most of them leading to temporary complications. The literature review endorsed the good outcomes of the casuistry. A critical analysis of the presented data reiterates the opinion of several authors that insulectomies are beneficial and safe for the patients. A broad anatomical knowledge of the insular region, preoperative planning (limits of resections), and the use of modern microsurgical techniques must be considered as basic principles by neurosurgeons for the prevention of perioperative morbidities. Insulectomies are safe and effective, although they result in temporary postoperative complications, and provide highly satisfactory results in terms of seizure control.

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