Microsurgical anatomy and clinical significance of the insular and basal ganglier region

Objective The purpose of this study was to define the relationships among the sylvian fissure,insular,basal ganglia and lateral ventricles.Methods Topographic anatomy of 10 cadaveric brains(20 cerebral hemispheres)were examined with microsurgical methods,the relationships among sylvian fissure,insular,basal ganglia and lateral ventricles were detailed.Results Opening specific of the sylvian fissure can expose different parts of the insular.The inferior end of the central sulcus on the convexity was located less than 5.5 mm posterior and 5.0 mm anterior to the central insular sulcus.Isular cortex and the extreme capsule coverd the claustrum,external capsule,putamen,globus pallidus,and the internal capsule.The anterior portion of the superior periinsular sulcus was separated from the frontal horn by the anterior isthmus,and the posterior portion of the periinsular sulcus was separated from the atrium by the posterior isthmus.Vertical distance between the anterior insular point and the frontal horn was approximately 10 mm.Distance between the posterior insular point and the atrium was 12 mm.Distance between the mid inferior periinsular sulcus and the temporal horn was 10 mm.The foramen of Monro was located deep to the posterior short gyrus at the midpoint level of the middle short gyrus.Conclusions An understanding of the relationship among the sylvian fissure,the insular cortex and the deep landmarks is helpful in planning transinsular approaches.