The anatomy of transsylvian fissure-insular surgical approach for removal of intracerebral hematoma in basal ganglia region

Objective To study the anatomy via transsylvian fissure-insular surgical approach in the surgery of intracerebral hematomas in basal ganglia region for a good removal of hematoma,well preservation of brain tissues and decrease of post-operation complications.Methods Dissection and relative measurement were performed in the sylvian fissure,operculum insulae,insular,middle cerebral artery and basal ganglia of 10 adult cadaveric heads(20 hemispheres).Results There were 3 branches in the surface of sylvian fissure,which had a close relationship with the operculum insulae,making the exposure of the insular more easy;the insular had a shape of the incompletely inverted pyramid,had 4~7 insular gyri in its surface,and the anterior,superior and inferior limiting sulcus separated from frontal,parietal and temporal lobe along the periphery of the insula;the M1 of the middle cerebral artery(MCA) coursing outward the sphenoidal crest,and the bifurcation of the M1 segment usually located at the level of the limen insulae;and the M2 of MCA appeared as a shape of v or mesh,expanding backward and upward on the surface of insula in a shape of fan,and terminal tiny perforating arteries of the M2 segments provided the supply to the insula;internal surface of the insula covered the basal ganglia,inner vesicle and thalamus.In this study,we found that the middle horizontal section of the insula,the middle and post short gyrus pointed to inward the widest part of the putamen and also the genu of internal capsule.Conclusion A knowledge of the anatomy of the sylvian fissure-insular surgical approach is helpful for the clearing of intracerebral hematomas in basal ganglia region.