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Oğuz Kağan Demirtaş et al.
of the Department of Neurosurgery at Ankara Kaz University Hospital, Turkey, combined fiber bundle microdissection, tomographic dissection and DTI techniques to study the insula leaf and the insular cover as a whole, and the results were published online in J Neurosurg in March 2022
.
- Excerpted from the article chapter
【Ref: Demirtaş OK, et al.
J Neurosurg.
2022 Mar 18:1-15.
doi: 10.
3171/2021.
12.
JNS212297.
[Epub ahead of print] 】
Research background
The insular leaf is surrounded by the island cover, and there are many important white matter fiber bundles running deep on the insular leaf
.
Radiological, anatomical, and electrophysiological studies have shown that the insula and operculum have higher cortical function, and therefore have higher
surgical complications in this area compared with surgery in other areas of the brain.
Although many studies have focused on the white matter fiber anatomy of the insula leaf, most removal of the insular cover begins to peel off the insular leaf.
Oğuz Kağan Demirtaş et al.
of the Department of Neurosurgery at Ankara Kaz University Hospital, Turkey, combined fiber bundle microdissection, tomographic dissection and DTI techniques to study the insula leaf and the insular cover as a whole, and the results were published online in J Neurosurg in March 2022
.
Research methods
The researchers took 20 formalin-fixed adult cerebral hemispheres for fiber bundle dissection (Klingler technique) and tomographic anatomy
.
dissection from outside to inside, inside to outside, bottom to top, top to bottom; Silicone models are used to show the anatomy of the normal gyrus, and the MRI fiber beam imaging technique DTI helps to understand anatomy
.
The results revealed the anatomical relationship between the outermost capsule and the outer capsule and the surrounding insular operculum, and the anatomical relationship
between the frontal occipital tract and the frontal orbital insular operculum.
The fibers of the outermost capsule connect the medial surface of the island cover to the insular leaf via the annular sulcus
.
Study results
The following is an illustration to describe the microdissection
of the insula leaf and the fibrous bundle of the insular lid.
1.
Microanatomy of the insula and insular lid A.
Side view
of the cerebral hemisphere of the silicone model.
B.
The posterior and horizontal branches of the lateral fissure divide the insular operculum into three parts, the horizontal branch of the lateral fissure is the dividing line between the frontal orbital operculum and the frontal parietal operculum, and the posterior ramus is the boundary between the temporal operculum and the frontal parietal part
.
C.
Magnified view of Figure B, the orbital part of the inferior frontal gyrus, the retroorbital gyrus, and the lateral orbital gyrus constitute the lateral surface of the frontal orbital operculum, and the anterior circumferential sulcus separates the frontal orbital operculum and the anterior part of the insula
.
The outer surface of the frontal parietal operculum consists of the triangular part of the inferior frontal gyrus, the operculum, the lower part of the anterior and posterior central gyrus, and the upper part of the superior marginal gyrus, and the superior ring sulcus separates the frontal parietal operculum from the insular lobe
.
The lower parts of the superior temporal gyrus and the superior marginal gyrus constitute the outer surface of the temporal operculum, and its inner surface is composed
of the polar plane, the transverse temporal gyrus and the temporal plane from anterior to posterior, respectively.
The insula is divided into two parts
, anterior and posterior, by the central sulcus of the island.
There are three short iles in the anterior part of the island leaf and two long gyrus
in the posterior part of the island leaf.
In addition, the island can be seen horizontally
.
Figure 2.
A.
Brodmann area around the lateral fissure roughly matches
the gyrus.
B.
About 1.
5 cm above the lateral fissure, cut the insular operculum from the anterior orbit posteriorly to the upper margin to the superior toric sulcus, removing the frontal orbital operculum and the frontal parietal operculum to reveal the medial surface
of the temporal operculum.
C.
Cut the island cap from the superior temporal sulcus to the inferior toric sulcus and observe the temporal operculum
.
Figure 3.
The relationship between
the frontal orbital operculum, the frontal parietal operculum and the insular lobe after temporal lobe removal was observed from different angles.
The upper fornix body and the lower parahippocampal gyrus are preserved, stripping the central core region (thalamus, caudate head and internal capsule, globus pallidus, putamen, outer capsule, screen-like nucleus, outermost capsule, and insular cortex)
from the inside out.
A.
The relationship
between the island cap and the surrounding brain tissue is shown from the medial surface.
B.
Magnified view
of Figure A.
C.
4K endoscopic close-up
.
Figure 5.
A.
The medial surface of the sagittal fault dissection of the left cerebral hemisphere at the level of the circumferential sulcus, the relationship
between the insula and the insular operculum gyrus is visible.
B.
After removing each turn of the island leaf, the inner surface
of the entire island cover is visible.
2.
Anatomy of white matter fibers in the insula and insular operculum 6.
A.
Remove the cortex around the lateral side of the insula lobe, retain the anterior and posterior central gyrus as reference points and the transverse temporal gyrus, and peel off the frontal orbital operculum, frontal parietal operculum and temporal operculum, and the insular cortex, arcuate bundle and three short insulins
are visible.
B.
Preserve the anterior and posterior short glorums facing the central sulcus of the island, and peel off the remaining insular cortex, revealing the outermost U-shaped fibers
.
C.
Magnified view
of Figure B.
D.
Pull the frontal operculum upwards to reveal white matter fibers
emanating from the superficial layer of the outermost capsule to the parietal part of the forehead.
E.
Pulling down the temporal operculum reveals white matter fibers
emanating from the superficial layer of the outermost capsule to the temporal operculum.
F.
Pulling the frontal orbital operculum forward, visible white matter fibers
emanating from the superficial layer of the outermost capsule to the frontal parietal operculum.
G.
DTI shows the main white matter fiber bundle - arcuate bundle
surrounding the island cover.
H.
DTI shows white matter fiber bundles aggregating
in the island lid.
Figure 7.
A.
Preservation of the central sulcus of the island, showing hooked and frontal-occipital tracts
after removal of the insular cortex and superficial layer of the outermost capsule.
B.
Magnified view of Figure A, the gray matter in the deep surface of the central ditch of the island is a screen-like nucleus; The hooked bundle is the liaison fiber
that connects the frontal orbital cortex and the temporal pole at the threshold level.
On its dorsal medial, there are frontal-occipital tracts
connecting the frontal, occipital, parietal, and temporal regions.
On the dorsal side of the screen nucleus, the cortical fibers of the screen nucleus connect the screen nucleus to the cortex
.
C.
Sequential peeling of the screen-like cortical fibers, posterior part of the putamen, showing globus pallidus, anterior commissure, and internal capsule
.
D.
Peel off to the deep surface of the outermost capsule, remove the frontal orbital cortex and its deep U-shaped fibers, and most of the fibers of the frontooccipital tract travel to the frontal pole; A shallow, thin fiber turns 90° horizontally to the frontal orbital operculum and terminates there
.
E.
DTI shows three main contact fibers: hooked bundle (yellow), frontal-occipital bundle (blue), and screen-shaped nucleocortical fiber (green).
F.
DTI shows that the frontal occipital bundle has two branches in the insular part, one with the opercular branch terminating at the frontal orbital operculum and the other with the frontal pole branch terminating at the frontal pole
.
A.
Right hemisphere dissection to the superficial level of the outermost capsule and left hemisphere dissection to the deep level
of the outermost capsule.
The fibers on the deep surface of the outermost capsule are composed of hooked bundles, long contact fibers of the frontal occipital tract, and the superficial layer consists of
U-shaped fibers between the adjacent insular cap and the insular gyrus.
B.
DTI shows the deep and superficial fibrous bundles
of the outermost capsule corresponding to the anatomy.
Conclusion of the study
Finally, the authors believe that understanding the anatomical relationship between the insula and the surrounding insular cover is necessary for neurosurgeons, and that this anatomical study provides new insights
into the connection between the insula and the insular cap through the outermost capsule and the outer capsule fibers.
