Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA.
Neurosurgery. 2009 Dec;65(6 Suppl):1-35; discussion 36. doi: 10.1227/01.NEU.0000336314.20759.85.
We present observations of the anatomy of the sylvian fissure region and their clinical application in neuroimaging, microsurgery for middle cerebral artery aneurysms and insular lesions, frontobasal resections, and epilepsy surgery.
Sixty adult cadaveric hemispheres and 12 adult cadaveric heads were studied after perfusion of the arteries and veins with colored latex. The anatomic information was applied in more than 200 microsurgeries in and around the sylvian fissure region in the past 15 years.
The sylvian fissure extends from the basal to the lateral surface of the brain and presents 2 compartments on each surface, 1 superficial (temporal stem and its ramii) and 1 deep (anterior and lateral operculoinsular compartments). The temporal operculum is in opposition to the frontal and parietal opercula (planum polare versus inferior frontal and precentral gyri, Heschl's versus postcentral gyri, planum temporale versus supramarginal gyrus). The inferior frontal, precentral, and postcentral gyri cover the anterior, middle, and posterior thirds of the lateral surface of the insula, respectively. The pars triangularis covers the apex of the insula, located immediately distal to the genu of the middle cerebral artery. The clinical application of the anatomic information presented in this article is in angiography, middle cerebral artery aneurysm surgery, insular resection, frontobasal resection, and amygdalohippocampectomy, and hemispherotomy.
The anatomic relationships of the sylvian fissure region can be helpful in preoperative planning and can serve as reliable intraoperative navigation landmarks in microsurgery involving that region.
我们展示了外侧裂区域的解剖结构，并将其应用于神经影像学、大脑中动脉动脉瘤和岛叶病变的显微手术、额底切除术和癫痫手术。
60 个成人尸头的大脑半球和 12 个成人尸头的头颅经动脉和静脉彩色乳胶灌注后进行研究。在过去的 15 年中，我们在外侧裂区域及其周围进行了 200 多次以上的显微手术，将解剖信息应用于手术中。
外侧裂从脑底部延伸到脑的外侧表面，在每个表面上有 2 个隔室，1 个浅部（颞干及其分支）和 1 个深部（前外侧脑岛隔室）。颞叶脑岛与额盖和顶盖相对（极盖相对于额下回和中央前回，Heschl 回相对于中央后回，颞叶盖相对于缘上回）。额下回、中央前回和中央后回分别覆盖脑岛外侧表面的前、中、后三分之一。三角部覆盖脑岛的顶点，位于大脑中动脉膝部的远端。本文所介绍的解剖信息的临床应用包括血管造影、大脑中动脉动脉瘤手术、岛叶切除术、额底切除术和杏仁核海马切除术，以及半球切开术。
外侧裂区域的解剖关系有助于术前规划，并可作为该区域显微手术中可靠的术中导航标志。
