Bykanov A E, Pitskhelauri D I, Dobrovol'skiy G F, Shkarubo M A
Burdenko Neurosurgical Institute, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2015;79(4):48-60. doi: 10.17116/neiro201579448-60.
The objective of the study was to investigate the surgical anatomy of the insular cortex, morphology and vascularization of the insula and adjacent opercula in terms of transsylvian and transcortical approaches, and identification of the permissible anatomical boundaries for resection of glial tumors of the insula.
The study was conducted on 18 anatomical specimens fixed in an alcohol-glycerol solution. Perfusion of the internal carotid artery with red latex was used to study the arterial system. Dissection of the arteries and Sylvian fissure, investigation of the morphological features of the opercula as well as simulation of the transsylvian and transcortical approaches to the insula were performed using a surgical microscope, in a certain sequence.
In the trassylvian approach, the anteroinferior part of the insula (including the limen insulae) is the most technically easy-to-reach area, whereas the superior parts of the insula are the most difficult-to-reach areas. With the tumor localized in the superior insula, the transcortical approach may be recommended that, unlike the transsylvian approach, does not require a significant retraction of the brain matter and provides a larger surgical corridor. The transcortical approach, regardless the insular region, provides a better surgical view and workspace compared to the transsylvian approach. However, the previous approach is characterized by less access to the important anatomical landmarks such as the peri-insular sulci, limen insulae, and lateral lenticulostriate arteries. Furthermore, the approach requires dissection of the brain matter of the frontal and temporal lobes.
Detailed knowledge of the surgical anatomy of the insular region provides correct intraoperative identification of a number of the major anatomical landmarks (limen insulae, peri-insular sulci, most distal lenticulostriate artery) and facilitates choosing the proper surgical approach.
本研究的目的是从经外侧裂和经皮质入路的角度，研究岛叶皮质的手术解剖结构、岛叶及相邻脑盖的形态和血管分布，以及确定岛叶胶质瘤切除的允许解剖边界。
本研究对18个固定在酒精 - 甘油溶液中的解剖标本进行。通过向颈内动脉灌注红色乳胶来研究动脉系统。使用手术显微镜按一定顺序进行动脉和外侧裂的解剖、脑盖形态特征的研究以及对岛叶的经外侧裂和经皮质入路的模拟。
在经外侧裂入路中，岛叶的前下部（包括岛阈）是技术上最容易到达的区域，而岛叶上部是最难到达的区域。当肿瘤位于岛叶上部时，可能推荐经皮质入路，与经外侧裂入路不同，该入路不需要大幅度牵拉脑实质，并且提供更大的手术通道。无论岛叶区域如何，经皮质入路与经外侧裂入路相比，能提供更好的手术视野和工作空间。然而，前一种入路的特点是较难触及重要的解剖标志，如岛周沟、岛阈和外侧豆纹动脉。此外，该入路需要切开额叶和颞叶的脑实质。
对岛叶区域手术解剖的详细了解有助于术中正确识别一些主要的解剖标志（岛阈、岛周沟、最远端的豆纹动脉），并有助于选择合适的手术入路。
