Varnavas G G, Grand W
Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, USA.
Neurosurgery. 1999 Jan;44(1):127-36; discussion 136-8. doi: 10.1097/00006123-199901000-00079.
We undertook this anatomic study of the insula to investigate its vasculature, morphological features, and surrounding cortical relationships.
Under magnification of x2 to x32, 53 formalin-fixed, adult cadaver hemispheres were dissected. Overlying opercular landmarks were identified and used as guides to portions of the deeper insula.
The insula has a complex venous system; 50 (94.3%) hemispheres exhibited a combination of superficial and deep venous connections. The venous connections divide the insular cortex into the following three anatomic zones, with some overlap: subapical region (insular pole), anterior lobe, and posterior lobe. Arterial contributions to the insula originated entirely from the middle cerebral artery, predominantly via the superior division. Thirty-six (67.9%) specimens exhibited a dedicated terminal vessel to the insula; in 34 of these (94.4%), this terminal vessel arose from the middle cerebral artery branch to the central sulcus. There was never more than one terminal vessel in each insular cortex.
Historically, it has been reported that the insula drains primarily via the deep middle cerebral vein (DMCV). We found more complex (typically both superficial and deep) venous connections. In most specimens, the DMCV exhibited a direct venous connection to only a portion of the insular cortex. The deep drainage connections of the insula and the vessels that form the DMCV suggest that the DMCV drains primarily the lateral lenticular veins and secondarily the insula. Arterial contributions to the insula tended to be centered around the central insular sulcus, independent of the location of the middle cerebral artery bifurcation. Although the insular vascular anatomic features showed great variability, the anatomic and structural relationships described in this dissection series should facilitate safe surgical and endovascular interventions.
我们对脑岛进行了这项解剖学研究，以调查其血管系统、形态特征及周围皮质关系。
在2倍至32倍放大倍数下，解剖了53个用福尔马林固定的成人尸体半球。识别覆盖的岛盖标志，并将其用作更深层脑岛各部分的引导。
脑岛有一个复杂的静脉系统；50个（94.3%）半球表现出浅静脉和深静脉连接的组合。静脉连接将岛叶皮质分为以下三个解剖区域，有一些重叠：顶下区域（脑岛极）、前叶和后叶。供应脑岛的动脉完全起源于大脑中动脉，主要通过上支。36个（67.9%）标本有一条专门供应脑岛的终末血管；其中34个（94.4%），这条终末血管起源于大脑中动脉至中央沟的分支。每个脑岛皮质中终末血管从不超过一条。
历史上曾有报道称脑岛主要通过大脑中深静脉（DMCV）引流。我们发现了更复杂的（通常是浅静脉和深静脉都有）静脉连接。在大多数标本中，DMCV仅与部分脑岛皮质有直接静脉连接。脑岛的深引流连接以及形成DMCV的血管表明，DMCV主要引流外侧豆状核静脉，其次是脑岛。供应脑岛的动脉倾向于围绕脑岛中央沟集中，与大脑中动脉分叉的位置无关。尽管脑岛血管解剖特征存在很大变异性，但本解剖系列中描述的解剖和结构关系应有助于安全的手术和血管内介入。
