Surgical assessment of the insula. Part 1: surgical anatomy and morphometric analysis of the transsylvian and transcortical approaches to the insula

Journal of Neurosurgery
Arnau BenetM S Berger

Abstract

Transcortical and transsylvian corridors have been previously described as the main surgical approaches to the insula, but there is insufficient evidence to support one approach versus the other. The authors performed a cadaveric comparative study regarding insular exposure, surgical window and freedom, between the transcortical and transsylvian approaches (with and without cutting superficial sylvian bridging veins). Surgical anatomy and skull surface reference points to the different insular regions are also described. Sixteen cadaveric specimens were embalmed with a customized formula to enhance neurosurgical simulation. Two different blocks were defined in the study: first, transsylvian without (TS) and with the superficial sylvian bridging veins cut (TSVC) and transcortical (TC) approaches to the insula were simulated in all (16) specimens. Insular surface exposure, surgical window and surgical freedom were calculated for each procedure and related to the Berger-Sanai insular glioma classification (Zones I-IV) in 10 specimens. Second, the venous drainage pattern and anatomical landmarks considered critical for surgical planning were studied in all specimens. In the insular Zone I (anterior-superior), the TC approach provid...Continue Reading

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Citations

Apr 15, 2017·World Neurosurgery·Chikezie I EseonuAlfredo Quinones-Hinojosa
May 19, 2017·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Marec von Lehe, Yaroslav Parpaley
Nov 11, 2017·Neurosurgery·Doris D WangMitchel S Berger
Jan 20, 2018·Journal of Neurosurgery·Eberval G FigueiredoLeonardo C Welling
Sep 22, 2018·Journal of Neurosurgery·Ramin A MorshedMitchel S Berger
Jan 6, 2019·Journal of Neurosurgery·Shawn L Hervey-Jumper, Mitchel S Berger
Nov 30, 2018·Journal of Neurosurgery·N U Farrukh HameedJinsong Wu
Aug 24, 2019·Journal of Neurosurgery·Harsh DeoraSanjay Behari
Aug 31, 2019·Journal of Neurosurgery·José Pedro LavradorRanjeev Singh Bhangoo
May 27, 2017·Journal of Neurosurgical Sciences·Domenico MurroneFrancesco Signorelli
May 14, 2019·Operative Neurosurgery·Sergio García-GarcíaArnau Benet
Feb 2, 2020·Journal of Neuro-oncology·Zhenye LiJian Xie
Aug 29, 2020·Acta neurochirurgica·Alexandre RouxJohan Pallud
Dec 29, 2020·British Journal of Neurosurgery·Amanjot SinghSanjay Behari
Feb 22, 2021·Journal of Neuro-oncology·Colin J PrzybylowskiNader Sanai
Oct 30, 2021·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·Jaclyn J RenfrowIan F Parney

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Methods Mentioned

BETA
dissection
dissector

Software Mentioned

Stryker
JMP

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