Arteries and Veins of the Sylvian Fissure and Insula: Microsurgical Anatomy

2016 ◽  
pp. 185-216 ◽  
Author(s):  
Matthieu Delion ◽  
Philippe Mercier ◽  
Gilles Brassier
Keyword(s):  
Sylvian Fissure ◽  
Microsurgical Anatomy ◽  
Arteries And Veins

Microsurgical Anatomy and Surgical Exposure of the Petrous Segment of the Internal Carotid Artery

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS210-ONS239 ◽  
Author(s):  
Shigeyuki Osawa ◽  
Albert L. Rhoton ◽  
Necmettin Tanriover ◽  
Satoru Shimizu ◽  
Kiyotaka Fujii
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Lateral Wall ◽  
Common Trunk ◽  
Microsurgical Anatomy ◽  
Carotid Canal ◽  
Complex Relationships ◽  
Arteries And Veins

Abstract Objective: The petrous segment of the internal carotid artery has been exposed in the transpetrosal, subtemporal, infratemporal, transnasal, transmaxillary, transfacial, and a variety of transcranial approaches. The objective of the current study was to examine anatomic features of the petrous carotid and its branches as related to the variety of approaches currently being used for its exposure. Methods: Twenty middle fossae from adult cadaveric specimens were examined using magnification of ×3 to ×40 after injection of the arteries and veins with colored silicone. Results: The petrous carotid extends from the entrance into the carotid canal of the petrous part of the temporal bone to its termination at the level of the petrolingual ligament laterally and the lateral wall of the sphenoid sinus medially. The petrous carotid from caudal to rostral was divided into 5 segments: posterior vertical, posterior genu, horizontal, anterior genu, and anterior vertical. Fourteen (70%) of the 20 petrous carotids had branches. The branch that arose from the petrous carotid was either a vidian or periosteal artery or a common trunk that gave rise to both a vidian and 1 or more periosteal arteries. The most frequent branch was a periosteal artery. Conclusion: An understanding of the complex relationships of the petrous carotid provides the basis for surgically accessing any 1 or more of its 5 segments.

Middle Meningeal Origin of the Ophthalmic Artery

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 401-407 ◽  
Author(s):  
Qingliang Liu ◽  
Albert L. Rhoton
Keyword(s):  
Ophthalmic Artery ◽  
Middle Meningeal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Microsurgical Anatomy ◽  
Superior Orbital Fissure ◽  
Anatomic Dissection ◽  
Retinal Artery ◽  
Arteries And Veins ◽  
Meningeal Artery

Abstract OBJECTIVE To examine the microsurgical anatomy and clinical significance of an anomalous origin of the ophthalmic artery from the middle meningeal artery. METHODS In the course of an anatomic study of the cavernous sinus, an anomalous ophthalmic artery arising from the middle meningeal artery was found. To further define the anatomy of the region, five additional skulls, in which the arteries and veins were injected with colored latex, were dissected using 3× to 40× magnification. RESULTS The anomalous ophthalmic artery arose from the frontal branch of the middle meningeal artery, passed through the superior orbital fissure, and supplied the entire contents of the orbit, as well as giving rise to the central retinal artery. This study provides the first display of this anomaly in an anatomic dissection. CONCLUSION The ophthalmic artery may infrequently arise from the middle meningeal artery. This anomaly places the ophthalmic artery at risk during procedures in which the dura is elevated from the greater and lesser wings of the sphenoid or when the sphenoid ridge is removed and during embolization procedures involving the branches of the external carotid artery.

Microsurgical Anatomy of the Temporal Lobe: Part 2—Sylvian Fissure Region and Its Clinical Application

2009 ◽  
Vol 65 (suppl_6) ◽  
pp. ons1-ons36 ◽  
Author(s):  
Hung Tzu Wen ◽  
Albert L. Rhoton ◽  
Evandro de Oliveira ◽  
Luiz Henrique M. Castro ◽  
Eberval Gadelha Figueiredo ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Clinical Application ◽  
Cerebral Artery ◽  
Lateral Surface ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Microsurgical Anatomy ◽  
Temporal Stem ◽  
Middle Cerebral Artery Aneurysms ◽  
Anatomic Information

Abstract Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Microsurgical Anatomy of the Hypoglossal Nerve in the Lateral Approaches to the Craniovertebral Junction: A Study on Fresh Non-Formalin-Fixed Human Specimens

2022 ◽  
Author(s):  
Lorenzo Pescatori ◽  
Maria Pia Tropeano ◽  
Manolo Piccirilli ◽  
Pasqualino Ciappetta
Keyword(s):  
Hypoglossal Nerve ◽  
Anatomical Study ◽  
Craniovertebral Junction ◽  
Lateral Approach ◽  
Anterolateral Approach ◽  
Microsurgical Anatomy ◽  
Arteries And Veins ◽  
Formalin Fixed

AbstractThe aim of this anatomical study is to describe the anatomy of the hypoglossal nerve (HN) from its origin to the extracranial portion as it appears by performing a combined posterolateral and anterolateral approach to the craniovertebral junction (CVJ). Twelve fresh, non-formalin-fixed adult cadaveric heads (24 sides) were analyzed for the simulation of the combined lateral approach to the CVJ. The HN is divided into three main parts: cisternal, intracanalicular, and extracranial The anatomical relationships between the HN and other nerves, muscles, arteries and veins were carefully recorded, and some measurements were made between the HN and related structures. Thus, various landmarks were determined for the easy identification of the HN. Understanding the detailed anatomy of the HN and its relationships with the surrounding structures is crucial to prevent some complications during CVJ surgery.

Comparison of Posterior Approaches to the Posterior Incisural Space: Microsurgical Anatomy and Proposal of a New Method, the Occipital Bi-transtentorial/Falcine Approach

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1208-1221 ◽  
Author(s):  
Masatou Kawashima ◽  
Albert L. Rhoton ◽  
Toshio Matsushima
Keyword(s):  
Pineal Region ◽  
New Method ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
New Approach ◽  
Quadrigeminal Cistern ◽  
Occipital Transtentorial Approach ◽  
Arteries And Veins ◽  
Lateral Walls ◽  
Transtentorial Approach

Abstract OBJECTIVE Direct surgical approaches to the posterior incisural space, including the pineal region, remain as challenges for neurosurgeons. The purposes of this study were 1) to compare the surgical views in the various posterior approaches to the posterior incisural space and 2) to propose a new approach, which is a modification of the occipital transtentorial approach. METHODS Ten adult cadaveric specimens (20 sides) were studied, using ×3 to ×40 magnification, after perfusion of the arteries and veins with colored silicone. Intraoperative views in the posterior approaches to lesions were examined in stepwise dissections. In addition, the efficacy of the occipital bi-transtentorial/falcine approach was studied. RESULTS The posterior incisural space has a roof, a floor, and anterior and lateral walls and extends backward to the level of the tentorial apex. The operative views defined by each approach differ in the extent to which they allow observation of the anatomic structures in the posterior incisural space. The occipital bi-transtentorial/falcine approach permits better observation of the contralateral half of the quadrigeminal cistern. CONCLUSION Precise surgical anatomic knowledge of each approach is required for the treatment of lesions in the posterior incisural space, because the operative fields obtained with different approaches differ significantly. The occipital bi-transtentorial/falcine approach provides greater contralateral exposure of the posterior incisural space than does the occipital transtentorial approach.

Microsurgical anatomy of the middle cerebral artery

1981 ◽  
Vol 54 (2) ◽  
pp. 151-169 ◽  
Author(s):  
Hirohiko Gibo ◽  
Christopher C. Carver ◽  
Albert L. Rhoton ◽  
Carla Lenkey ◽  
Robert J. Mitchell
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Sylvian Fissure ◽  
Microsurgical Anatomy ◽  
Main Trunk ◽  
Content Type ◽  
Posterior Parietal ◽  
Relationship Of ◽  
The Relationship ◽  
Temporal Middle

✓ The microsurgical anatomy of the middle cerebral artery (MCA) was defined in 50 cerebral hemispheres. The MCA was divided into four segments: the M1 (sphenoidal) segment coursed posterior and parallel to the sphenoid ridge; the M2 (insular) segment lay on the insula; the M3 (opercular) segment coursed over the frontoparietal and temporal opercula; and the M4 (cortical) segment spread over the cortical surface. The Sylvian fissure was divided into a sphenoidal and an operculoinsular compartment. The M1 segment coursed in the sphenoidal compartment, and the M2 and M3 segments coursed in the operculoinsular compartment. The main trunk of the MCA divided in one of three ways: bifurcation (78% of hemispheres), trifurcation (12%), or division into multiple trunks (10%). The MCA's that bifurcated were divided into three groups: equal bifurcation (18%), inferior trunk dominant (32%), or superior trunk dominant (28%). The MCA territory was divided into 12 areas: orbitofrontal, prefrontal, precentral, central, anterior parietal, posterior parietal, angular, temporo-occipital, posterior temporal, middle temporal, anterior temporal, and temporopolar. The smallest cortical arteries arose at the anterior end and the largest one at the posterior end of the Sylvian fissure. The largest cortical arteries supplied the temporo-occipital and angular areas. The relationship of each of the cortical arteries to a number of external landmarks was reviewed in detail.

Microsurgical anatomy of the insula and the sylvian fissure

2004 ◽  
Vol 100 (5) ◽  
pp. 891-922 ◽  
Author(s):  
Necmettin Tanriover ◽  
Albert L. Rhoton ◽  
Masatou Kawashima ◽  
Arthur J. Ulm ◽  
Alexandre Yasuda
Keyword(s):  
Venous Drainage ◽  
Sylvian Fissure ◽  
Cerebral Vein ◽  
Microsurgical Anatomy ◽  
Venous Anatomy ◽  
Content Type ◽  
Important Landmark ◽  
Lenticulostriate Artery ◽  
The One ◽  
Fine Print

Object. The purpose of this study was to define the topographic anatomy, arterial supply, and venous drainage of the insula and sylvian fissure. Methods. The neural, arterial, and venous anatomy of the insula and sylvian fissure were examined in 43 cerebral hemispheres. Conclusions. The majority of gyri and sulci of the frontoparietal and temporal opercula had a constant relationship to the insular gyri and sulci and provided landmarks for approaching different parts of the insula. The most lateral lenticulostriate artery, an important landmark in insular surgery, arose 14.6 mm from the apex of the insula and penetrated the anterior perforated substance 15.3 mm medial to the limen insulae. The superior trunk of the middle cerebral artery (MCA) and its branches supplied the anterior, middle, and posterior short gyri; the anterior limiting sulcus; the short sulci; and the insular apex. The inferior trunk supplied the posterior long gyrus, inferior limiting sulcus, and limen area in most hemispheres. Both of these trunks frequently contributed to the supply of the central insular sulcus and the anterior long gyrus. The areas of insular supply of the superior and inferior trunks did not overlap. The most constant insular area of supply by the cortical MCA branches was from the prefrontal and precentral arteries that supplied the anterior and middle short gyri, respectively. The largest insular perforating arteries usually arose from the central and angular arteries and most commonly entered the posterior half of the central insular sulcus and posterior long gyrus. Insular veins drained predominantly to the deep middle cerebral vein, although frequent connections to the superficial venous system were found. Of all the insular veins, the precentral insular vein was the one that most commonly connected to the superficial sylvian vein.

Lateral Transsulcal Approach to Asymptomatic Trigonal Meningiomas with Correlative Microsurgical Anatomy: Technical Case Report

2005 ◽  
Vol 56 (suppl_4) ◽  
pp. ONS-E438-ONS-E438 ◽  
Author(s):  
Shinji Nagata ◽  
Tomio Sasaki
Keyword(s):  
Parietal Lobe ◽  
Posterior Part ◽  
Superior Temporal Sulcus ◽  
Sylvian Fissure ◽  
Neurological Deficits ◽  
Microsurgical Anatomy ◽  
Transsylvian Approach ◽  
Asymptomatic Patients ◽  
Sylvian Cistern ◽  
Dominant Side

Abstract OBJECTIVE: We introduce the lateral transsulcal approach to asymptomatic trigonal meningiomas. METHODS: The approach was studied in two cadaver brains and three asymptomatic patients with trigonal meningiomas. The posterior part of the sylvian fissure, or superior temporal sulcus, is opened to the bottom. Through a small horizontal cortical incision, the trigone of the lateral ventricle is exposed in the shortest distance. The trigonal meningiomas are detached from the choroid plexus and removed. RESULTS: In patients with meningiomas on the nondominant side, the transsylvian approach was adopted. In patients with meningiomas on the dominant side, the transsylvian approach was adopted for patients with a wide sylvian cistern, and the approach through the superior temporal sulcus was adopted for patients with a narrow sylvian cistern. The transverse gyrus of Heschl was a good anatomic landmark in the operative field of the transsylvian approach. Patients with meningiomas on the dominant side exhibited transient amnestic aphasia and dyscalculia, but the symptoms disappeared in a few days or weeks. These patients were discharged without any neurological deficits. Although there are potential risks of damaging association fibers, optic radiation, the transverse gyrus of Heschl, and the parietal lobe, a thorough understanding of the topographical anatomy and careful dissection techniques can avoid morbidity. Wide opening of the sylvian fissure and debulking of the tumor are other important factors to reduce the retraction of the parietal and temporal lobes. CONCLUSION: The lateral transsulcal approach is applicable for small asymptomatic trigonal meningiomas with an acceptable risk of morbidity, even in the dominant hemisphere.

Microsurgical anatomy of the recurrent artery of Heubner

1984 ◽  
Vol 60 (1) ◽  
pp. 130-139 ◽  
Author(s):  
Francisco Gomes ◽  
Manuel Dujovny ◽  
Felix Umansky ◽  
James I. Ausman ◽  
Fernando G. Diaz ◽  
...  
Keyword(s):  
Sylvian Fissure ◽  
Injection Technique ◽  
Anterior Communicating Artery ◽  
Outer Diameter ◽  
Type I ◽  
Microsurgical Anatomy ◽  
Reconstructive Procedures ◽  
Content Type ◽  
Human Brains ◽  
Fine Print

✓ The recurrent arteries of Heubner were studied in 30 unfixed human brains (60 hemispheres) obtained from routine autopsies of individuals with a mean age of 34 years. The arteries were injected with tinted polyester resin via cannulation of the internal carotid arteries, and dissected under microscopic magnification. The recurrent artery of Heubner was absent in two hemispheres and double in seven hemispheres, either with a separate origin (in two) or from a common stem (in five). The artery of Heubner had a mean outer diameter of 0.8 ± 0.04 mm (range 0.3 to 1.5 mm) and a mean length of 23.4 ± 1.1 mm (range 12 to 38 mm). It originated from the A2 segment of the anterior cerebral artery (ACA) in 57% of the specimens, from the junction of the ACA and the anterior communicating artery in 35%, and from the A1 segment of the ACA in 8%. Three types of recurrent courses were observed. In the Type I or superior course, seen in 41 (63%) of the 65 arteries, the artery followed the superior wall of the A1 segment of the ACA. In the Type II or anterior course, the arteries found in 22 (34%) of specimens maintained a rostral position in relation to the A1 segment. In the Type III or posterior course, taken by two (3%) arteries, a posterior course of the vessel in the anterior perforated substance was found. The branching pattern was identified down to a range of 100 to 200 µ, and the average number of branches was 6.5 ± 0.4 (range 3 to 12). Four groups of branches were observed. The olfactory group was represented in 91% by a single olfactory branch, with a mean outer diameter of 0.3 ± 0.03 mm. On average, 1.9 ± 0.27 frontal branches were found with a mean diameter of 0.13 ± 0.01 mm. The branches penetrating the anterior perforated substance had a larger outer diameter (mean 0.4 ± 0.03 mm) with an average number of 2.5 ± 0.2 branches. The Sylvian fissure branches were more numerous (mean 3 ± 0.3) with a mean outer diameter of 0.4 ± 0.03 mm. The point of penetration of the main trunk was found to be constant at the level of the lateral perforated substance-medial Sylvian fissure in 85% of the cases. This report emphasizes the advantages of the intravascular casting resin injection technique in unfixed human brains over other conventional methods. It also describes the application of these anatomic data to the surgical strategy for the anterior circle of Willis, including the possible use of the recurrent artery of Heubner for microvascular reconstructive procedures.

Immunoelectron microscopic localization of elastic tissue in archival material using an improved method

1990 ◽  
Vol 48 (3) ◽  
pp. 794-795
Author(s):  
J. C. Fanning ◽  
J. F. White ◽  
R. Polewski ◽  
E. G. Cleary
Keyword(s):  
Normal Animal ◽  
Animal Tissue ◽  
Elastic Tissue ◽  
Human Tissues ◽  
Improved Method ◽  
Tissue Samples ◽  
Archival Material ◽  
Immuno Electron Microscopy ◽  
Arteries And Veins ◽  
Biochemical Examination

Elastic tissue is an important component of the walls of arteries and veins, of skin, of the lungs and in lesser amounts, of many other tissues. It is responsible for the rubber-like properties of the arteries and for the normal texture of young skin. It undergoes changes in a number of important diseases such as atherosclerosis and emphysema and on exposure of skin to sunlight.We have recently described methods for the localizationof elastic tissue components in normal animal and human tissues. In the study of developing and diseased tissues it is often not possible to obtain samples which have been optimally prepared for immuno-electron microscopy. Sometimes there is also a need to examine retrospectively samples collected some years previously. We have therefore developed modifications to our published methods to allow examination of human and animal tissue samples obtained at surgery or during post mortem which have subsequently been: 1. stored frozen at -35° or -70°C for biochemical examination; 2.

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