Surgical Anatomy of Supratentorial Midline Lesions

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FIGURE 5. Lateral view of the left cerebral hemisphere during serial dissection. Total removal of the insular cortex reveals the extreme capsule (exc). The outer layer of the extreme capsule is composed of arcuate fibers that connect the insula with the opercula in the region of the peri-insular (circular) sulci (arrows). cs, central sulcus of Rolando;slf, superior longitudinal fasciculus. FIGURE 6. Lateral view of the left cerebral hemisphere during serial dissection. Removal of the extreme capsule reveals the claustrum (c) in the region of the insular apex and exposes the external capsule (ec) at the periphery of the claustrum. cs, central sulcus of Rolando;of, occipitofrontal fasciculus;slf, superior longitudinal fasciculus;uf, uncinate fasciculus. The external capsule is a thin lamina of white substance that separates the claustrum from the putamen. It is joined to the internal capsule at both ends of the putamen and forms a capsule of white matter external to the lenticular nucleus. The external capsule consists mostly of deeper fibers of the occipitofrontal fasciculus. Removal of the inferior aspect of the superior longitudinal fasciculus exposes the entire posterior portion of the occipitofrontal fasciculus. Further dissection of the uncinate and occipitofrontal fasciculi (external capsule) reveals the putamen, which is composed of gray matter substance (Fig. 7). The putamen has a spongy consistency, enabling differentiation from the firmer globus pallidus. At this stage, a suction system can gently remove the putamen and reveal the globus pallidus and the internal capsule at its periphery (Fig. 8). With higher magnification, the strionigral fibers that pass through the globus pallidus can be identified. These fibers connect the putamen and caudate nucleus to the substantia nigra. The caudolenticular gray matter that passes through the internal capsule and connects the caudate and putamen
can also be identified. FIGURE 7. Lateral view of the left cerebral hemisphere during serial dissection. Removal of the claustrum and external capsule reveals the putamen (p). Removal of the inferior aspect of the superior longitudinal fasciculus (slf) exposes the posterior portion of the occipitofrontal fasciculus (of). cr, corona radiata;cs, central sulcus of Rolando;uf, uncinate fasciculus. FIGURE 8. Lateral view of the left cerebral hemisphere during serial dissection. After removal of the putamen, the globus pallidus (gp) and the internal capsule (ic) at its periphery can be observed. Arrows, connections between the putamen and caudate nucleus via the internal capsule. cr, corona radiata;of, occipitofrontal fasciculus;slf, superior longitudinal fasciculus;uf, uncinate fasciculus. The firmer globus pallidus is excavated to reveal the entire internal capsule and the lateral extension of the anterior commissure (Fig. 9). Removal of the globus pallidus requires skill and patience, to prevent damage to the anterior commissure and the ansa peduncularis. The lateral extension of the anterior commissure passes through the basal portion of the globus pallidus, perpendicular to the optic tract and medial to the uncinate fasciculus, to the temporal pole region. The lateral extensions of the anterior commissure are severed and followed into the temporal lobe. Some fibers of the anterior commissure merge with the uncinate fasciculus at the temporal pole, but most fibers are directed posteriorly
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Page 3 and 4: After cutting through the medial po
Page 5 and 6: Figure 3. Case 1. A-C: Preoperative
Page 11 and 12: Figure 10. Case 8. A-C: Preoperativ
Page 13 and 14: Case 1 Figure 12. Case 10. A-C: Pre
Page 15 and 16: interhemispheric fissure or via a s
Page 17 and 18: Copyright © by the Congress of Neu
Page 19 and 20: We dissected 20 previously frozen,
Page 21 and 22: FIGURE 4. A, anterior view coronal
Page 23 and 24: and to end nowhere, and is composed
Page 25 and 26: Türe et al. present an anatomic re
Page 27 and 28: FIGURE 1. Lateral view of the inter
Page 29 and 30: temporo-occipital) gyrus (5, 13, 20
Page 31: FIGURE 4. Lateral view of the left
Page 35 and 36: severed and the remainder of the su
Page 37 and 38: FIGURE 13. Illustration of the brai
Page 39 and 40: FIGURE 15. Drawing from one of Reil
Page 41 and 42: FIGURE 18. Superbly detailed depict
Page 43 and 44: Our contribution to improving the t
Page 45 and 46: adjacent territories. This occurs v
Page 47 and 48: atrial portion of the lateral ventr
Page 49 and 50: FIGURE 2. Anatomic variations of th
Page 51 and 52: FIGURE 11. Arterial vascularization
Page 53 and 54: FIGURE 5. Branches of the pericallo
Page 55 and 56: from 0 to 7 (average, 1.1) per hemi
Page 57 and 58: DISCUSSION The fibers of the corpus
Page 59 and 60: circulation to be determined, which
Page 61 and 62: diencephalon. For this group, the t
Page 63 and 64: Arteries of the insula middle, and
Page 65 and 66: Arteries of the insula divided into
Page 67 and 68: Arteries of the insula Parasylvian
Page 69 and 70: Arteries of the insula The frontal
Page 71 and 72: Arteries of the insula FIG. 7. Phot
Page 73: Arteries of the insula 17. Penfield

Surgical Anatomy of Supratentorial Midline Lesions

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