[The insula and the central core concept].
The characterization of well defined and circumscribed brain regions is particularly useful for the neurosurgical practice once it enhances the tridimensional understanding of its structures and related lesions, and because it induces the development and the utilization of more standard microneurosurgical approaches. In this direction, it is noteworthy that each cerebral hemisphere harbors an evident central core constituted externally by the insula, internally by the basal ganglia and the thalamus, and with the internal capsule within. With a biconvex configuration when seen from above, and located between the sylvian cistern and the supratentorial ventricular cavities, morphologically this central core resembles a head of each brainstem half top, covered by the neocortical mantle of its hemisphere. The central core is attached to the rest of the cerebral hemisphere by isthmi constituted by the different internal capsule fibers. Anteriorly and under the anterior limiting sulcus of the insula there are fibers of the internal capsule anterior limb, superiorly and under the superior limiting sulcus there are the rest of the anterior limb fibers, and the knee and posterior limb fibers that harbors the corticonuclear and the corticospinal tracts, and inferiorly and under the insular inferior limiting sulcus there are the sub- and the retrolentiform internal capsule fibers that enclose the auditory and the optic radiations. Laterally the central core is composed by the insular surface that resembles a shield of the main cerebral subcortical structures. The options of microneurosurgical approaches to the central core related lesions should consider particularly their relationships with the thalamus and with the internal capsule fibers.
Ribas
Guilherme Carvalhal
GC
Setor de Neuroanatomia Aplicada, Departamento de Cirurgia, Faculdade de Medicina, Universidade de São Paulo, Rua Prof. Eduardo Monteiro 567, 05614-120 São Paulo, SP, Brazil. guilherme@ribas.med.br
Oliveira
Evandro de
Ed
D002540:Cerebral Cortex / Q000033:anatomy & histology*; D006801:Humans; D009626:Terminology as Topic