Microsurgical anatomy of the temporal lobe: part 2--sylvian fissure region and its clinical application.
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.


CONCLUSIONS
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.
Wen
Hung Tzu
HT
Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA. wenht@uol.com.br
Rhoton
Albert L
AL
de Oliveira
Evandro
E
Castro
Luiz Henrique M
LH
Figueiredo
Eberval Gadelha
EG
Teixeira
Manoel Jacobsen
MJ
D001932:Brain Neoplasms / Q000601:surgery; D002102:Cadaver; D002533:Cerebral Angiography / Q000379:methods; D002540:Cerebral Cortex / Q000033:anatomy & histology* / Q000098:blood supply / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000601:surgery; D004210:Dissection / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000601:surgery; D005625:Frontal Lobe / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D008866:Microsurgery / Q000379:methods; D020768:Middle Cerebral Artery / Q000033:anatomy & histology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D010296:Parietal Lobe / Q000033:anatomy & histology / Q000601:surgery; D057234:Preoperative Period; D013702:Temporal Lobe / Q000033:anatomy & histology* / Q000098:blood supply / Q000601:surgery*