title: Microsurgical anatomy of the inferior limiting insular sulcus and the temporal stem.
abstract: OBJECTIVE
  The purpose of this study was to describe the location of each white matter pathway in the area between the inferior limiting insular sulcus (ILS) and temporal horn that may be crossed in approaches through the temporal stem to the medial temporal lobe.
  
  
  METHODS
  The fiber tracts in 14 adult cadaveric cerebral hemispheres were examined using the Klingler technique. The fiber dissections were completed in a stepwise manner, identifying each white matter pathway in different planes and describing its position in relation to the anterior end of the ILS.
  
  
  RESULTS
  The short-association fibers from the extreme capsule, which continue toward the operculae, are the most superficial subcortical layer deep to the ILS. The external capsule fibers are found deeper at an intermediate layer and are formed by the uncinate fasciculus, inferior frontooccipital fasciculus, and claustrocortical fibers in a sequential anteroposterior disposition. The anterior commissure forms the next deeper layer, and the optic radiations in the sublenticular part of the internal capsule represent the deepest layer. The uncinate fasciculus is found deep to the anterior third of the ILS, whereas the inferior frontooccipital fasciculus and optic radiations are found superficial and deep, respectively, at the posterior two-thirds of this length.
  
  
  CONCLUSIONS
  The authors' findings suggest that in the transsylvian approach, a 6-mm incision beginning just posterior to the limen insula through the ILS will cross the uncinate fasciculus but not the inferior frontooccipital fasciculus or optic radiations, but that longer incisions carry a risk to language and visual functions.
authors: 1Department of Neurosurgery, University of Florida, Gainesville, Florida; and.|2Division of Neurosurgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors: Eduardo Carvalhal
authors: EC
authors: Ribas
authors: 1Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
authors: Kaan
authors: K
authors: Yagmurlu
authors: 2Division of Neurosurgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors: Hung Tzu
authors: HT
authors: Wen
authors: 1Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
authors: Albert L
authors: AL
authors: Rhoton
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000033:anatomy & histology*; D006801:Humans; D009413:Nerve Fibers, Myelinated; D013702:Temporal Lobe / Q000033:anatomy & histology*; D066127:White Matter / Q000033:anatomy & histology*
keywords: DTI = diffusion tensor imaging; ILS = inferior limiting insular sulcus; LGB = lateral geniculate body; TLP = temporal limen point; cerebrum; inferior limiting insular sulcus; microsurgical anatomy; temporal stem; transsylvian approach; white matter fibers