AUCTORES
Globalize your Research
Research article | DOI: https://doi.org/10.31579/2642-973X/080
1 Neurosurgery Service of the Maciel Hospital, Montevideo, Uruguay.
2 Department of Anatomy, Faculty of Medicine, University ofthe Republic, Montevideo, Uruguay.
*Corresponding Author: Alejandra JAUME, Neurosurgery Service of the Maciel Hospital, Montevideo, Uruguay.
Citation: Alejandra Jaume, Matilde Lissarrague, (2023), Anatomical-Imagenological Correlation of the Insula. J. Brain and Neurological Disorders. 6(7): DOI:10.31579/2642-973X/080
Copyright: © 2023, Alejandra Jaume. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 15 September 2023 | Accepted: 25 September 2023 | Published: 05 October 2023
Keywords: lobe of the insula; sylvian fissure; trans-sylvian approach; temporal peduncle
Introduction: The Reil insula, located deep in the Sylvian fissure, has important relationships. It is proposed to perform an anatomical-imaging correlation of the morphological and topographic anatomy of the insula. the insula of Reil, at the depth of the crack Silviana has important relationships. It is proposed to make an anatomical imaging correlation of morphological and topographical anatomy of the insula. Methods: 16 adult cerebral hemispheres were dissected formed corpses, and coronal, horizontal and sagittal sections were performed. In 4 parts white matter was dissected by Klingler method. Then correlation was performed with 20 nuclear magnetic resonance tractography and 2 images.Results: The island grooves measured on average: SIS: 53mm; IBS: 47mm; SIA 24mm. SIC: 38mm. The most posterior topography of the SIC is up to the Rolandic sulcus.
Material and Method: 16 cerebral hemispheres were dissected from formed adult cadavers, and coronal, horizontal and sagittal cuts were made. The white matter was dissected into 4 pieces using the Klingler method. Correlation was then performed with 20 nuclear magnetic resonance images and 2 tractography images.
Results: The insular grooves measured on average: SIS: 53mm; IBS: 47mm; SIA 24mm. SIC: 38mm. The most posterior sector of the SIC is topography at the height of the Rolandic sulcus.
Conclusions: Correct knowledge of the morphological and topographic anatomy of the insula is essential for the correct interpretation of imaging studies and the basis for surgical approaches to this region. the right knowledge of morphological and topographical anatomy of the island, is essential for the correct interpretation of imaging studies and the basis for surgical approaches to this region. Keywords: insula lobe, sylvianfissure, trans-sylvian approach, temporal stem.
Reil's insula was described for the first time by Johann Christian Reil in 1809. It is a cortical region that derives from the mesocortex, being a transition between the neocortex and allocortex, which has important functional implications since it is a center of connection between the limbic system and the neocortex, participating in various functions such as: perception of taste and smell, visceral control and somatoperception, integration between emotional-perceptual information and empathy, among others [1,2].
The insula is topography at the bottom of the sylvian fissure, being framed in the depth of the frontal, parietal, and temporal lobes, acquiring transcendent relationships at that level [3].
It is important to know in detail the microsurgical anatomy and its imaging correlation, given the anatomical variants, since the insula can have between 4 and 7 turns, and depending on this variation the anatomy can change, which has implications for the surgical approach to this region. where innumerable pathologies settle [4]. We know that to approach the insula, a wide opening of the Sylvian fissure is required, which is more accessible in the anterior sector at the level of the pars triangularis, due to the anatomical arrangement of the insula [5]
This is a descriptive study that included16 cerebral hemispheres, 9 right and 7 left, from formed adult cadavers, without previous intracerebral pathology. The frontoparietal and temporal opercula were resected, exposing the insula. The length of the insular sulci was recorded: anterior (SIA), superior (SIS), inferior (SII) and central (SIC). The topography of the limen insulae, the apex of the insula, and the number of turns of the anterior and posterior lobes were then recorded. Subsequently, coronal, horizontal and sagittal cuts were made to correlate with the imaging. In 4 pieces of those previously included, the white matter was dissected using the Klingler method. The use of cadaveric material was carried out after donation, through written and signed informed consent. intrinsic condition for its use for academic purposes in the Department of Anatomy. The procedures carried out were in accordance with the tenets of the 1975 Helsinki Declaration and its subsequent amendments.
Then, 20 magnetic resonance images and 2 tractography images obtained from the Clinical Radiology Department of the Hospital de Clínicas were analyzed.
Subsequently, an extensive bibliographic review on insula was carried out in Pubmed as well as in high-impact neurosurgical and anatomical journals with the following keywords (lobe of the insula, sylvian fissure, trans-sylvian approach, temporal peduncle). Works published until 2020 that were written in both English and Spanish were selected.
The insula is located deep to the frontoparietal and temporal opercula. If the lateral face of the hemisphere is observed, said cortical region is not visible on its surface, but at the moment in which the opening of the sylvian fissure occurs, the lobe of the insula begins to be observed, called the apex of the insula, when most superficial sector of this lobe (figure 1)3.
Figure 1: inferior view of the lateral aspect of the hemisphere, apex of the insula.
Usually the insula is triangular in shape with an anterior base. It is limited by three sulcus: the anterior insular sulcus (AIS), the superior insular sulcus (SIS), and the inferior insular sulcus (SII)1.
The SIA measured an average of 24mm, the SIS had an average of 52mm, and the SII measured an average of 47mm (Figure 2 and 3).
Figure 2 and 3: vision in anatomical preparation and in MRI of the insula, with its SIA, SIS, and SII.
The insula contains a central insular sulcus (CIS), which divides it into two lobes: an anterior lobe (LAI), and a posterior lobe (LPI)1.
The SIC presented an average of 38mm in length, and its posterior sector was superficially topography at the level of the central or Rolandic sulcus.
The number of island gyres is variable, with a total of between 4 and 7 gyres. In our pieces we found: between 3 and 5 turns in the LAI (3-turn mode, in 12 cases); and between 1 and 3 turns in LPI (2-turn mode, in 12 cases) (figures 4 and 5).
Figure 4 and 5: anatomical preparation and MRI showing the SIC and insular gyri.
The deep topography of the insula, surrounded and hidden by the frontoparietal and temporal opercula, makes its approach complex, being the seat of multiple vascular and tumor pathologies3. In turn, the sylvian fissure is a widely used neurosurgical corridor. For all this, we believe that it is essential to have a solid knowledge of the surgical and imaging anatomy of the insula for neurosurgeons, neurologists, neuroimaging scientists and doctors in general.
To organize the discussion we will follow the following order: 1) limit of the insula and its limiting sulci; and, 2) intrinsic structures of the insula: central sulcus, and insular gyri, highlighting that all measurements and results obtained in the present work were comparable with the published international literature.
Figure 6and 7: anatomical preparation, axial section and its imaging correlation.
The PIAS corresponds to the union of the SIA with the SIS. At this level the frontal horn of the lateral ventricle projects in depth6. The ventricular system is not usually addressed at this point, however it must be taken into account and known. In some surgical procedures, such as functional hemispherotomies, it is used to perform hemispheric deafferentation, severing the connecting fibers of the basal ganglia7.
The PIAI is the union of the SIA with the SII, and at this level the limen insulae is topography. The limen insulae is a sector of cortex that separates the insula from the anterior perforated space, or vallecula sylviana. In turn, it corresponds to the limit between the sphenoidal sector and the operculo-insular sector of the sylvian fissure. Here we must highlight two important relationships: the uncinate fasciculus, and the middle cerebral artery (MCA)8,9.
The uncinate fasciculus joins the orbitofrontal cortex with the temporal uncus, mainly with the amygdala, forming part of the limbic system (figure 8).
Figure 8: anatomical preparation of the uncinate fasciculus.
The MCA at this level presents its first genu or knee that marks the limit between M1 (sphenoidal sector) and M2 (opercular sector) (figures 9 and 10). The AIS has as its main relationships: the orbito-frontal cortex, the ventricular system, the basal ganglia, and the uncinate fasciculus.
Figure 9 and 10: anatomical preparation and arteriography frontal projection pointing with an arrow to the limen insulae, and its correlation with the 4 segments of the MCA.
2. Superior insular sulcus: separates the insula from the fronto-parietal cortex, and its main relationships are: the ventricular system, the basal ganglia and the corona radiata with its projection fibers10. As mentioned previously, this sulcus is used as a reference to perform hemispheric deafferentation in hemispherotomies for the treatment of epilepsy. In these procedures, the surgeon moves towards the ventricular system following the superior sulcus, thereby severing the fibers of the corona radiata11. Thus, the relationship of this sulcus can be seen with conventional MRI images1 and with tractography11 (Figure 11 and 12).
Figure 11: anatomical preparation, sagittal section.
Figure 12: MRI tractography, descending fibers.
3. Inferior Insular Sulcus: It is the boundary between the insula and the temporal lobe. The relationship of the insula is mainly with the superior aspect of the temporal lobe, which consists of three sectors: the polar planum (PP), Heschl's gyrus (HG), and the temporal planum (PT). At the same time, we must highlight the relationship that this inferior insular sulcus has with the temporal peduncle (PedT). The temporal peduncle is a set of white matter fibers that communicate with the temporal lobe and include temporo-pontine and temporo-thalamic fibers, as well as auditory fibers, optic radiation, uncinate fasciculus, and anterior white commissure6, 7 (Figure 13 and 14).
Figure 13 and 14: anatomical preparation, axial and coronal section.
At the level of the SII, two important points are also topography: the postero-superior insular point (PIPS), and the postero-inferior insular point (PIPI)1.
The PIPS is the union of the SIS and the SII, and this level corresponds to the ventricular atrium. Several authors have pointed out this point as an
area of approach to the ventricular atrium, putting it as an alternative to parietal approaches. Given the relationships of this sector, the potential sequelae of the approach through this point is injury from optic radiation.
The PIPI is located at the intersection of the SII and the HG, and at this level the optical radiation is topographic4 (Figure 15).
Figure 15: Tractography, sagittal section of optical radiation.
In the remaining 25%, 2 inconstant gyres were found, called accessory insular gyrus; and transverse insular gyrus. Both are located near the limen insulae.
From a functional point of view, the insula is part of the limbic system and has been associated with multiple functions such as: gustatory sensations, pleasurable sensations when faced with visual and gustatory stimuli, and cardiovascular reflexes. Usually, a function related to motor modalities is assigned to the anterior lobe of the insula, and to the posterior lobe with sensory modalities.
Based on everything analyzed, we can conclude that the insula is a complex lobe, whose topographic and functional importance makes it necessary to delve into its correct anatomy and imaging correlation, to achieve good management of the pathologies that occur in said region.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
