Navegando por la fisura silviana: anatomía microquirúrgica, neuroimágenes y técnica quirúrgica

Abstract

Objective: The aim of this study is to describe the microsurgical anatomy of the sylvian fissure, through cadaveric dissections and neuroimaging and to elucidate its clinical application for microsurgery.
Methods: One human skull and ten cadaveric human hemispheres were studied through white matter fiber dissections and arterial and neural anatomy of the sylvian fissure and insular dissections under the microscope. The cerebral arteries were perfused with colored latex. The surgical anatomy was correlated with neuroimaging anatomy. Finally, the microsurgical experienced gained applying this anatomical knowledge was gathered, and the literature about the anatomy of the sylvian complex was revised, as well.
Results: The Sylvian fissure extends from the basal to the lateral surface of the brain. Each surface has a superficial (sylvian stem and its rami), intermediate (anterior and lateral opercular compartments) and deep parts (sphenoidal compartment, anterior and lateral insular clefts and retroinsular region). In 7 out of 10 hemispheres, the central sulcus did not intersect with the sylvian fissure on the lateral surface of the brain. In 80% of the hemispheres, the middle cerebral artery main bifurcation was localized at or proximal to the limen insulae. Beneath the pars triangularis, the widest point of the lateral surface of the sylvian fissure is located. The authors start dissecting the sylvian fissure at this point.
Conclusion: The thorough anatomical knowledge with its clinical application in modern neuroimaging are essential tools for preoperative planning and are mandatory requisites to safely operate through and around the sylvian fissure anatomical complex.