Summary
The insula is the only cortical part of the brain which is not visible on the surface of the hemisphere. This is due to the fact that it is totally covered by the fronto-parietal and temporal opercula. The insula has a triangular shape, and is separated from the opercula by the anterior, superior, and inferior periinsular sulci. The limen insulae is the antero-inferiorly located insular cortical surface which conjoins the inferior insular point, the anterior perforated surface, and the temporo-mesial surface.
The insula is morphologically divided into two parts by the central insular sulcus. The anterior part of the insula bears 3 gyri: the anterior, middle, and posterior short insular gyri, separated by the anterior and precentral insular sulcus. The posterior part of the insula contains the anterior and posterior long insular gyri, separated by the postcentral insular sulcus. The vascular supply of the insula is mainly provided by the M2 segment of the middle cerebral artery, which constitutes a substantial obstacle to any open or stereotactic procedure aiming at the insular region. Histologically, the insula is a part of the paralimbic cortex, as it bears in its antero-inferior part an allo and mesocortical area. The insula is functionally involved in cardiac rythm and arterial blood pressure control, as well as in viscero-motor control and in viscero-sensitive functions. There is considerable evidence for the involvement of the insula as a somesthetic area, including a major role in the processing of nociceptive inputs. Its possible role in some epilepsies may explain some failures of temporal lobe resection. Surgery of the insular lobe is a technical challenge, whose risks can be minimized by the use of intra-operative direct cerebral stimulation.
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References
Augustine JR (1996) Circuitry and functional aspects of the insular lobe in primates including human. Brain Res Brain Res Rev 22(3):229–244
Cukiert A, Forster C, Andrioli MS, Frayman L (1998) Insular epilepsy. Similarities to temporal lobe epilepsy. Case report. Arq Neuropsiquiatr 56(1):126–128
Duffau H, Bauchet L, Lehericy S, Capelle L (2001) Functional compensation of the left dominant insula for language. Neuroreport 12(10):2159–2163
Duffau H, Capelle L, Lopes M, Bitar A, Sichez JP, Van Effenterre R (2002) Medically intractable epilepsy from insular low-grade gliomas: improvement after an extended lesionectomy. Acta Neurochir (Wien) 144:563–573
Duffau H, Capelle L, Lopes M, Faillot T, Sichez JP, Fohanno D (2000) The insular lobe: physiopathological and surgical considerations. Neurosurgery 47(4):801–810
Ebeling U, Kothbauer K (1995) Circumscribed low grade astrocytomas in the dominant opercular and insular region; a pilot study. Acta Neurochir (Wien) 132(1–3):66–74
Frot M, Garcia-Larrea L, Guenot M, Mauguiere F (2001) Responses of the supra-sylvian (SII) cortex in humans to painful and innocuous stimuli. A study using intra-cerebral recordings. Pain 94:65–73
Frot M, Rambaud L, Guenot M, Mauguiere F (1999) Intracortical recordings of early pain-related CO2 laser potentails in the human SII-insular cortex. Clin Neurophysiol 110:133–145
Frot M, Mauguiere F (1999) Timing and spatial distribution of somatosensory responses recorded in the upper bank of the sylvian fissure (SII area) in humans. Cerebral cortex 9:854–863
Frot M, Isnard J, Guenot M, Mauguiere F (2000) Effects of noxious stimulus intensity on signals from operculo-insular cortex: an intra-cerebral recordings study in humans. Clin Neurophysiol 111 (l):131
Guenot M, Isnard J, Ryvlin P, Fischer C, Ostrowsky K, Mauguiere M, Sindou M (2002) Neurophysiological monitoring for epilepsy surgery: the Talairach SEEG method. Stereotact Funct Neurosurg 73:84–87
Isnard J, Guenot M, Ostrowsky K, Sindou M, Mauguiere F (2000) The role of the insular cortex in temporal lobe epilepsy. Ann Neurol 48(4):614–623
Isnard J, Guenot M, Ostrowsky K, Sindou M, Mauguiere F (2000) Stereoelectroencephalographic (SEEG) study of electrophysiological relations between insular lobe and temporal lobe in temporal lobe epilepsy (TLE). Clin Neurophysiol 111(1):100
Isnard J, Ryvlin P, Guenot M, Ostrowsky K, Fischer C, Sindou M, Mauguiere F (1998) Role of the insular cortex in temporolimbic seizures: a stereoelectroencephalographic (SEEG) study. Epilepsia 39 [Suppl] 6:65
Kumabe T, Nakasato N, Suzuki K, Sato K, Sonoda Y, Kawagishi J, Yoshimoto T (1998) Two-staged resection of a left frontal astrocytoma involving the operculum and insula using intraoperative neurophysiological monitoring-case report. Neurol Med Chir (Tokyo) 38:503–507
Lang FF, Olansen NE, DeMonte F, Gokaslan ZL, Holland EC, Kalhorn C, Sawaya R (2001) Surgicla resection of intrinsic insular tumors: complication avoidance. J Neurosurg 95:638–650
Mesulam MM, Mufson EJ (1982) Insula of the old world monkey. III: efferent cortical output and comments on function. J Comp Neurol 212(1):38–52
Mufson EJ, Mesulam MM (1982) Insula of the old world monkey. II: afferent cortical intput and comments on the claustrum. J Comp Neurol 212(1):23–37
Nagara S, Rhoton AL, Barry M (1988) Microsurgical anatomy of the choroidal fissure. Surg Neurol 30:3–59
Nieuwenhuys R, Voogd J, Van Huijzen C (1988) The human cerebral nervous system: a synopsis and atlas, 3rd edn. Springer, Berlin
Ono M, Kubik S, Abernathey CD (1990) Atlas of the cerebral sulci. Georg Thieme Verlag, Stuttgart
Ostrowsky K, Isnard J, Ryvlin P, Guenot M, Fischer C, Mauguiere F (2000) Functional mapping of the insular cortex: clinical implication in temporal lobe epilepsy. Epilepsia 41:681–686
Ostrowsky K, Magnin M, Ryvlin P, Isnard J, Guenot M, Maugiuere F (2002) Representation of pain and somatic sensation in the human insula: a study of responses to direct electrical stimulation. Cerebral cortex (in press)
Peyron R, Garcia-Larrea L, Laurent B (2000) Functional imaging of brain responses to pain. A review. Neurophysiol Clin 30:263–288
Peyron R, Garcia-Larrea L, Gregoire MC, Costes N, Convers P, Lavenne F, Mauguiere F, Michel D, Laurent B (1999) Hemodynamic brain responses to acute pain in humans: sensory and attentional networks. Brain 122:1765–1780
Peyron R, Garcia-Larrea L, Gregoire MC, Convers P, Richard A, Lavenne F, Barral FG, Mauguiere F, Michel D, Laurent B (2000) Parietal and cingulate processes in central pain. A combined positron emission tomography (PET) anf functional magnetic resonance imaging (fMRI) study of an unusual case. Pain 84:77–87
Roper SN, Levesque MF, Sutherling WW, Engel J Jr (1993) Surgical treatment of partial epilepsy arising from the insular cortex. Report of two cases. J Neurosurg 79(2):266–269
Rougier A, Saint-Hilaire JC, Loiseau P, Bouvier G (1992) Investigations et traitement chirurgical des épilepsies. Neurochirurgie 38:2–112
Sindou M, Auque J (2000) The intracranial venous system as a neuro-surgeon’s perspective. In Cohadon F et al (eds) Advances and technical standards in Neurosurgery, vol 26. Springer Wien, New York, pp 131–216
Szikla G, Bouvier G, Hori T, Petrov V (1977) Angiography of the human brain cortex. Springer-Verlag, Wien
Talairach J, Bancaud J (1973) Stereotaxic approach to epilepsy. Methodology of anatomo-functional stereotaxic investigations. Progr Neurol Surg 5:297–354
Talairach J, Tournoux P (1988) Co-planar stereotaxic atlas of the human brain. Georg Thieme Verlag, Stuttgart, p 122
Türe U, Yasargil DCH, Al-Mefty O, Yasargil MG (1999) Topographic anatomy of the insular region. J Neurosurg 90:720–733
Türe U, Yasargil MG, Al-Mefty O, Yasargil DCH (2000) Arteries of the insula. J Neurosurg 92:676–687
Valeriani M, Restuccia D, Barba C, Le Pera D, Tonali P, Mauguiere F (2000) Sources of early cortical responses to painful CO2 laser skin stimulation of the hand and foot in human brain. Clin Neurophysiol 111:1103–1112
Vanaclocha V, Saiz-Sapena N, Garcia-Casacola C (1997) Surgical treatment of insular gliomas. Acta Neurochir (Wien) 139:1126–1134
Varnavas GG, Grand W (1999) The insular cortex: morphological and vascular anatomic characteristics. Neurosurgery 44:127–136
Walsh AR, Schmidt RH, Marsh HT (1990) Cortical mapping and resection under local anesthetic as an aid to surgery of low and intermediate grade gliomas. Br J Neurosurg 4:485–491
Yasargil MG (1994) Microneurosurgery IV A (CNS tumors). Georg Thieme Verlag, Stuttgart, p 396
Zentner J, Meyer B, Stangl A, Schramm J (1997) Intrinsic tumors of the insula: a prospective study of 30 patients. J Neurosurg 85:263–271
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Guenot, M., Isnard, J., Sindou, M. (2004). Surgical Anatomy of the Insula. In: Pickard, J.D., et al. Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 29. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0558-0_7
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