Neurosurgical anatomy of the insula and Sylvian fissure: Literature review and personal experience. The third report. Anatomy of sylvian fissure, sylvian cistern, gyri and fissures of the insula

Despite being a region where numerous pathological processes may develop, the insula remains one of the least studied anatomical structures of the human brain. The clinical course of insular glioma is accompanied by a severe morbidity, caused by the proximity of the central core, important projection and associative pathways, main arteries and large venous collectors. For a long time, surgery of patients with insular gliomas, which would involve the total volume tumor removal while ensuring high quality of post-surgery life, was considered impossible. Understanding the surgical anatomy of the insula is key to successful transsylvian-transinsular, transopercular approaches to insular gliomas and their radical removal. The article provides a detailed surgical anatomy of the sylvian fissure, the operculum and the insula.