Skip to main content
SpringerLink
Log in

Microanatomical study of the insular perforating arteries

  • Experimental research - Neurosurgical Anatomy
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The insular perforating arteries originate from the middle cerebral artery. They have only been very partially described up to now. In the literature, they come from the M2 segment and three types are listed: the short, medium and long perforators. The first two types supply the claustrum as well as the external and extreme capsules.

Objective

We describe the anatomy of long perforating insular arteries and their arterial contribution to the main white matter bundles of the oval center of Vieussens.

Materials and method

Twenty adult cadaveric hemispheres were studied after perfusion of the arteries and veins with colored latex. The arteries were dissected and photographed under an operating microscope.

Results

The long insular perforating arteries come from the M2 segment or from the junction of the M2 and M3 segments and sometimes from the M3 segment. They often perforate the insular cortex on the top of the posterior short insular gyrus and the insular long gyri, or in the superior peri-insular sulcus, before coming together in the oval center. At this level, they give arterial contribution to the main white matter bundles such as corticospinal and corticonuclear tracts for motricity, and the arcuate fasciculus and the occipitofrontal tract for language in the dominant hemisphere.

Conclusion

These perforating arteries have to be carefully respected during insular surgery to avoid neurologic weakness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Donzelli R, Marinkovic S, Brigante L, de Divitiis O, Nikodijevic I, Schonauer C, Maiuri F (1998) Territories of the perforating (lenticulostriate) branches of the middle cerebral artery. Surg Radiol Anat 20:393–398

    Article  PubMed  CAS  Google Scholar 

  2. Duffau H, Capelle L, Lopes M, Faillot T, Sichez JP, Fohanno D (2000) The insular lobe: physiopathological and surgical consideration. Neurosurgery 47(4):801–810, discussion 810-811

    Article  PubMed  CAS  Google Scholar 

  3. Hentschel SJ, Lang FF (2005) Surgical resection of intrinsic insular tumors. Neurosurgery 57:176–183, discussion 176-183

    Article  PubMed  Google Scholar 

  4. Herman LH, Ostrowski AZ, Gurdjian ES (1963) Perforating branches of the middle cerebral artery. an anatomical study. Arch Neurol 8:32–34

    Article  PubMed  CAS  Google Scholar 

  5. Lang FF, Olansen NE, DeMonte F, Gokaslan ZL, Holland EC, Kalhorn C, Sawaya R (2001) Surgical resection of intrinsic insular tumors: complication avoidance. J Neurosurg 95:638–650

    Article  PubMed  CAS  Google Scholar 

  6. Marinkovic SV, Kovacevic MS, Marinkovic JM (1985) Perforating branches of the middle cerebral artery. Microsurgical anatomy of their extracerebral segments. J Neurosurg 63:266–271

    Article  PubMed  CAS  Google Scholar 

  7. Marinkovic SV, Milisavljevic MM, Kovacevic MS, Stevic ZD (1985) Perforating branches of the middle cerebral artery. Microanatomy and clinical significance of their intracerebral segments. Stroke 16:1022–1029

    Article  PubMed  CAS  Google Scholar 

  8. Moshel YA, Marcus JD, Parker EC, Kelly PJ (2008) Resection of insular gliomas: the importance of lenticulostriate artery position. J Neurosurg 109:825–834

    Article  PubMed  Google Scholar 

  9. Tanriover N, Kawashima M, Rhoton AL Jr, Ulm AJ, Mericle RA (2003) Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation. J Neurosurg 98:1277–1290

    Article  PubMed  Google Scholar 

  10. Tanriover N, Rhoton AL Jr, Kawashima M, Ulm AJ, Yasuda A (2004) Microsurgical anatomy of the insula and the sylvian fissure. J Neurosurg 100:891–922

    Article  PubMed  Google Scholar 

  11. Ture U, Yasargil MG, Al-Mefty O, Yasargil DC (200) Arteries of the insula. J Neurosurg 92:676-687

  12. Umansky F, Gomes FB, Dujovny M, Diaz FG, Ausman JI, Mirchandani HG, Berman SK (1985) The perforating branches of the middle cerebral artery. A microanatomical study J Neurosurg 62:261–268

    Article  CAS  Google Scholar 

  13. Umansky F, Juarez SM, Dujovny M, Ausman JI, Diaz FG, Gomes F, Mirchandani HG, Ray WJ (1984) Microsurgical anatomy of the proximal segments of the middle cerebral artery. J Neurosurg 61:458–467

    Article  PubMed  CAS  Google Scholar 

  14. Varnavas GG, Grand W (1999) The insular cortex: morphological and vascular anatomic characteristics. Neurosurgery 44:127–136, discussion 136-128

    Article  PubMed  CAS  Google Scholar 

  15. Vincentelli F, Caruso G, Andriamamonjy C, Rabehanta P, Graziani N, Grisoli F, Gouaze A, Vigouroux RP (1990) Micro-anatomy of collateral perforating branches of the middle cerebral artery. Neurochirurgie 36:3–14, discussion 14-15

    PubMed  CAS  Google Scholar 

  16. Wen HT, Rhoton AL Jr, de Oliveira E, Castro LH, Figueiredo EG, Teixeira MJ (2009) Microsurgical anatomy of the temporal lobe: part 2–sylvian fissure region and its clinical application. Neurosurgery 65:1–35, discussion 36

    Article  PubMed  Google Scholar 

  17. Yasargil MG (1996) Microneurosurgery. New York, G Thieme IV B:pp263-267

  18. Yasargil MG, Caglar YS (1999) The insular cortex: morphological and vascular anatomic characteristics, Comments. Neurosurgery 44:136–138

    Article  Google Scholar 

  19. Yasargil MG, Reeves JD (1992) Tumours of the limbic and paralimbic system. Acta Neurochir (Wien) 116:147–149

    Article  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Angers Teaching Hospital, 49933, Angers, France

    Matthieu Delion & Philippe Mercier

  2. Anatomy Laboratory, Medical Faculty, rue haute de Reculée, 49045, Angers Cedex 01, France

    Matthieu Delion & Philippe Mercier

Authors
  1. Matthieu Delion
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philippe Mercier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthieu Delion.

Additional information

Comment

Surgical treatment of insular gliomas is one of the "hottest topic" of contemporary neurosurgery. In low grade tumors, the surgical treatment should aim to achieve the total (or more than total) resection while avoiding neurological deficits. To achieve these goals, a combination of functional neuroimaging, intraoperative neurophysiology and awake craniotomies have been introduced into the clinical practice of neurosurgical centers dealing with those lesions. Nevertheless, these instruments are insufficient without a deep understanding of regional functional and microvascular anatomy.

The question of potential vascular injuries during resection of insular gliomas is well known, in particular with reference to the potential damage to the lenticulostriate arteries.[2] In this interesting anatomic study, Authors describe the anatomy of insular long perforating arteries. These arteries, originating from M2 or M2-M3 junction, penetrate into the posterior insula and superior limiting sulcus to supply the motor fibers of the corona radiata and possibly the corticospinal tract. This location encompasses the zone II of the Berger-Sanai classification of insular gliomas (the area above the line of the sylvian fissure and plane passing through the foramen of Monro)[3]. According to Authors observations, such long perforating arteries have a larger section (0.3-0.5 mm), as compared to other perforating arteries with less functional relevance. Nevertheless, it could be difficult to identify such long perforators during surgery and it could be recommended to avoid injuries to any "large" perforating artery penetrating into the posterior insular area. Recently, Iwasaki et al. [1] have adopted an interesting approach to the problem in a report of two cases. These Authors confirm the necessity to identify very carefully all perforating arteries at the posterior insular-opercular segment of the MCA. A temporary clip was then applied to perforating arteries along with continuous MEPs recording. If the MEP amplitude was decreased by greater than 50% from the baseline, blood flow insufficiency to the descending motor pathway was suspected. If no significant change was recorded after 10 minutes, the artery could be sacrificed. ICG videoangiography was used to check the temporary occlusion of such perforators. This approach is appealing, but perforators can be as small as 0.3 according to the study by and the temporary occlusion cannot be easy, with a risk of vasospasm or irreversible injury to the perforator.

Alfredo Conti

Messina, Italy

References

1. Iwasaki M, Kumabe T, Saito R, Kanamori M, Yamashita Y, Sonoda Y, Tominaga T (2014) Preservation of the long insular artery to prevent postoperative motor deficits after resection of insulo-opercular glioma: technical case reports. Neurol Med Chir (Tokyo) 54:321-326

2. Saito R, Kumabe T, Inoue T, Takada S, Yamashita Y, Kanamori M, Sonoda Y, Tominaga T (2009) Magnetic resonance imaging for preoperative identification of the lenticulostriate arteries in insular glioma surgery. Technical note. J Neurosurg 111:278-281

3. Sanai N, Polley MY, Berger MS (2010) Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. J Neurosurg 112:1-9

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Delion, M., Mercier, P. Microanatomical study of the insular perforating arteries. Acta Neurochir 156, 1991–1998 (2014). https://doi.org/10.1007/s00701-014-2167-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-014-2167-9

Keywords

Search

Navigation