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Lipoma of the insula

Case report

Shizuo Hatashita, Tokiwa Sakakibara, and Shozo Ishii

first case of a lipoma of the insula, in which the diagnosis was made and verified surgically during life. Case Report This 20-year-old man was admitted to our hospital on March 10, 1981, with a 2-year history of grand mal seizure. Even with the continued use of anticonvulsant drugs, the frequency of the seizures increased 3 or 4 months prior to admission. Examination . Physical and neurological examinations were normal. An electroencephalogram recorded dysrhythmia and sporadic spike waves over the left frontotemporal region. Tomograms of the skull revealed an

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Uğur Türe, M. Gazi Yaşargil, Ossama Al-Mefty, and Dianne C. H. Yaşargil

T he insula, or island of Reil, forms the base of the sylvian fissure and constitutes the invaginated portion of the cerebral cortex that covers the claustrum and the basal ganglia. Adequate visualization of the insula requires that the sylvian fissure be opened along its entire length. The insula is one of the paralimbic structures known as the mesocortex, which is anatomically and functionally interposed between the allocortex and neocortex. 15 The insula has long been a subject of research and speculation; however, the distinct realm of its function

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Atman Desai, Kimon Bekelis, Terrance M. Darcey, and David W. Roberts

I nsular epilepsy has been the subject of increasing investigation over the past decade, but the concept of seizures arising within the insula was in fact first proposed over half a century ago on the basis of intraoperative electrocorticographic recordings in patients undergoing epilepsy surgery, 9 findings that went on to be replicated several years later by Wilder Penfield. 19 There followed several decades of anecdotal reports of seizures associated with insular lesions, including tumors and cavernomas, 4 , 6 , 10 , 23 but owing perhaps to hazardous

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M. Yashar S. Kalani, Maziyar A. Kalani, Ryder Gwinn, Bart Keogh, and Victor C. K. Tse

T he description of the insula is commonly credited to Johann C. Reil. 29 The insula is located at the base of the sylvian fissure on the lateral surface of the brain within the lateral sulcus. It is surrounded by the basal ganglia and hidden by the frontal, parietal, and temporal cortices. Given its position relative to other cortical structures, the insula has been described as an extension of the temporal lobe, a unique and phylogenetically ancient lobe of the telencephalon as well as a component of deeper limbic structures. Despite much discourse on

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M. Yashar S. Kalani, Maziyar A. Kalani, Ryder Gwinn, Bart Keogh, and Victor C. K. Tse

T he description of the insula is commonly credited to Johann C. Reil. 29 The insula is located at the base of the sylvian fissure on the lateral surface of the brain within the lateral sulcus. It is surrounded by the basal ganglia and hidden by the frontal, parietal, and temporal cortices. Given its position relative to other cortical structures, the insula has been described as an extension of the temporal lobe, a unique and phylogenetically ancient lobe of the telencephalon as well as a component of deeper limbic structures. Despite much discourse on

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Josef Zentner, Bernhard Meyer, Armin Stangl, and Johannes Schramm

. These form the basis for a better understanding of the functional and microarchitectonic aspects of this area. The cortical layers covering the basal nuclei in the early embryological stages form the insula until the end of the 5th month of gestation. 3, 34 The apposition of the frontal, parietal, and temporal opercula is only completed with the end of gestation. 3, 23 This process transforms the insular cortex into a deep-seated area that, nevertheless, represents in gross anatomical form a copy of the superficial superolateral cortical areas. At the base of

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Necmettin Tanriover, Albert L. Rhoton Jr., Masatou Kawashima, Arthur J. Ulm, and Alexandre Yasuda

T he insula is a roughly triangular area, located deep to the frontal, parietal, and temporal opercula in the floor of the sylvian fissure. Complete exposure of the insula requires that the sylvian fissure be opened widely. The technical complexity involved in opening the sylvian fissure for insular exposure and the vital pathways coursing deep to the insula make surgery for vascular and neoplastic lesions in this area hazardous. 3–5, 9, 16, 18, 23, 31, 43, 45, 46 There have been numerous reports on the anatomy of the sylvian fissure and insula. 1, 2, 10, 12

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Atman Desai, Barbara C. Jobst, Vijay M. Thadani, Krzysztof A. Bujarski, Karen Gilbert, Terrance M. Darcey, and David W. Roberts

T he concept of seizures arising within the insula was first proposed in the 1940s by Guillaume and Mazars, 10 based on electrocorticographic recordings obtained intraoperatively in patients undergoing epilepsy surgery. Several years later, their findings were replicated by Penfield. 20 There followed several decades of anecdotal reports of seizures associated with insular lesions, 4 , 5 , 11 , 22 but perhaps owing to the hazardous surgical anatomy and poor outcomes reported with insular resection, 25 there was little focused investigation of the role of

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Chang-Chia Liu, Shayan Moosa, Mark Quigg, and W. Jeffrey Elias

treat patients with refractory chronic pain, the anterior part of the insula is also a part of the limbic system and is involved in affective-motivational and cognitive-evaluative brain functions that have fundamental roles in human awareness and pain perception. 5–8 Intracranial electroencephalogram (EEG) recordings have demonstrated that nociceptive inputs are processed in the insula along the posterior-to-anterior direction, with each subarea related to a different dimension of pain; 9 thus, whereas the posterior insula is involved in the sensory processing of

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Arnau Benet, Shawn L. Hervey-Jumper, Jose Juan González Sánchez, Michael T. Lawton, and Mitchel S. Berger

I nsular gliomas are among the most challenging lesions to manage in neurosurgery. In contrast to other regions of the cerebral cortex, the insular lobe is located beyond the cerebral surface, in the depth of the sylvian fissure and covered by the opercula and many critical vascular structures. Additionally, a fair amount of cortical areas covering the insula are functional. Also, the venous complex covering the sylvian fissure often contains important drainage that must be preserved, further narrowing surgical options for tumor removal. Despite this