Microsurgical anatomy of the central lobe

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OBJECT

Central Lobe consists of the pre- and postcentral gyri on the lateral surface and the Paracentral Lobule on the medial surface and corresponds to the sensorimotor cortex. The objective of the present study was to define the neural features, craniometric relationships, arterial supply, and venous drainage of the central lobe.

METHODS

Cadaveric hemispheres dissected using microsurgical techniques provided the material for this study.

RESULTS

The coronal suture is closer to the precentral gyrus and central sulcus at its lower rather than at its upper end, but they are closest at a point near where the superior temporal line crosses the coronal suture. The arterial supply of the lower two-thirds of the lateral surface of the central lobe was from the central, precentral, and anterior parietal branches that arose predominantly from the superior trunk of the middle cerebral artery. The medial surface and the superior third of the lateral surface were supplied by the posterior interior frontal, paracentral, and superior parietal branches of the pericallosal and callosomarginal arteries. The venous drainage of the superior two-thirds of the lateral surface and the central lobe on the medial surface was predominantly through the superior sagittal sinus, and the inferior third of the lateral surface was predominantly through the superficial sylvian veins to the sphenoparietal sinus or the vein of Labbé to the transverse sinus.

CONCLUSIONS

The pre- and postcentral gyri and paracentral lobule have a morphological and functional anatomy that differentiates them from the remainder of their respective lobes and are considered by many as a single lobe. An understanding of the anatomical relationships of the central lobe can be useful in preoperative planning and in establishing reliable intraoperative landmarks.

ABBREVIATIONSACA = anterior cerebral artery; AVM = arteriovenous malformation; MCA = middle cerebral artery.

Article Information

Correspondence Albert L. Rhoton Jr., Department of Neurological Surgery, University of Florida, P.O. Box 100265, Gainesville, FL 32610. email: rhoton@neurosurgery.ufl.edu.

INCLUDE WHEN CITING Published online January 2, 2015; DOI: 10.3171/2014.11.JNS14315.

DISCLOSURE Financial support was provided by the University of Florida Foundation. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Gyral and sulcal variations in multiple hemispheres. A: Part of the frontal and parietal lobes has been removed while preserving the pre- and postcentral gyri separated by a central sulcus. The central sulcus commonly opens directly into the interhemispheric fissure but is separated from the sylvian fissure by a gyral bridge, the subcentral gyrus. It has a gently convex posterior upper curve and a gently convex anterior lower curve. The shallow indention on the subcentral gyrus is not a sulcus but is related to an artery crossing the gyrus. B: Gyral bridges frequently interrupt the precentral and postcentral gyri but not the central sulcus (Table 1). The postcentral sulcus in this hemisphere is continuous and not interrupted by any gyral or sulcal bridge. The central sulcus opens into the interhemispheric fissure but is separated from the sylvian fissure by a subcentral gyrus. Two complex gyral bridges (red arrows) connect the superior and middle frontal gyri to the lower part of the precentral gyrus. C and D: Medial surface of two right hemispheres. C: The paracentral lobule is formed by the extension of the pre- and postcentral gyri onto the medial surface of the hemisphere. The paracentral lobule is limited posteriorly by the ascending ramus of the cingulate sulcus and anteriorly by the paracentral ramus of the cingulate sulcus. The paracentral sulcus was present in approximately half of hemispheres. The ascending ramus was found in nearly all hemispheres and is easily seen on MRI at the posterior edge of the paracentral lobule. The precuneus is located between the ascending ramus and the parietooccipital sulcus. D: The paracentral sulcus, which was absent in approximately 50% of hemispheres, does not reach the upper margin of this hemisphere. The anterior limit of the paracentral lobule can be determined by the overlap of the central sulcus onto the medial surface. E: Superior view. On the left hemisphere there is a large gyral bridge (red arrow) connecting the upper edges of the pre- and postcentral gyri and separating the upper end of the central sulcus from the interhemispheric fissure. The “hand knob” on the precentral gyrus is seen in both hemispheres (yellow stars). F: Lateral surface. The lower third of the central sulcus usually courses lateral and parallel to the central insular sulcus. Asc. = ascending; Cent. = central; Cing. = cingulate; Corp. Call. = corpus callosum; Front. = frontal; Gyr. = gyrus; Ins. = insular; Lob. = lobule; Mid. = middle; Occip. = occipital; Operc. = opercularis; Par. = parietal; Paracent. = paracentral; Postcent. = postcentral; Precent. = precentral; Subcent. = subcentral; Sulc. = sulcus; Sup. = superior.

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    A: The right coronal suture and the precentral gyrus converge as they descend from their upper ends and become closer. The point of maximal convergence is approximately at the junction of the superior temporal line and the coronal suture (yellow star). This point, named the stephanion, is located an average of 7.6 cm lateral to the midline along the coronal suture. B: The anterior edge of the right precentral sulcus is closest to the coronal suture around 1 cm lateral to the point where the superior temporal line crosses the coronal suture (yellow star) as was found in 25% of the hemispheres. Below this point they diverge, but their lower ends remain closer than their upper ends. C and D: Typical course of the central sulcus (C) and coronal suture (D) (red dots measured at 1-cm intervals) starting superiorly at the interhemispheric fissure. E: Graph showing the distance between the coronal suture and central sulcus starting above at the interhemispheric fissure and at every cm along their descent in 20 hemispheres (Table 2). As they run downward and lateral from the vertex, they converge to near where they cross the superior temporal line after which they diverge. The lower end of the central sulcus is closer to the coronal suture than the upper end. F: Graph showing the average inclination of the upper and lower halves of the coronal suture and central sulcus in comparison with the coronal plane passing through the upper end of their upper and lower halves in 20 hemispheres (Table 3). The central sulcus is steeper in the lower than the upper half. The opposite is true for the coronal suture, for which the upper half is steeper than the lower half. Cor. = coronal; Sag. = sagittal; Squam. = squamous; Sup. = superior; Temp. = temporal.

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    A: The anterior part of the frontal lobe was removed using a coronal cut anterior to the foramen of Monro. The upper part of the superior frontal gyrus was removed to expose the course of the posterior internal frontal artery, which folds over the superior margin of the lateral surface approximately 1.5 cm anterior to the precentral gyrus after supplying the supplementary motor area. It also supplies the superior portion of the precentral gyrus on the lateral surface but not the paracentral lobule on the medial surface. B: The callosomarginal artery gives rise to the posterior internal frontal and paracentral arteries. The posterior internal frontal artery folds over the superior margin of the lateral surface and supplies the supplementary motor area (green shaded area) and the superior portion of the precentral gyrus. The paracentral artery courses inside the cingulate sulcus before turning upward to supply the paracentral lobule and a small portion of the upper part of the postcentral gyrus. Sacrificing these arteries may lead to a supplementary motor area syndrome with contralateral lower-limb weakness. C: An enlarged view of the paracentral lobule. The paracentral lobule is commonly supplied by the paracentral and superior parietal arteries. In this hemisphere the superior parietal artery is a branch of the pericallosal artery and runs in the ascending ramus of the cingulate sulcus to supply the lower and posterior borders of the paracentral lobule. The paracentral artery, a branch of the callosomarginal artery, courses in the cingulate sulcus and supplies the majority of the paracentral lobule. D–G: Other arteries have been removed to show the trajectory and area of supply of the left posterior internal frontal artery. D: Medial surface of left hemisphere. This posterior internal frontal artery arises from the pericallosal artery, runs upward and posterior to supply the posterior portion of the medial surface of the superior frontal gyrus. It folds over the superior margin of the hemisphere anterior to the paracentral lobule. E: Upper lateral surface of the left hemisphere shown in D. The posterior internal frontal artery folds around the superior border anterior to the central lobe to supply the posterior portion of the superior frontal gyrus and the upper part of the precentral gyrus. F: Medial surface of a right hemisphere. The callosomarginal artery arises from the precallosal segment of the pericallosal artery and gives rise to both the middle and posterior internal frontal arteries. The paracentral artery arises from the pericallosal artery and courses upward to reach the anterior part of the paracentral lobule. G: Superior part of the lateral surface of the right hemisphere shown in F. The watershed area between the ACA and MCA is located approximately 1.5 cm lateral to the superior margin of the lateral surface (green shaded area), where there are anastomoses between branches of the MCA and ACA. The posterior internal frontal artery runs in an anterior to posterior direction. The watershed area is supplied by the central branches of the MCA and by the posterior internal frontal, paracentral, and superior parietal branches of the ACA. A. = artery; Callosomarg. = callosomarginal; Caud. = caudate; Lat. = lateral; Med. = medial; M.I.F.A. = middle internal frontal artery; Nucl. = nucleus; P.I.F.A. = posterior internal frontal artery; Pericall. = pericallosal; Vent. = ventricle.

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    A: Right cerebral hemisphere. The cortical distribution of the MCA includes most of the lateral surface of the hemisphere and all the insular and opercular surfaces. The cortical branches anastomose with the terminal branches of the ACA approximately 1.5 cm lateral to the superior border. The M4, composed of the cortical branches of the MCA usually begins at the surface of the sylvian fissure and runs on the lateral surface commonly within the sulci. The cortical branches of the M4 segment, named based on their supply to 12 different areas, are as follows: orbitofrontal, prefrontal, central, anterior parietal, posterior parietal, angular, temporooccipital, posterior temporal, middle temporal, anterior temporal, and temporopolar.43 B: View of the M2, M3, and M4 segments. The bifurcation occurs just proximal to the genu. The M2 is constituted by the trunks that cross and supply the insula and end at the limiting sulci of the insula. The M3 segment starts at or near the limiting sulci where the M2 branches turn to course on the frontoparietal and temporal opercula. The M4 segment is formed by the cortical branches. In this hemisphere the inferior trunk gives rise to the temporopolar, anterior temporal, middle temporal, posterior temporal, temporooccipital, angular and posterior parietal branches. An early frontal branch gives origin to the orbitofrontal and prefrontal arteries. The superior trunk gives rises to the precentral, central, and anterior parietal branches. C: Enlarged view. The cortical arteries that supply the central lobe can be followed from their origin on the postbifurcation trunks on the insular surface to the cortex. The superior trunk gives rise to 3 stem arteries from which the cortical branches arise. The anterior stem artery bifurcates into the precentral arteries that supply the lower portion of the precentral gyrus, and the large stem artery bifurcates and gives rise to 2 central arteries in what was found to be a frequent pattern. Another stem artery arose from the superior trunk as a single branch to become the anterior parietal artery. D: The central artery arises at the outer edge of the sylvian fissure as a double artery and supplies most of the central lobe. The precentral artery supplies the lower part of the precentral gyrus. The anterior parietal artery supplies the middle third of the posterior portion of the postcentral gyrus. Ang. = angular; Ant. = anterior; Ant. Par. = anterior parietal; Bifurc. = bifurcation; br. = branch; Fiss. = fissure; Orbitofront. = orbitofrontal; Post. = posterior; Prefront. = prefrontal; Sylv. = sylvian; Temp. Pol. = temporopolar; Temp. Occip. = temporooccipital; Tr. = trunk.

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    A–E: Arterial supply of the lateral surface of the central lobe: posterior internal frontal artery (dark blue), paracentral artery (orange), superior parietal artery (light blue), precentral artery (green), central artery (red), and anterior parietal artery (yellow). A: Most common pattern. The posterior interior frontal and paracentral branches of the ACA supply the upper part. The majority of the lateral surface is supplied by the central branch of the MCA. The areas not supplied by the central artery are the anterior inferior part of the precentral gyrus supplied by the precentral and the posterior edge of the postcentral gyrus supplied by the anterior parietal artery. These cortical arteries often course in the sulci as well as on the surface of the gyri. B–E: Frequently encountered variations. B: The lower two-thirds of the central lobe is predominantly supplied by the central artery. On the superior third, the precentral gyrus is supplied by the posterior interior frontal artery and the postcentral gyrus by the superior parietal artery. C: The superior parts of the precentral and postcentral gyri are supplied by the paracentral and superior parietal arteries, respectively. There is no supply from the posterior inferior frontal artery. A larger than usual area of the precentral gyrus is supplied by the precentral artery. D: The precentral and the anterior parietal arteries have a larger than usual area of supply that narrows the large proximal area usually supplied by the central artery. The superior third is supplied by the posterior internal frontal and paracentral arteries. E: There is no contribution from the precentral artery. The anterior parietal artery supplies the lower two-thirds of the posterior part of the postcentral gyrus. The area supplied by the cortical branches of the ACA is divided between the posterior interior frontal, paracentral, and superior parietal arteries. Parac. = paracentral; Prec./Precent. = precentral. Copyright Albert L. Rhoton Jr. Published with permission.

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    Illustration showing the percentage of cortical branches of the ACA and MCA that supply the upper, middle, and lower thirds of the central lobe. The watershed area between the ACA and MCA is located approximately 1.5 cm lateral to the superior margin (green shaded area). The branches of the MCA (central, precentral, and anterior parietal arteries) arise near the surface of the sylvian fissure and ascend to anastomose with the descending cortical branches of the ACA (posterior interior frontal, paracentral, and superior parietal arteries), which fold around the superior margin. Copyright Albert L. Rhoton Jr. Published with permission.

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    A–F: Venous drainage of the central lobe. A: A common pattern of drainage. The superior two-thirds of the right hemisphere is drained by the cortical veins emptying into the superior sagittal sinus. The inferior third drains through the frontosylvian and parietosylvian veins to a superficial sylvian vein that empties into a large vein of Labbé and the transverse sinus. B: Three veins of Trolard (green arrows) crossed this left hemisphere, connecting the superficial sylvian vein with the superior sagittal sinus. The posterior part of the central lobe is drained through the posterior vein of Trolard. A precentral vein drains a large portion of the central lobe. The inferior third is drained by the frontosylvian and parietosylvian veins, except for the anterior part of the precentral gyrus, which drains through the middle anastomotic vein of Trolard. C: A large common trunk receives drainage from several cortical veins before passing below a large venous lacuna to empty into the superior sagittal sinus. The majority of the posterior right central lobe is drained by central and precentral veins that pass below this lacuna. The posterior part of the central lobe drains to the superior sagittal sinus through a large anastomotic vein of Trolard. D: A large precentral vein drained the majority of the superior two-thirds of the precentral gyrus. The central vein drained a portion of the precentral gyrus and emptied into the larger precentral vein that emptied into the superior sagittal sinus. The inferior third of the central lobe drained into a hypoplasic superficial sylvian vein joined to a vein of Labbé that emptied into the transverse sinus. The superior two-thirds of the postcentral gyrus is drained by a postcentral vein that empties into the superior sagittal sinus. E: The right central lobe is drained predominantly by a large central vein that empties into the superior sagittal sinus. A small portion of the anterior edge of the precentral gyrus is drained by the posterior and middle frontal veins that form a common trunk before emptying into the superior sagittal sinus. The lower portion of the central lobe is drained by frontosylvian and parietosylvian veins that empty into the superficial sylvian vein. F: Enlarged view of the opercular region of another right hemisphere. The lower portion of the central lobe is drained by frontosylvian and parietosylvian veins that empty into a superficial sylvian vein that emptied predominantly through a large vein of Labbé into the transverse sinus. Comm. = communicating; Cort. = cortical; V. = vein; Ven. = venous.

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    Dominant drainage pathways of different parts of the central lobe. A, B, and C are respectively the upper, middle, and lower thirds of the precentral gyrus, and D, E, and F are the upper, middle, and lower thirds of the postcentral gyrus. Parts A, B, and D drain to the superior sagittal sinus in 100% of the hemispheres. Parts C and F drain predominantly to the sphenoparietal and transverse sinuses with a slightly higher proportion of the precentral gyrus draining to the sphenoparietal and the postcentral gyrus to the transverse sinus. In some hemispheres the lower third drained to the superior sagittal sinus due to the presence of a large vein of Trolard that drained predominantly upwards. The most common location of the vein of Trolard was along the territory drained by the postcentral vein. In 10% of the hemispheres, area E drained to the transverse sinus due to the presence of larger than average parietosylvian veins. Sin. = sinus; Sphen. Par. = sphenoparietal; Trans. = transverse. Copyright Albert L. Rhoton Jr. Published with permission.

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    Diagram of the left hemisphere showing the correlation of the most common pattern of central lobe arterial supply to the classic homunculus on the lateral surface. The cortical areas supporting fine movements are disproportionally large in comparison with areas supporting more gross movements. Obliteration of a single arterial branch may lead to a motor or sensory deficit in a specific part of the body. See Fig. 5 for legend for arteries on pre- and postcentral gyri. Copyright Albert L. Rhoton Jr. Published with permission.

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