The Study Of The Insula Lesion Surgery Anatomy And Clinical

The first partObjective Resin head specimens were pterion craniotomy-the microdissection sylviusprocedure research, provide a reference basis for surgery insula lesions. Insula anatomyknowledge, for more accurate and efficient complete excision of the region of epileptic foci,tumor, vascular malformation, and minimize the damage to the important neural structures isof great significance.Methods Surgical microscope was applied to4cases of cadaver head specimenspterion craniotomy-via the lateral crack surgical approach microdissection and study,provide a reference basis for surgery insula lesions.Results Superficial vein in the brain is a constant venous drainage of the lateral fissure,usually return to sphenoid sinus or cavernous sinus. Lateral fissure into big sylvius and smalllateral crack, large lateral fissure (60%), small lateral fissure (40%). Insula pyramid, isseparated from the cerebral cortex around the annular groove. Island prefrontal groove grooveis the most important, the deepest, exists in all sides, it from the threshold or islands above thethreshold at the back of the backward inclined line across the island, with the central grooveparallel to the line of basic, reaches the limit groove, the insula is divided into the rear of thefront of the big and small. Bean grain arrogant since the brain artery trunk, cortical branches,dry, bifurcation, or up and down by former wear mass into brain parenchyma, along thelentiform nucleus or shallow, or wear into the lentiform nucleus arc rise, almost all of the beangrain artery before wear into the lentiform nucleus substance formed a arcuate bending andbending ring, and ultimately through the internal capsule and the caudate nucleus. Accordingto bean grain arterial stroke, they can be divided into brain parenchyma outside and within the brain parenchyma. Wear mass: before the wear mass in threshold tight inside of the island isan important marker of surgical operation. To the outer wear artery into the top point isregarded as before the wear properties of the lateral side.Conclusion Pterion craniotomy-via the lateral crack surgical approachmicrodissection research results show that the lateral fissure type were divided into two largelateral fissure and small lateral fissure. Is important to wear the mass medial to the islandthreshold tight before surgery. The lateral bean grain arteries enter wear qualitative point isconsidered before the wear properties of the lateral boundary. Insula located in lateral fissureof the deep, is not easy to expose, the blood vessels at the surface of the barrier, fullyunderstand the microdissection of insula and the surface of the vascular lesions of the insulasurgery is very important. Middle cerebral artery bifurcation occurs near the threshold of theisland. Lateral bean grain arteries starting point on the M1before, during and after the periodof bifurcation of medial and lateral groups bean grain arteries after putamen bow inward andbackward supply almost the length of the internal capsule and the head of the caudate nucleus,the upper part of the body. The second partObjective To improve with seizures in the insula: pathological changes in patients withthe diagnosis and treatment level and summarize18cases of insula lesion resection in patientswith clinical data, analysis of the clinical manifestations, surgery and prognosis of epilepsy,etc., to explore characteristics of patients with seizures, operation strategy, and prognosis ofepilepsy.Methods Collection of ningxia medical university general hospital neurosurgery,2008.10to2010.10,18patients with insula lesion excision, summarize its clinicalmanifestations, neuroimaging data, semeiology, electrophysiological data, surgical methodsand histopathologic data, postoperative complications and prognosis of epilepsy, etc., toexplore characteristics of patients with seizures, operation strategy, and prognosis of epilepsy.Conclusion In18patients,7cases of male, female in11cases,35years old on average.Preoperative MRI to determine the lesion location, left4cases (22%),14cases (78%) on theright side.9cases of isolated island lobe lesions,4cases of temporal lobe,3cases of frontallobe,2cases involving multiple lobes. Epileptic seizures in history, among them,14caseswith epilepsy as starting symptoms,9cases had a systemic rigidity at least-clonus.13patients before surgery has carried on the scalp eeg examination,11cases of abnormal brainwaves.11patients in the insula lesions all cut (including4patients with vascular lesions),7cases due to extensive disease or involves the language area, JiDeJieOu, and time.Histopathology:14cases of astrocytoma,4cases were cavernous hemangioma.11-33monthpostoperative follow-up (mean20.8months). The incidence of early postoperativecomplications was28%, permanent complication rate was11%. No deaths. Seizure outcome:13cases (72%) patients with seizures completely disappear,2cases of occasional bouts ofnumbness of the limbs on one side and convulsions,2cases of epileptic seizure,1~2timesper month,1case of epileptic seizure4~5times/month. According to Engel effect level classification: Ⅰ level13cases; Ⅱ level2cases; Ⅲ level in2cases,1case was Ⅳ level.