• Matias Baldoncini, Alvaro Campero, Julio César Pérez Cruz, Rodolfo Recalde, Richard Parraga, Federico J Sanchez Gonzalez, Martin Fortte, and Pablo González López.
• Department of Neurological Surgery, San Fernando Hospital, Buenos Aires, Argentina; Laboratory of Neuroanatomic Microsurgical, II Division of Anatomy, Medicine School, University of Buenos Aires, Buenos Aires, Argentina. Electronic address: drbaldoncinimatias@gmail.com.
• World Neurosurg. 2019 Sep 1; 129: e23-e34.

ObjectiveThrough a cadaveric study, we divided the cerebral central core (CCC) into different areas and have proposed a corresponding neurosurgical approach for each sector. As a secondary objective, we analyzed the cortical and subcortical microsurgical anatomy of the CCC. The CCC includes the insula, extreme capsule, claustrum, external capsule, lenticular nucleus, internal capsule, caudate nucleus, and thalamus.MethodsTwelve adult human brain hemispheres and one cadaveric head specimen were dissected and studied at the Laboratory of Neuroanatomic Microsurgical of the University of Buenos Aires. Nine cases of CCC neurosurgical pathologies were included in the present study and analyzed. Digital drawings were created of the approaches proposed for each sector of the CCC showing the most relevant surgical details. Photographs of each dissection and measurements obtained were taken.ResultsWe divided the CCC into a medial, intermediate, and lateral sector, with specific subdivisions for the lateral and medial sectors. The lateral projection of the foramen of Monro was found deep to the third short gyri of the insula with the following distances: anterior insular limen margin, 23.95 mm; posterior insular limen margin, 22.92 mm; superior limiting sulcus, 14.99 mm, and inferior limiting sulcus, 13.76 mm. We have proposed the following approaches: an ipsilateral transcallosal approach, a contralateral transcallosal approach, a choroidal transfissure approach, a trans-splenial approach, transparietal access entering the intraparietal sulcus, and trans-sylvian approach. The preoperative imaging studies should be analyzed using our method to select the most accurate and safe approach.ConclusionsWe have provided a description of the limits and anatomy of the CCC using brain dissection, an analysis of operated cases, and useful measurements for the neurosurgeon.Copyright © 2019 Elsevier Inc. All rights reserved.

2 keywords...

hide…