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Window anatomy for neurosurgical approaches
Simel Kendir, m.d.,1 Halil ibraHim acar, m.d.,1 ayHan comert, m.d.,1 mevci ozdemir, m.d., 2 GoKmen KaHiloGullari, m.d., 2 alaittin elHan, d.v.m., PH.d.,1 and HaSan caGlar uGur, m.d., PH.d. 2
Departments of 1Anatomy and 2Neurosurgery, Ankara University, Sihhiye, Ankara, Turkey
Object. Knowledge of the cranium projections of the gyral structures is essential to reduce the surgical complications and to perform minimally invasive interventions in daily neurosurgical practice. Thus, in this study the authors aimed to provide detailed information on cranial projections of the eloquent cortical areas. Methods. Ten formalin-fixed adult human skulls were obtained. Using sutures and craniometrical points, the crania were divided into 8 windows: superior frontal, inferior frontal, superior parietal, inferior parietal, sphenoidal, temporal, superior occipital, and inferior occipital. The projections of the precentral gyrus, postcentral gyrus, inferior frontal gyrus, superior temporal gyrus, transverse temporal gyri, Heschl gyrus, genu and splenium of the corpus callosum, supramarginal gyrus, angular gyrus, calcarine sulcus, and sylvian fissure to cranial vault were evaluated. Results. Three-fourths of the precentral gyrus and postcentral gyrus were in the superior parietal window. The inferior frontal gyrus extended to the inferior parietal window in 80%. The 3 important parts of this gyrus were located below the superior temporal line in all hemispheres. The orbital and triangular parts were in the inferior frontal window, and the opercular part was in the inferior parietal window. The superior temporal gyrus was usually located in the inferior parietal and temporal windows, whereas the supramarginal gyrus and angular gyrus were usually located in the superior and inferior parietal windows. The farthest anterior point of the Heschl gyrus was usually located in the inferior parietal window. The mean positions of arachnoid granulations were measured as 3.9 ± 0.39 cm anterior and 7.3 ± 0.51 cm posterior to the bregma. Conclusions. Given that recognition of the gyral patterns underlying the craniotomies is not always easy, awareness of the coordinates and projections of certain gyri according to the craniometric points may considerably contribute to surgical interventions. (DOI: 10.3171/2008.10.JNS08159)
Key WordS • gyral anatomy • neurosurgical approach • sulcal anatomy • surgical anatomy • window anatomy
great advances in image-guided technologies, studying actual brain structures is still one of utmost importance. A detailed study of neuroanatomy through dissections in cadavers can provide the best orientation in that regard.18,22,24,25,27,28 The modern microneurosurgical approaches mainly require gyri and sulci orientation.3,10,13,20 With the contribution of surgical anatomical studies on the brain surface, several neurosurgical approaches can be easily performed today.7,8,11,16,17,23 Despite considerable knowledge of intracranial anatomy, little is known about eloquent brain parts and their bone relationships. Cranial-cerebral relationships, firstly described in the 19th century by Broca, were reevaluated in this study. Misinterpretation of the gyri and sulci pre- and intraoperatively may increase the complication rates.16,29,30 Identifying the gyri, especially when they are not neighespite
boring the sulci or fissures, which are always persistent in the brain, may be very problematic. Therefore, in this study we especially aimed to highlight the methods to identify the gyri with the guidance of the craniometrical points and sutures.
Ten formalin-fixed adult skulls were obtained. Skulls with the signs of CNS trauma or disease were excluded. The scalp and cranial muscles were removed. The cranial sutures, lines, and craniometrical points were protected,
This article contains some figures that are displayed in color online but in black and white in the print edition.
J Neurosurg / Volume 111 / August 2009
Shrinkage of the cerebral hemispheres may occur at the time of fixation. supramarginal gyrus.S. sphenoidal. the sulci that separated the parts were used. 2). and all the remaining bone tissues were removed with the aid of a high-speed drill (Midas Rex Legend Gold Touch) (Fig. shrinkage. the gyrus reached Fig. inferior frontal.2 ± 4. and inferior occipital (8). locations of the arachnoid granulations. and a standard goniometer (precision 1°) was used for angular measurements. and sylvian fissure on the windows were evaluated. Heschl gyrus. superior view.66 ± 0. and squamous [SqS] sutures. inferior frontal gyrus. 1). Then. angular gyrus. left 59.49°.37°) angle with the sagittal suture. inferior parietal. At the lower margin of the inferior parietal window. 1). temporal (6). showing the branches of the middle meningeal artery on the dura mater. sagittal. Given that the reference points and the direction of measurements varied according to the gyrus examined. temporal. SS = sagittal suture. and their distances. The procedure disclosed 8 windows in each hemisphere: superior frontal. and temporal and superior occipital) were taken into consideration during evaluation. stephanion [S]. 3. superior parietal. sphenoidal (3). cranial sutures (coronal [CS]. the sagittal distances of a gyrus located close to the middle of the cerebrum. inferior parietal (5). creating a 59° (right 58.1 mm). inferior frontal (2). 2. To perform a detailed investigation of the parts of the inferior frontal gyrus. Craniotomies disclose the following 8 windows on each side: superior frontal (1). The arachnoid granulations and branches of middle meningeal artery on the dura mater were observed (Fig. and squamous sutures. inferior parietal. 3) and coursed laterally and frontally. postcentral gyrus. left 4. a constant linear correction factor was not used in this study. The locations of the arachnoid granulations through the sagittal sinus were observed. Results Precentral Gyrus The precentral gyrus was located 4. superior parietal (4). such as precentral gyrus. the distances of the gyrus located far from the middle of the cerebrum. lambda [L]. will not be significantly affected by the Fig. stephanion. Photograph showing the exposure of the cranium. Kendir et al. The measurements were obtained using a measuring tape (precision 0. and superior temporal line [STL]) and craniometric points (bregma [B]. 1. these 5 windows (inferior frontal. Because these important cortical areas were located in 5 of the 8 windows when craniotomies were performed.8 ± 5. superior occipital. genu and splenium of the corpus callosum. Three-fourths of the precentral gyrus was in the superior parietal window. superior parietal.34 ± 1. pterion [P]. the dura mater was removed and the cortical structures were inspected. Photograph showing the relationships and distances of the precentral gyrus in the superior and inferior parietal windows with the craniometric points (bregma. The projections of the precentral gyrus. Photograph. may be affected more. however. Fig. The morphometric measurements were done from the bone to the midgyral point. superior occipital (7).5 cm (right 4. Thus. 366 J Neurosurg / Volume 111 / August 2009 . and inferior occipital windows (Fig. and asterion [A]) in the cadaver skulls. and pterion) and cranial sutures (coronal. superior temporal gyrus. lambdoid [LS]. An analysis of the measurements (mean ± SD) was also performed. transverse temporal gyri.91 cm) behind the bregma on the midline (Fig. calcarine sulcus. and superior temporal line).06 cm. such as the orbital part of inferior frontal gyrus.
the gyrus was located 4.4 cm (right 0. Transverse Temporal Gyri.58 cm) below this line (Fig.79 cm) below the superior temporal line. Superior Temporal Gyrus. which was also the anterior boundary of the Heschl gyrus. supramarginal gyrus (SMG). and asterion) and cranial sutures (coronal.9 cm (right 1. The posterior-most boundary of the transverse temporal gyrus was in the area where the posterior ramus of the sylvian fissure curved upward. The triangular part was located 1. The sylvian fissure and its branches (anterior and ascending rami) were used to separate the inferior frontal gyrus into 3 parts: orbital.5 cm (right 2.9 cm behind the stephanion. stephanion. 4.18 cm) above the superior temporal line. and opercular. pterion. left 4.97 ± 0. pterion.Window anatomy for neurosurgical approaches Fig. sagittal.75. Fig. the gyrus reached to the sylvian fissure. In most cases (80%).50 ± 0.65 cm) behind the bregma on the midline (Fig. The transverse temporal gyrus constitutes the posterior part of the upper surface of the temporal lobe.52 cm. This point was located in the third quarter of the inferior parietal window in all cases. Although the inferior frontal gyrus extended to the inferior parietal window in 80% of the cases. left 0.9 cm (right 2. 5).85 ± 0.63 cm.38°) angle with the sagittal suture. and the superior temporal line). squamous.38 ± 0. 3).04 cm. Photograph showing the relationships and distances of the angular gyrus (AG). was usually located in the inferior parietal window.70 ± 0. and the opercular part was in the inferior parietal window (Fig. right 40%). 5). triangular [Tr]. In cases in which the inferior frontal gyrus extended to the inferior parietal window. stephanion. left 2.45 cm) behind the stephanion (Fig. and superior temporal line). Postcentral Gyrus The postcentral gyrus was located 6. right 50%) (Fig.5 cm (right 6. On the lateral surface. in which it was seen in the superior parietal window. which is known as the temporal plane.1 cm (right 4. and squamous sutures. 4) and coursed laterally and frontally constituting a 62° (right 61.14 cm.9° ± 4. left 1. and lambda) and cranial sutures (coronal. 5).00 ± 0. except in 1 hemisphere (5%).50 ± 0. the end of this gyrus was 1. the precentral gyrus was a strip that had no connection with other gyri.13 ± 0.33. the sylvian fissure.7 cm (right 0.97 ± 1.54 cm. In most of the cases (90%).63 cm) anterior to the coronal suture.68 cm. the end of the gyrus was located 0. Three-fourths of the postcentral gyrus was in the superior parietal window.8 cm (right 2. the postcentral gyrus was a strip that had no connection with other gyri.07 ± 0. left 6.1 ± 4. left 1. and parts of the inferior frontal gyrus (orbital [Or]. 4). 5. The 367 J Neurosurg / Volume 111 / August 2009 .54 ± 0. The precentral gyrus extended to the temporal window in some hemispheres (30%). lambda. The end of the inferior frontal gyrus was noted near the stephanion. it extended to the superior parietal window in 20%. and the opercular part could be seen in inferior frontal window (left 30%. At the lower margin of the inferior parietal window. sagittal. Photograph showing the relationships and distances of the postcentral gyrus in the superior and inferior parietal windows with the craniometric points (bregma. This point was placed on the same vertical line with the beginning point of the ascending ramus of the sylvian fissure and in 1 specimen. The triangular part was located 1.54 cm) posterior to the coronal suture (Fig.89 ± 0.54 cm) behind the stephanion (Fig.70 ± 0.46 ± 0. On the lateral surface. the gyrus was only 2.70 ± 0. the crossing point of this gyrus with the superior temporal line was located 7.34 ± 1. The farthest anterior point of the temporal plane. and Heschl Gyrus Inferior Frontal Gyrus In all hemispheres. In the cases in which the inferior frontal gyrus extended to the superior parietal window. The postcentral gyrus extended to the temporal window in some hemispheres (10%). The locations of these 3 important parts were below the superior temporal line in all the hemispheres. left 62. the superior temporal gyrus was located in the inferior parietal and temporal windows. and lambdoid sutures. and opercular [Op]) with the craniometric points (bregma. the point was located in the temporal window. The orbital and triangular parts were in the inferior frontal window. 1.42 cm. left 1. left 0. The triangular part could be seen in the inferior parietal window (left 60%. triangular. 5).
the measurements refer to a relatively small number of cases. which terminates in the middle of the supramarginal gyrus.33 cm) laterally to the sagittal suture (Fig.59 ± 1. It was located 4. left 2.02 cm.2. Given that the measurements were obtained after 10% formalin fixation. In all the hemispheres. a constant linear correction factor was not used in this study. To this end.39 cm anterior and 7. To identify these structures.16 One end of the precentral and postcentral gyri is in J Neurosurg / Volume 111 / August 2009 Discussion 368 . 5). Another indication for the importance of anatomical knowledge is the fact that advanced technology is not always available and applicable.0 cm (right 5. as described by Hattingen et al.S. Therefore.93 ± 0.00 ± 0. Angular Gyrus Calcarine Sulcus The end of calcarine sulcus on superolateral surface was observed 4.61 ± 0. this point was seen in the superior and inferior parietal windows.16 ± 1. the supramarginal gyrus was seen under the parietal tuber.5 This study reformatted images for fast and easy determination of the locations of the precentral gyrus and perirolandic lesions. the use of bone structures of the cranium may prove to be beneficial.90 ± 0.4 cm (right 4. left 0.15 The integration of sulcal and functional information of the brain and the importance of imaging were described by Jannin et al. The positive contribution of advanced technology to surgical outcome is undeniable.45 ± 0.00 ± 0.1.00 cm) in front of the lambdoid suture (Fig.6 In another study.4 cm (right 6.0 cm (right 4. This detailed anatomical information may prove useful in finding and interpreting the areas under the bone. The distance between this point and the sagittal suture was 6.42 cm) on the lateral surface of the hemisphere (Fig. was noted in order to evaluate the location of the gyrus.8 cm (right 0.9 as a shrinkage correction factor in the present study. Gong et al.43 cm. A reliable identification of functional cortical areas can be achieved through preoperative cortical mapping.77 ± 0.41 ± 0. However.44 cm. The point at which the sylvian fissure ended. The crossing point of the sylvian fissure with the superior temporal line was located 6. Arachnoid Granulations Proper craniotomy of a brain lesion and correct interpretation of the gyral structures under the craniotomy site is one of the most important steps in successful surgery. left 5.83 ± 1.21 cm.8 cm (right 2.62 ± 0. left 6. 5).8 ± 0.3 cm (right 4.10.39 ± 1.9 ± 0. this point was seen in the superior and inferior parietal windows. The linear correction factors of 0.4 described some cortical area findings obtained through diffusion weighted MR imaging techniques. left 6.01 ± 0. In 80% of the cases.64 cm) lateral to the lambda.80 cm. The location of this point was 4.40 ± 0. it is also an undeniable fact that anatomical knowledge and 3D orientation are indispensable for successful surgical outcome.6 ± 0.33 ± 0.25 There are very few persistent sulci in the brain that are always present in every individual. This point was located 0. The turning point of calcarine sulcus from the superolateral surface to the medial surface was different on the right and left hemispheres.3 ± 0.0 cm (right 6.14 However.21. In all the hemispheres. 5). identification of gyral structures may not be easy. which was one of the objectives of our study.88 cm) behind the stephanion in 12 hemicrania (right 4.49 cm. It was located 6.54 cm) behind the stephanion. These structures were located 2.83 cm. left 8.9 In that study.28 cm.82 cm. the positions of arachnoid granulations were measured as 3. left 6. the authors described the functional MR imaging–integrated neuronavigation for correlation between the cranial lesion and motor cortex.12. left 8) (Fig. left 2.88–0. 2).26. which terminates in the middle of the angular gyrus.50 ± 1.82 cm. Kendir et al. In 20% of the cases.30 ± 1.51 cm posterior to the bregma (Fig. anterior-most point of the temporal plane was found 2. 5).7 cm (right 6.23 cm. in our study a window anatomy model was developed.55 cm.6 cm (right 2. calculations of absolute linear measurements had to include ~ 0. left 4.39 cm) posterior to the coronal suture.29 In addition.40 ± 0.40 ± 0. Although we have used MR imaging assistance in surgical practice. was considered to evaluate the location of the gyrus. 2).15.20. the study itself focused on the detection of the important cortical areas by using craniometric points in the skull. Since the reference points and the direction of measurements varied according to the gyrus examined. The area comprising these granulations was supplied by the branches of the middle meningeal artery (Fig.39 ± 0. The end of the superior temporal sulcus.32 cm) on the lateral surface of the hemisphere (Fig. Supramarginal Gyrus Corpus Callosum The distance between the nasion and genu of the corpus callosum was measured as 12. The crossing point of superior temporal sulcus with superior temporal line was 8.7 cm (right 1.00 ± 1.04 ± 0. Arachnoid granulations were accumulated around (especially behind) the bregma (Fig.80 cm.70 cm) in front of the lambdoid suture.7 cm (right 2. A similar study was reported by Krishnan et al.92 ± 0. left 3.01 ± 1.4 cm (right 8. The MR imaging techniques can also be used for superficial brain lesions in the precentral gyrus. the combination of the data obtained from neuronavigation systems and functional MR imaging evaluations may provide information on the functional cortical areas.03 ± 1. 2).13 cm) inferior and 1. The distance between this point and the sagittal suture was 5.15 cm. left 0. 2). The superficial veins of the hemispheres drained into these granulations. In all the skulls. and the distance between the nasion and splenium of corpus callosum was 19. the angular gyrus was located under the parietal tuber.76 cm) inferior and 0.39 cm. left 4.94 can be determined at the usual fixation in ~ 4% formalin.26 cm) lateral to the lambda. left 1.80 cm) inferior to the superior temporal line.
2006 3. Fleig OJ. it can easily be recognized during surgery. in the inferior parietal window) should be kept in mind. Weidauer S. Hermann E. The sylvian fissure is a very important corridor for neurosurgical interventions. and Heschl gyrus neighbor the sylvian fissure. One point to consider in interventions to the midline lesions of the brain is the location of the arachnoid villi. McCracken JT.8. Particularly when the posterior ramus of the sylvian fissure is not observed in the craniotomy area. Herminghaus S.18 The Monro foramen is always in front of the coronal suture and for pathological entities that are not behind the Monro foramen. motor and sensory cortices. Matsushima T.27. is where the supramarginal and angular gyri are located. Sasaki T: Surgical strategy for distal anterior cerebral artery aneurysm: microsurgical anatomy. Thus. the craniotomy should not exceed the coronal suture. Consequently. Ersoy M. J Neurosurg 102:302–310. 2004 10. The same should be observed in interventions to the Monro foramen (the interventricular foramen). Zhang X. and this area is located at the level of the interhemispheric origin of the postcentral gyrus. et al: Integration of sulcal and functional information for multimodal neuronavigation. Yahya H. Smalley S. where the inferior parietal and superior parietal windows merge. Germann J. However. and the other end is in the sylvian fissure. their reflections on the midline are significantly different from those of the sylvian fissure. Good C. Kawashima M.8 Thus. the definition of these gyri may be highly challenging. Bozkurt MC. J Neurosurg 99:517–525. Robbins S. Tuna Karahan and Prof. The closer the precentral gyrus is to the sylvian fissure.Window anatomy for neurosurgical approaches the interhemispheric fissure. Morandi X. Because these areas point to the venous drainage areas. et al: Cortical sulcal maps in autism. which may lead to loss of functions related to these areas. If the rami of the sylvian fissures are not observed in the craniotomy area preoperatively. Disclaimer The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.20 The anterior and ascending rami are of great importance in defining the inferior frontal gyrus. and thus. Crawford N. Hattingen E. Fang M. Blanton RE. Levitt JG. precentral. 2005 4. 2003 9. Deshmukh P. Most of the distal anterior cerebral artery aneurysms are found in the genu region. This will help refrain from unnecessary hemorrhage and potential venous injuries. Li X.31 These villi become denser right below the coronal suture and nearly 5 cm behind the coronal suture. Toulouse P. Krishnan R. with the distance reducing to as much as 2. Neurosurgery 53:168–173. Wernicke. it is important that the posterior border of the craniotomy be 1 cm ahead of the coronal suture while clipping any aneurysm located in this area. and in opening the sylvian fissure. Halsband U. References 1. Tekdemir I. J Neurosurg 96:713–723. The genu of the corpus callosum is located nearly in the middle of the nasion-bregma space. Figueiredo EG. Raab P. Deshmukh V. Keeping this in mind when handling the pathologies of this area may contribute in defining the postcentral gyrus. Thompson PM. et al: Brain surface reformatted images for fast and easy localization of perirolandic lesions. Fujii K: Surgical approaches to the atrium of the lateral ventricle: microsurgical anatomy. Ulm AJ. J Biomed Sci 11:711–716. Cereb Cortex 13:728–735. it is important to know that the area behind the external ear canal. the presence of inferior frontal. The splenium of the corpus callosum is ~ 10 cm away from the bregma. it should be kept in mind that the confluence of sinuses in particular may deviate 2 cm from the midline to the right. Konuskan B. A wide opening of the sylvian fissure is recommended for many neurosurgical interventions.8 cm at the stephanion. Acknowledgments The authors thank Prof. in planning an interhemispheric intervention. et al: An anatomical evaluation of the minisupraorbital approach and comparison with standard craniotomies. Sun J. Nakaji P. It should be kept in mind that all of the important cortical areas such as the Broca. the venous drainage of the cortical areas may be damaged during craniotomy and dura opening. 2004 5. 2006 8. Hattingen E. J Comp Neurol 493:334–356. and the posterior ramus is important in defining the supramarginal gyrus. Gibaud B. Kwong WH. 2005 6. 2002 7. Raabe A. The calcarine sulcus is located 4 cm below the lambJ Neurosurg / Volume 111 / August 2009 da. Rhoton AL: Role of the zygomaticofacial foramen in the orbitozygomatic craniotomy: anatomic report. Crusius MU. 2003 Conclusions 369 . Szelenyi A. Minim Invasive Neurosurg 46:363–365. Petrides M: Precentral sulcal complex of the human brain: morphology and statistical probability maps. Kawashima M. Dr.13. Li X. a craniotomy closer to the midline will have a different motor and sensorial cortex orientation from that of a craniotomy closer to the sylvian fissure. et al: Three-dimensional reconstruction of brain surface anatomy based on magnetic resonance imaging diffusion-weighted imaging: a new approach. Martins C. Evliyaoglu C. the closer it is to the coronal suture. In that case. awareness of the coordinates and projections of certain gyri according to the craniometric points may considerably contribute to surgical intervention. Rhoton AL. the calcarine sulcus may deviate from the midline on the right.19. Oka H. Gong X.22. et al: Functional magnetic resonance ımagingintegrated neuronavigation:correlation between lesion-to-motor cortex distance and outcome. Neurosurgery 55:904–915. trauma is likely to occur to the pial or vascular structures. Rumeur EL. Dr. and postcentral gyri in the area on the superior temporal line (in other words. Marquardt G. Guthrie D. S. Neurosurgery 59:212–220. Jannin P. Ibrahim Tekdemir (Department of Anatomy. Ankara University Faculty of Medicine) for their invaluable contributions and Mrs. No sulcal structures exist that will aid in defining the angular and supramarginal gyri. Wang J. Given that recognition of the gyral patterns underlying the craniotomies is not always easy. Surg Neurol 65:436–445. 2003 11. Keskil IS: Epipteric bones in the pterion may be a surgical pitfall. 2003 2. These gyri project forward with an angle of 60°. Safak Ugur for her editorial assistance. and because of its proximity to the confluence of sinuses.
Hori T.. Please include this information when citing this paper: published online April 10. Esmer AF. 2002 18. J Neurosurg 100:891–922. Ugur HC. Miga MI. Rhoton AL Jr. 2006 26. Ojemann SG. Quiñones-Hinojosa A. Ph. Sinha TK. Rhoton AL. J Neurosurg 104:278–284. Neuroimage 22:706–719. Neurosurgery 59:177–211. J Neurosci Methods 75:81–89. Rhoton AL Jr: The lateral and third ventricles. Neurosurg Focus 18(6B): E2. 2004 17.JNS08159. Berger MS: Preoperative correlation of intraoperative cortical mapping with magnetic resonance imaging landmarks to predict localization of the Broca area. 370 J Neurosurg / Volume 111 / August 2009 . Ungersböck K: Anatomical landmarks for image registration in frameless stereotactic neuronavigation. Oakes WJ: Superficial surgical landmarks for the transverse sinus and torcular herophili. 2001 29. Maudgil DD. Kim EJ. Neurosurgery 59:368–377. Hütter BO. J Craniomaxillofac Surg 34:415–420.D. Ibn-i Sina Hospital. Uz A. Ochiai T. Ankara University Faculty of Medicine. Accepted October 22. J Neurosurg 93:279–281. Rohde V. Krings T. J Neurosurg 99:311–318. O’Neil JT Jr. Rodrigues CJ: The anterior sylvian point and the suprasylvian operculum. 2006 22. Ribas EC. Wolfsberger S. 2005 20. Quester R. 2006 30. Lemieux L. 2005 Manuscript submitted March 19. Riviere D. DOI: 10. Scavarda D. Neurosurgery 51:207–271. 2006 21. Neurosurg Rev 25:68–72. Rodrigues AJ Jr: Surgical anatomy of microneurosurgical sulcal key points. Kahilogullari G. Tekdemir I: Is the asterion a reliable landmark the lateral approach to posterior fossa? J Clin Neurosci 8:146–147. J Anat 193:559–571. Yasuda A. 2009. Tanriover N. Neurosurgery 51:21–58. Ulm AJ. Woermann FG. et al: A neurosurgical view of anatomical variations of the distal anterior cerebral artery: an anatomical study. Odabasi AB. Clin Anat 20:498– 501. Marino R Jr: Gray matter overlying anterior basal temporal sulcus an intraoperative landmark for locating the temporal horn in amygdalohippocampectomies. 1998 13. 2003 16. Turkey. Tubbs RS. Reinges MH. Key CD. et al: Arterial vascularization of primary motor cortex (precentral gyrus). 2008. Gilsbach JM: Course of brain shift during microsurgical resection of supratentorial cerebral lesions: limits of conventional neuronavigation. Address correspondence to: Hasan Caglar Ugur.D. 2004 14. et al: Identifying homologous anatomical landmarks on reconstructed magnetic resonance images of the human cerebral cortical surface. Neurosurgery 59:221–227. Regatschnig R. Tekdemir I. Sanai N. Wen HT. Türe U. Ankara. Department of Neurosurgery. 2006 28. Neurosurg Focus 18(6B):E1. Tubbs RS. 2002 19. 2002 31. Yaşargil DC: Surgical anatomy of supratentorial midline lesions.. 2006 24. email: hasanugur2001@hotmail. Schröder R: The shrinkage of the human brain stem during formalin fixation and embedding in paraffin. Nishikuni K. Kendir et al. M. et al: Superficial temporal artery as an external landmark for deeper-lying brain structures. Yaşargil MG. Kawashima M. et al: Sulcal pattern and morphology of the superior temporal sulcus. Govsa F: Asterion as a surgical surgical landmark for lateral cranial base approaches.S. 2004 23. 2008. Ugur HC. Ugur HC.10. Coscarella E. Fulghum SB. Sisodiya SM. Yasuda A: Microsurgical anatomy of the insula and the Sylvian fissure. Acta Neurochir (Wien) 146:369–377. Ribas GC. 1997 15. Weil RJ: Intraoperative cortical surface characterization using laser range scanning: preliminary results. Rössler K.com. Dillon WP. Morcos JJ. Fish DR. Tekdemir I. Nguyen HH. Ucerler H. 2005 27. 12. Roch G. Comert A. 2000 25. Zarzour JG. 06100 Sihhiye. Cash DM. Surg Neurol 64:48–52. Ribas EC. Ribas GC. Grimault S.3171/2008. Rhoton AL Jr: Aneurysms. Free SL. Kahilogullari G. Salter G. Unlu A.
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