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Transinsular approach can provide shorter intracerebral distance to target the hematoma, and the Sylvian fissure is the nature pathway to reach the insular cortex.
The posterior disconnection takes place after fully opening the Sylvian fissure and promptly elevating the parietal opercula (28,50).
Cranial MRI conducted approximately 2 weeks later showed prominent leptomeningeal enhancement in the Sylvian fissure (A) and basilar cistern (B) bilaterally (Figure 2).
A subsequent study reported that the shape and slope of the sylvian fissure were different in the right and left hemispheres (Rubens, Mahwold, & Hutton, 1976).
sup][1],[2],[3],[4] The sylvian fissure (SF) can be identified at 13–17 weeks of gestation in fetal brain specimens.
Brain magnetic resonance imaging (MRI) demonstrated subacute hemorrhage in the left frontotemporal lobe with mild mass effect, and a nodular lesion near the Sylvian fissure [Figure 1]a], yet contrast study showed no abnormal enhancement.
Pattern of hemorrhage Location of aneurysm Anterior interhemispheric fissure Anterior communicating artery Chiasmatic cistern Carotid terminus Sylvian fissure MCA bifurcation 4th ventricle PICA
A biopsy was then taken from the meninges in the left sylvian fissure, which confirmed GBM.
In glutaric aciduria, MRI reveals symmetric widening of the Sylvian fissure, frontotemporal volume loss and delayed myelination.
The MCA dot sign is a punctate focus of hyperattenuation located in the sylvian fissure on non-enhanced CT, and is a recently described variant of the HMCA sign.
The insular cortex and early formation of the Sylvian fissure occur during weeks 11 to 28 of gestation through a process termed operculization.