The insula is a lobe located deep in each hemisphere of the brain and is surrounded by eloquent cortical, white matter, and basal ganglia structures. The aim of this study was to provide an anatomical description of the insula and white matter tracts related to surgical treatment of gliomas through a transcortical approach. The study also discusses surgical implications in terms of intraoperative brain mapping. Five adult brains were prepared according to the Klingler technique. Cortical anatomy was evaluated with the naked eye, whereas white matter dissection was performed with the use of a microscope. The widest exposure of the insular surface was noted through the temporal operculum, mainly in zones III and IV according to the Berger-Sanai classification. By going through the pars triangularis in all cases, the anterior insular point and most of zone I were exposed. The narrowest and deepest operating field was observed by going through the parietal operculum. This method provided a suitable approach to zone II, where the corticospinal tract is not covered by the basal ganglia and is exposed just under the superior limiting sulcus. At the subcortical level, the identification of the inferior frontoocipital fasciculus at the level of the limen insulae is critical in terms of preserving the lenticulostriate arteries. Detailed knowledge of the anatomy of the insula and subcortical white matter that is exposed through each operculum is essential in preoperative planning as well as in the intraoperative decision-making process in terms of intraoperative brain mapping.

岛叶是位于大脑每个半球深处的一个叶叶，周围环绕着雄辩的皮质、白质和基底神经节结构。本研究的目的是通过经皮层方法提供与神经胶质瘤手术治疗相关的岛叶和白质束的解剖学描述。该研究还讨论了术中脑映射方面的手术意义。根据 Klingler 技术准备了五个成人大脑。用肉眼评估皮质解剖，而使用显微镜进行白质解剖。根据 Berger-Sanai 分类，通过颞盖注意到岛状表面的最广泛暴露，主要在 III 区和 IV 区。通过在所有情况下通过pars triangularis，前岛叶点和 I 区大部分暴露。穿过顶盖观察到最窄、最深的手术视野。这种方法为 II 区提供了一种合适的方法，其中皮质脊髓束没有被基底神经节覆盖，而是暴露在上界沟下方。在皮层下水平，在岛叶水平识别额枕下束对于保护豆纹动脉至关重要。详细了解通过每个岛盖暴露的岛叶和皮质下白质的解剖结构对于术前计划以及术中脑映射的术中决策过程至关重要。穿过顶盖观察到最窄、最深的手术视野。这种方法为 II 区提供了一种合适的方法，其中皮质脊髓束没有被基底神经节覆盖，而是暴露在上界沟下方。在皮层下水平，在岛叶水平识别额枕下束对于保护豆纹动脉至关重要。详细了解通过每个岛盖暴露的岛叶和皮质下白质的解剖结构对于术前计划以及术中脑映射的术中决策过程至关重要。穿过顶盖观察到最窄、最深的手术视野。这种方法为 II 区提供了一种合适的方法，其中皮质脊髓束没有被基底神经节覆盖，而是暴露在上界沟下方。在皮层下水平，在岛叶水平识别额枕下束对于保护豆纹动脉至关重要。详细了解通过每个岛盖暴露的岛叶和皮质下白质的解剖结构对于术前计划以及术中脑映射的术中决策过程至关重要。其中皮质脊髓束不被基底神经节覆盖，仅在上界沟下方暴露。在皮层下水平，在岛叶水平识别额枕下束对于保护豆纹动脉至关重要。详细了解通过每个岛盖暴露的岛叶和皮质下白质的解剖结构对于术前计划以及术中脑映射的术中决策过程至关重要。其中皮质脊髓束不被基底神经节覆盖，仅在上界沟下方暴露。在皮层下水平，在岛叶水平识别额枕下束对于保护豆纹动脉至关重要。详细了解通过每个岛盖暴露的岛叶和皮质下白质的解剖结构对于术前计划以及术中脑映射的术中决策过程至关重要。