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.2011 Jun;216(2):137-49.
doi: 10.1007/s00429-010-0296-3. Epub 2010 Dec 14.

Functional neuroanatomy of the insular lobe

Affiliations

Functional neuroanatomy of the insular lobe

C Stephani et al. Brain Struct Funct.2011 Jun.

Abstract

The insula is the fifth lobe of the brain and it is the least known. Hidden under the temporal, frontal and parietal opercula, as well as under dense arterial and venous vessels, its accessibility is particularly restricted. Functional data on this region in humans, therefore, are scarce and the existing evidence makes conclusions on its functional and somatotopic organization difficult. 5 patients with intractable epilepsy underwent an invasive presurgical evaluation with implantation of diagnostic invasive-depth electrodes, including insular electrodes that were inserted using a mesiocaudodorsal to laterorostroventral approach. Altogether 113 contacts were found to be in the insula and were stimulated with alternating currents during preoperative monitoring. Different viscerosensitive and somatosensory phenomena were elicited by stimulation of these electrodes. A relatively high density of electrode contacts enabled us to delineate several functionally distinct areas within the insula. We found somatosensory symptoms to be restricted to the posterior insula and a subgroup of warmth or painful sensations in the dorsal posterior insula. Viscerosensory symptoms were elicited by more anterior electrode contacts with a subgroup of gustatory symptoms occurring after stimulation of electrode contacts in the central part of the insula. The anterior insula did not show reproducible responses to stimulation. In line with previous studies, we found evidence for somato- and viscerosensory cortex in the insula. In addition, our results suggest that there is a predominantly posterior and central distribution of these functions in the insular lobe.

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Figures

Fig. 1
Fig. 1
Presurgical MRI and postsurgical cranial CT were superimposed using the software Brainlab®. Then each single electrode contact was located and displayed on three planes. One electrode contact is indicated by anarrow
Fig. 2
Fig. 2
Superimposition of a postsurgical cranial CT on a presurgical MRI using the software Brainlab®. Example of an electrode contact in the grey-white matter transition (indicated by anarrow)
Fig. 3
Fig. 3
Superimposition of a postsurgical cranial CT on a presurgical MRI using the software Brainlab®. Example of an electrode in the subinsular white matter (indicated by anarrow)
Fig. 4
Fig. 4
Scheme of the insula. Included are the locations of all 113 contacts that were allocated in the insula after superimposing the postsurgical cranial CT on the presurgical MRI. Anatomical landmarks of the insula are indicated by numbers as follows:1 posterior long gyrus of the insula,2 postcentral insular sulcus,3 anterior long gyrus of the insula,4 central insular sulcus,5 Posterior short gyrus of the insula,6 precentral insular sulcus,7 middle short gyrus of the insula,8 short insular sulcus,9 anterior short gyrus of the insula,10 accessory gyrus of the insula
Figs. 5–8
Figs. 5–8
The color-coded pictograms of the insula include the localizations of those electrode contacts that evoked clinical responses with electrocortical stimulation. The responses were grouped into gustatory responses (Fig. 5), viscerosensory responses (Fig. 6), responses of warmth or pain (Fig. 7) and into general somatosensory responses (Fig. 8). The following color code is applied:blue gustation,yellow viscerosensation,red thermosensation,red with mark pain,green somatosensation.Composite color bars indicate qualitatively inconsistent or ambiguous symptoms after stimulation
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