Sagittal Anatomy of the Sylvian Cistern Anil A. Kilpadikar, M.D., Edgardo J. Angtuaco, M.D., Rudy L. VanHemert, M.D., Eren Erdem, M.D., Gazi M. Yasargil, M.D. [view full presentation poster]*

Introduction

Anatomy

• Normal Anatomy - diagrams
• Normal Anatomy - Sagittal T1-weighted MR images and surgical anatomy specimen
• Normal Sagittal Anatomy - Sagittal T1-weighted STIR images
• Normal Axial Anatomy - Axial T1-weighted STIR images
• Normal Coronal Anatomy - Coronal T1-weighted STIR images
• Normal Arterial Anatomy - right internal carotid angiograms and surgical anatomy specimen showing arteries

Insular Lesions

• Insular Glioma
• Recurrent Low grade astrocytoma
• Recurrent pilocytic astrocytoma
• Left MCA infarct involving inferior trunk
• Left MCA infarct involving both trunks of MCA

Opercular Lesions

• Rucurrent pilocytic astrocytoma
• Low grade glioma
• Glioma
• Glioblastoma
• Cerebral metastases
• Cerebral abscess
• Left sphernoid wing meningioma

Conclusion

Sagittal imaging, although included in routine protocols in MR studies of the brain, is underutilized in interpreting lesions around the Sylvian cistern. While axial and coronal images demonstrate the insula as a rim of cortex, the sagittal plane displays the triangular shape of the insula and depicts the various gyri and sulci which compose the anatomy of the insular cortex. The addition of other imaging sequences in the sagittal plane, such as FLAIR, T1-weighted STIR-FSE, or contrast studies, can be used to better display lesions around the Sylvian cistern. Neurosurgeons using the Sylvian fissure as a surgical approach will find the sagittal plane as a good anatomical guide for preoperative planning.

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