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Cited by 251Epilepsy research and treatmentTactile and Sensory InteractionsPsychosomatic Disorders and Their Treatments

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Functional neuroanatomy of the insular lobe

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Stephani, C., Fernandez-Baca Vaca, G., Maciunas, R., Koubeissi, M., Lüders, H. O.·2011·Brain Structure and Function
DOI 10.1007/s00429-010-0296-3PMC PMC3097350
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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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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 an arrow
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 an arrowCC BY-NC · PubMed Central
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 an arrow)
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 an arrow)CC BY-NC · PubMed Central
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 an arrow)
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 an arrow)CC BY-NC · PubMed Central
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
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 insulaCC BY-NC · PubMed Central
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
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 stimulationCC BY-NC · PubMed Central

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Citations

Cites

Research works printed but not linked: 4

  1. Brodmann K (1909) Vergleichende Lokalisationslehre der Großhirnrinde des Menschen. Barth JA, Leipzig
  2. Reil JC (1809) Die sylvische Grube. Arch Physiol 9:195–208
  3. Rose M (1928) Die Inselrinde des Menschen und der Tiere. J Psychol Neurol 37:467–624
  4. Vogt C, Vogt O (1919) Allgemeine Ergebnisse unserer Hirnforschung. J Psychol Neurol 25:279–461

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Metadata

Authors
Stephani, C., Fernandez-Baca Vaca, G., Maciunas, R., Koubeissi, M., & Lüders, H. O.
Affiliations
University Hospitals Cleveland Medical Center (US)
Corresponding author
Stephani, C.
ORCID
Venue
Brain Structure and Function
Publisher
Springer Science and Business Media LLC
Published
2010-12-14
Volume
216
Issue
2
Pages
137-149
ISSN
  • 1863-2653 (ISSN-L)
  • 1863-2661
DOI
10.1007/s00429-010-0296-3
PMC
PMC3097350
OpenAlex
W2167344375
Cited by
251
References
69
Citations by year
2026: 8 · 2025: 20 · 2024: 12 · 2023: 17 · 2022: 18 · 2021: 20 · 2020: 14 · 2019: 18 · 2018: 26 · 2017: 21 · 2016: 17 · 2015: 19 · 2014: 10 · 2013: 11 · 2012: 13
FWCI
6.12
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Brain Structure and Function (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Epilepsy research and treatment
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Tactile and Sensory Interactions
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
insula, functional neuroanatomy, somatosensory cortex, gustatory cortex, insular lobe, drug-resistant epilepsy, preoperative assessment, electrical stimulation, somatotopic organization, depth electrodes
MeSH terms
Adult, Analysis of Variance, Brain Mapping, Cerebral Cortex, Electrodes, Implanted, Electroencephalography, Epilepsy, Female, Humans, Sensation, Deep Brain Stimulation

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