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. 2011 Mar 31;6(3):e18199.
doi: 10.1371/journal.pone.0018199.

Correlation between squamous suture and sylvian fissure: OSIRIX DICOM viewer study

Nunung Nur Rahmah  1 , Takahiro Murata, Takehiro Yako, Tetsuyoshi Horiuchi, Kazuhiro Hongo
Affiliations

Correlation between squamous suture and sylvian fissure: OSIRIX DICOM viewer study

Nunung Nur Rahmah et al. PLoS One. .

Abstract

Background: Sylvian fissure (SF) is an important corridor in neurosurgery, and the end of sylvian fissure (eSF) represents the optimal target area to expose suitable recipient artery in STA-MCA bypass. Unfortunately little have been addressed concerning its relationship with external cranial surface.

Objective: Correlation between Squamous Suture (SS) and SF was investigated.

Methods: 50-adult 3D-CTA images were studied using OSIRIX DICOM viewer. The measurement points were determined from external auditory meatus 0, 1, 1.5, 2, 2.5, 3, 3.5 and 4-cm anteriorly, perpendicular from orbitomeatal (OM) line. The distance of SF was compared with the one of SS.

Results: SSs were all located below SF at 0 cm. At a distance of 0 to 1.5 cm, SSs were located above SF, then started to merge and went side by side from 2 cm anteriorly. Anterior sylvian point, the most anterior part of SF, was found at 4 cm from OM line. Inferior Rolandic point, which corresponds to the central sulcus inferior extent, was found to be at 2 cm from OM line. The eSF was identified at 0 cm anteriorly from OM, and perpendicularly 1.5 cm above SS. 50% patients had Chater's point (CP) above eSF. Average value for CP was 0.01 below eSF, giving a significantly closer value compared to the one of SS (p<0.01). However, SS showed consistent value of 1.5 below SF. Furthermore, SS is a bony landmark, which has no shifting effect during surgery, therefore drawing a 1.5-cm line upward from SS could lead to exact location of eSF.

Conclusion: The course of SF and its correlation to SS have been identified, and this is also the first study to investigate the relationship of SS and eSF using OSIRIX DICOM viewer. SS is also comparable to CP, therefore it is usable for a simple landmark of eSF.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Illustrative methods of measurement.
Orbitomeatal (OM) line is drawn to define the base of measurement. Perpendicular line to EAM is drawn, and is regarded as horizontal 0 cm. Curved-black line is showing SF. White line is SS. Dotted lines are showing the measurement points, from 0 to 4 cm anteriorly.
Figure 2
Figure 2. Interface of Osirix DICOM viewer for Sylvian fissure course analysis.
a) Coronal view of default window/width level, which can show better visualization of the brain and vessels. b) Coronal bone window view, which can show a better visualization of the SS. White triangle is showing the length of SS, and white dot is showing the length of SF. c) Overall view of 2-D MPR; Crossed lines on sagittal image are movable to desired locations.
Figure 3
Figure 3. Illustrative methods of comparative measurement of Chater's point and Squamous suture.
Orbitomeatal (OM) line is drawn to define the base of measurement. Perpendicular line to EAM is drawn, and is regarded as horizontal 0 cm. Small-dotted line is showing the sylvian fissure. Curved-black line is SS. Bigger dotted line is showing the presumed position of CP, 6 cm from EAM.
Figure 4
Figure 4. Correlation between Squamous suture and Sylvian fissure.
Figure 5
Figure 5. Correlation between Chater's point and Squamous suture.
Figure 6
Figure 6. Clinical application of Squamous suture landmark in a representative case.
a) Skin marking of the OM line (black line), the donor artery (STA, red line) and Chater's Point (CP, blue star). b) Bone marking using SS as the center of the craniotomy, the adjacent STA is also visible; blue star is showing the CP. c) The clearly viewed SF with its correlated arties and veins at the center of the operative field after craniotomy. d) Illustration of the running SS (dotted red line), SF (dotted black line), CP (blue star) and start point of SS at 0 cm perpendicular to OM line (red circle).
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