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OBJECTIVES: Altered somatosensory processing in the posterior insula may play a role in chronic pain development and contribute to Parkinson disease (PD)-related pain. Posterior-superior insula (PSI) repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to have analgesic effects among patients with some chronic pain conditions. This study aimed at assessing the efficacy of PSI-rTMS for treating PD-related pain. METHODS: This was a double-blinded, randomized, sham-controlled, parallel-arm trial (NCT03504748). People with PD (PwP)-related chronic pain underwent five daily PSI-rTMS sessions for a week, followed by once weekly maintenance stimulations for seven weeks. rTMS was delivered at 10 Hz and 80% of the resting motor threshold. The primary outcome was a ≥ 30% pain intensity reduction at 8 weeks compared to baseline. Functionality, mood, cognitive, motor status, and somatosensory thresholds were also assessed. RESULTS: Twenty-five patients were enrolled. Mean age was 55.2 ± 9.5 years-old, and 56% were female. Nociceptive pain accounted for 60%, and neuropathic and nociplastic for 20% each. No significant difference was found for 30% pain reduction response rates between active (42.7%) and sham groups (14.6%, p = 0.26). Secondary clinical outcomes and sensory thresholds also did not differ significantly. In a post hoc analysis, PwP with nociceptive pain sub-type experienced more pain relief after active (85.7%) compared to sham PSI-rTMS (25%, p = 0.032). CONCLUSION: Our preliminary results suggest that different types of PD-related pain may respond differently to treatment, and therefore people with PD may benefit from having PD-related pain well characterized in research trials and in clinical practice.

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Introduction: The aim of the present study was to evaluate the influence of acute transcranial direct current stimulation (tDCS) on physical and subjective responses in professional rowing during the 2,000-m time trial test. Methods: Seven rowers (age 20.86 ± 4.49 years; weight 71.66 ± 7.97 kg) participated in this randomized triple-blind trial with a crossover experimental design. The protocol consists of 2 days with different conditions (anodal and sham). The tDCS anodic stimulation conducted was 2 mA for 20 min in the left temporal cortex (2.5 cm from the F7 zone and 2.5 cm from the T3 zone), targeting the left insular cortex. In the sham moment, the participants experienced 30 s of stimulation. Afterward, they performed a standardized progressive warm-up for 15 min, following the Brazilian Rowing Confederation's assessment protocols, and rested for 3 min before the test started. All procedures were made on an indoor rowing machine, which allowed the capture of performance variables such as time performed, power in watts (W), pace (m/min), and stroke rate (strokes/min). The ratings of perceived exertion [Borg scale (CR-20)] were recorded in each 2-min during the test. Results: The results presented differences in power [Z: -2.371; p = 0.018; effect size (ES) = -0.896 (large)] and pace [Z: -2.371; p = 0.018; ES = -0.896 (large)] and time performance [Z: -1.612; p = 0.107; ES = -0.609 (large)] throughout the protocol for the anodal moment. Discussion: However, no differences for the other variables were found. According to the results, the current tDCS with the present protocol improved the physical performance at the 2,000-m time trial Test providing ergogenic aid.

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It has been reported that cannabis consumption affects the anterior cingulate cortex (ACC), a structure with a central role in mediating the empathic response. In this study, we compared psychometric scores of empathy subscales, between a group of regular cannabis users (85, users) and a group of non-consumers (51, controls). We found that users have a greater Emotional Comprehension, a cognitive empathy trait involving the understanding of the "other" emotional state. Resting state functional MRI in a smaller sample (users = 46, controls = 34) allowed to identify greater functional connectivity (FC) of the ACC with the left somatomotor cortex (SMC), in users when compared to controls. These differences were also evident within the empathy core network, where users showed greater within network FC. The greater FC showed by the users is associated with emotional representational areas and empathy-related regions. In addition, the differences in psychometric scores suggest that users have more empathic comprehension. These findings suggest a potential association between cannabis use, a greater comprehension of the other's affective state and the functional brain organization of the users. However, further research is needed to explore such association, since many other factors may be at play.

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SUMMARY: Volumetric assessment of brain structures is an important tool in neuroscience research and clinical practice. The volumetric measurement of normally functioning human brain helps detect age-related changes in some regions, which can be observed at varying degrees. This study aims to estimate the insular volume in the normally functioning human brain in both genders, different age groups, and side variations. A cross-sectional retrospective study was conducted on 42 adult Sudanese participants in Al-Amal Hospital, Sudan, between May to August 2022, using magnetic resonance imaging (MRI) and automatic brain segmentation through a software program (BrainSuite). The statistical difference in total insular volume on both sides of the cerebral hemisphere was small. The insular volume on the right side was greater in males, while the left side showed no difference between both genders. A statistically significant difference between males and females was found (p > 0.05), and no statistical difference in different age groups was found according to the one-way ANOVA test (p>0.05). Adult Sudanese males showed a larger insular volume than females. MRI can be used to morphometrically assess the insula to detect any pathological variations based on volume changes.

La evaluación volumétrica de las estructuras cerebrales es una herramienta importante en la investigación y la práctica clínica de la neurociencia. La medición volumétrica del cerebro humano, que funciona normalmente, ayuda a detectar cambios relacionados con la edad en algunas regiones, las cuales se pueden observar en diversos grados. Este estudio tuvo como objetivo estimar el volumen insular en el cerebro humano que funciona normalmente, en ambos sexos, de diferentes grupos de edad y sus variaciones laterales. Se realizó un estudio retrospectivo transversal en 42 participantes sudaneses adultos en el Hospital Al-Amal, Sudán, entre mayo y agosto de 2022, utilizando imágenes de resonancia magnética y segmentación automática del cerebro a través de un software (BrainSuite). Fue pequeña la diferencia estadística en el volumen insular total, en los hemisferios cerebrales. El volumen insular del lado derecho fue mayor en los hombres, mientras que el lado izquierdo no mostró diferencia entre ambos sexos. Se encontró una diferencia estadísticamente significativa entre hombres y mujeres (p > 0,05), y no se encontró diferencia estadística en los diferentes grupos de edad, según la prueba de ANOVA de una vía (p> 0,05). Los hombres sudaneses adultos mostraron un mayor volumen insular que las mujeres. La resonancia magnética se puede utilizar para evaluar morfométricamente la ínsula y para detectar cualquier variación patológica basada en cambios de volumen.

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Increased activity in the insula has been consistently reported to be associated with anxiety and anxiety-related disorders. However, little is known on how the insula regulates anxiety. The present study aims at determining the role of the insula on the effects of glucocorticoids in anxiety. A combination of pharmacological manipulations, including blockade of adrenal GC synthesis by metyrapone and intra-insular microinjections of corticosterone, corticosterone-BSA, mineralocorticoid receptor (MR) antagonist spironolactone and glucocorticoid receptor (GR) antagonist mifepristone, were used to assess the short-term (5 min) effects of intra-insular corticosterone in two anxiety-like behaviors in male Sprague-Dawley rats. The elevated plus maze (EPM) and Novelty Suppressed Feeding (hyponeophagia) were utilized. We found that corticosterone in the insula is sufficient to prevent the anxiolytic effects corticosterone synthesis blockade in anxiety, and that intra-insular corticosterone has anxiolytic or anxiogenic effects depending on the amount of corticosterone microinjected and the arousal associated to the test, without affecting the HPA axis. Glucocorticoid anxiolytic effects in the insula are mediated by MRs, while its anxiogenic effects are dependent on a mifepristone-sensitive membrane-bound mechanism. Anxiety appears to be modulated at the insula through a competition between fast MR-dependent anxiolytic and membrane-associated anxiogenic signaling pathways that orchestrate the behavioral response to stress and determines the resulting level of anxiety.

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The insular cortex (IC) is engaged in behavioral and physiological responses to emotional stress. Control of physiological functions and behavioral responses has been reported to occur in a site-specific manner along the rostrocaudal axis of the IC. However, a functional topography of the IC regulation of anxiogenic responses caused by stress has never been evaluated. Therefore, we investigated the role of rostrocaudal subregions in the posterior IC in anxiogenic-like effect caused by exposure to acute restraint stress in male rats. For this, rats received bilateral microinjection of the non-selective synaptic inhibitor CoCl2 or vehicle into either the rostral, intermediate or caudal portions of the posterior IC before exposure to acute restraint stress. Then, behavior in the elevated plus maze (EPM) was evaluated immediately after restraint stress. The behavior of non-stressed animals in the EPM was also investigated. We observed that acute restraint stress decreased the exploration of the EPM open arms in animals treated with vehicle in all regions of the posterior IC, thus indicating an anxiogenic-like effect. The avoidance of the EPM open arms was completely inhibited in animals subjected to microinjection of CoCl2 into the intermediate posterior IC. Nevertheless, the same pharmacological treatment into either the rostral or caudal subregions of the posterior IC did not affect the restraint-evoked behavioral changes in the EPM. Taken together, these results suggest that regulation of anxiogenic-like effect to emotional stress along the rostrocaudal axis of the posterior IC might occur in a site-specific manner, indicating a role of the intermediate subregion.

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Introdução: Os gliomas são tumores encefálicos e da medula espinhal que se originam nas células gliais e cuja progressão invade o tecido cerebral adjacentee e dentre eles um dos mais desafiadores são localizados no lobo cerebral da ínsula. Estas artérias irrigam estruturas nobres e sua lesão pode produzir danos sensitivos, motores e de linguagem. Objetivo: Descrever o impacto da extensão da ressecção, sobrevida global e dos resultados funcionais após a cirurgia dos gliomas insulares, quando estes tumores estejam ou não envolvidos pelas artérias lenticuloestriadas. Métodos: Revisão integrativa nas plataformas virtuais em português e inglês, buscando AND ou OR dados através dos seguintes descritores "Gliomas da ínsula, Mapeamento cerebral, Artérias lenticuloestriadas". A busca inicial foi baseada no título e/ou resumo. Decididos os trabalhos incluíveis foi realizada a leitura na íntegra dos textos. Ao total foram estudados 55 artigos. Resultados: O lobo da ínsula fica "escondido" pela sobreposição dos lobos frontal, parietal e temporal. Para alcançá-lo pode-se realizar as abordagens transsilviana ou transcortical. Ocorre que ao chegar na ínsula visualiza-se significativa ramificação constituída pelas artérias lenticuloestriadas, cuja manipulação pode determinar déficit neurológico e, ao se aprofundar no córtex insular, depara-se com outras estruturas tão importantes quanto a própria ínsula. O conhecimento anatômico das artérias lenticuloestriadas e suas relações é de fundamental importância para a ressecção de glioma insular, pois o comprometimento delas e da artéria cerebral média podem determinar a isquemia dos núcleos da base e da cápsula interna. Conclusão: O tratamento dos gliomas insulares permanece como grande desafio. Devido à sua localização e possibilidade de desenvolvimento de déficits neurológicos na manipulação cirúrgica é necessário não somente conhecer sua localização topográfica, mas também a íntima relação vascular com as artérias lenticuloestriadas. O envolvimento delas pelo tumor possui implicações na sobrevida e na preservação da função neurológica. O conhecimento detalhado da anatomia da região é fundamental para diminuir complicações que afetem grandemente a qualidade de vida dos pacientes.

Introduction: Gliomas are brain and spinal cord tumors that originate in glial cells and whose progression invades the adjacent brain tissue and among them one of the most challenging are located in the cerebral lobe of the insula. These arteries supply noble structures and their damage can cause sensory, motor and language damage. Objective: To describe the impact of the extent of resection, overall survival and functional results after surgery for insular gliomas, when these tumors are or are not involved by lenticulostriate arteries. Methods: Integrative review on virtual platforms in Portuguese and English, searching for AND or OR data using the following descriptors "Insula gliomas, Brain mapping, Lenticulostriate arteries". The initial search was based on the title and/or abstract. Once the included works were decided, the texts were read in full. In total, 55 articles were studied. Results: The insula lobe is "hidden" by the overlap of the frontal, parietal and temporal lobes. To achieve this, transsylvian or transcortical approaches can be performed. It turns out that when arriving at the insula, a significant branch made up of lenticulostriate arteries is seen, the manipulation of which can cause neurological deficits and, when going deeper into the insular cortex, one comes across other structures as important as the insula itself. Anatomical knowledge of the lenticulostriate arteries and their relationships is of fundamental importance for the resection of insular glioma, as their involvement and that of the middle cerebral artery can determine ischemia of the basal ganglia and internal capsule. Conclusion: The treatment of insular gliomas remains a major challenge. Due to its location and the possibility of developing neurological deficits during surgical manipulation, it is necessary not only to know its topographic location, but also the intimate vascular relationship with the lenticulostriate arteries. Their involvement by the tumor has implications for survival and preservation of neurological function. Detailed knowledge of the region's anatomy is essential to reduce complications that greatly affect patients' quality of life.

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OBJECTIVES: The posterior-superior insula (PSI) has been shown to be a safe and potentially effective target for neuromodulation in peripheral neuropathic pain (PNP) in humans and animal models. However, it remains unknown whether there is a measurable responder profile to PSI stimulation. Two factors were hypothesized to influence the response of repetitive transcranial magnetic stimulation (rTMS) of the PSI: differences in rTMS target (discrete subregions of the PSI) or PNP phenotype. METHODS: This is a secondary analysis from a randomized, double-blind, sham-controlled, cross-over trial assessing PSI-rTMS in PNP (N = 31, 5 days rTMS) (10.1016/j.neucli.2021.06.003). Active PSI-rTMS true responders (>50% pain reduction from baseline after active but not after sham series of treatment) were compared with not true responders, to determine whether they differed with respect to 1) rTMS neuro-navigational target coordinates, and/or 2) specific neuropathic pain symptom inventory (NPSI) clusters (pinpointed pain, evoked pain, and deep pain) at baseline. RESULTS: Mean rTMS target coordinates did not differ between true (n = 45.1%) and not true responders (p = 0.436 for X, p = 0.120 for Y, and p = 0.116 for Z). The Euclidian distance between true and not true responders was 4.04 mm. When comparing differences in responders between NPSI clusters, no participant within the evoked pain cluster was a true responder (p = 0.024). CONCLUSION: Response to PSI-rTMS may depend on pain cluster subtype rather than on differences in targeting within the PSI.

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Von Economo neurons (VENs) have been mentioned in the medical literature since the second half of the 19th century; however, it was not until the second decade of the 20th century that their cytomorphology was described in detail. To date, VENs have been found in limbic sectors of the frontal, temporal and insular lobes. In humans, their density seems to decrease in the caudo-rostral and ventro-dorsal direction; that is, from the anterior regions of the cingulate and insular cortices towards the frontal pole and the superior frontal gyrus. Several studies have provided similar descriptions of the shape of the VEN soma, but the size of the soma varies from one cortical region to another. There is consensus among different authors about the selective vulnerability of VENs in certain pathologies, in which a deterioration of the capacities involved in social behaviour is observed. In this review, we propose that the restriction of VENs towards the sectors linked to limbic information processing in Homo sapiens gives them a possible functional role in relation to the structures in which they are located. However, given the divergence in characteristics such as location, density, size and biochemical profile among VENs of different cortical sectors, the activities in which they participate could allow them to partake in a wide spectrum of neurological functions, including autonomic responses and executive functions.

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OBJECTIVES: Peripheral neuropathic pain (pNeP) is prevalent, and current treatments, including drugs and motor cortex repetitive transcranial magnetic stimulation (rTMS) leave a substantial proportion of patients with suboptimal pain relief. METHODS: We explored the intensity and short-term duration of the analgesic effects produced in pNeP patients by 5 days of neuronavigated deep rTMS targeting the posterior superior insula (PSI) with a double-cone coil in a sham-controlled randomized cross-over trial. RESULTS: Thirty-one pNeP patients received induction series of five active or sham consecutive sessions of daily deep-rTMS to the PSI in a randomized sequence, with a washout period of at least 21 days between series. The primary outcome [number of responders (>50% pain intensity reduction from baseline in a numerical rating scale ranging from 0 to 10)] was significantly higher after real (58.1%) compared to sham (19.4%) stimulation (p = 0.002). The number needed to treat was 2.6, and the effect size was 0.97 [95% CI (0.6; 1.3)]. One week after the 5th stimulation day, pain scores were no longer different between groups, and no difference in neuropathic pain characteristics and interference with daily living were present. No major side effects occurred, and milder adverse events (i.e., short-lived headaches after stimulation) were reported in both groups. Blinding was effective, and analgesic effects were not affected by sequence of the stimulation series (active-first or sham-first), age, sex or pain duration of participants. DISCUSSION: PSI deep-rTMS was safe in refractory pNeP and was able to provide significant pain intensity reduction after a five-day induction series of treatments. Post-hoc assessment of neuronavigation targeting confirmed deep-rTMS was delivered within the boundaries of the PSI in all participants. CONCLUSION: PSI deep-rTMS provided significant pain relief during 5-day induction sessions compared to sham stimulation.

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BACKGROUND AND PURPOSE: Damage to the insula results in cardiovascular complications. In rats, activation of N-methyl-d-aspartate receptors (NMDARs) in the intermediate region of the posterior insular cortex (iIC) results in sympathoexcitation, tachycardia and arterial pressure increases. Similarly, focal experimental hemorrhage at the iIC results in a marked sympathetic-mediated increase in baseline heart rate. The dorsomedial hypothalamic region (DMH) is critical for the integration of sympathetic-mediated tachycardic responses. Here, whether responses evoked from the iIC are dependent on a synaptic relay in the DMH was evaluated. METHODS: Wistar rats were prepared for injections into the iIC and DMH. Anatomical (tracing combined with immunofluorescence) and functional experiments (cardiovascular and sympathetic recordings) were performed. RESULTS: The iIC sends dense projections to the DMH. Approximately 50% of iIC neurons projecting to the DMH express NMDARs, NR1 subunit. Blockade of glutamatergic receptors in the DMH abolishes the cardiovascular and autonomic responses evoked by the activation of NMDARs in the iIC (change in mean arterial pressure 7 ± 1 vs. 1 ± 1 mmHg after DMH blockade; change in heart rate 28 ± 3 vs. 0 ± 3 bpm after DMH blockade; change in renal sympathetic nerve activity 23% ± 1% vs. -1% ± 4% after DMH blockade). Experimental hemorrhage at the iIC resulted in a marked tachycardia (change 89 ± 14 bpm) that was attenuated by 65% ± 5% (p = 0.0009) after glutamatergic blockade at the DMH. CONCLUSIONS: The iIC-induced tachycardia is largely dependent upon a glutamatergic relay in the DMH. Our study reveals the presence of an excitatory glutamatergic pathway from the iIC to the DMH that may be involved in the cardiovascular alterations observed after insular stroke.

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The insular cortex (IC) is notably implicated in emotional and cognitive processing; however, little is known regarding to what extent its two main subregions play functionally distinct roles on memory consolidation of conditioned fear tasks. Here we verified the effects of temporary functional inactivation of the anterior (aIC) and posterior IC (pIC) on contextual and tone fear memory. Rats received post-training bilateral infusions of the GABAA receptor agonist muscimol into either the aIC or pIC and were tested 48 and 72 h after the delay tone fear conditioning session to assess the background contextual (CFC) and tone (TFC) fear conditioning, respectively. Inactivation of the aIC during memory consolidation did not affect fear memory for CFC or TFC. On the other hand, post-training inactivation of the pIC impaired TFC but not CFC. Our findings indicate that the pIC is a necessary part of the neural circuitry related to the consolidation of cued-fear memories.

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Mice cohabiting with a conspecific in chronic pain display anxiogenesis in the elevated plus-maze (EPM). Given that the anterior cingulate (ACC) and insular (InC) cortices play a role in the modulation of anxiety, pain, and emotional contagion, we investigated (a) the FosB activation in both brain areas and (b) the effects of intra-ACC or -InC injection of cobalt chloride (CoCl2, a synaptic blocker), on the anxiety of mice cohabiting with a cagemate suffering pain. Twenty-one days after birth, male Swiss mice were housed in pairs for 14 days to establish familiarity. On the 14th day, mice were divided into two groups: cagemate sciatic nerve constriction (CNC; i.e., one animal of each pair was subjected to sciatic nerve constriction), and cagemate sham (CS; i.e., a similar procedure but without suffering nerve constriction). After that, both groups were housed again with the same pairs for the other 14 days. On the 28th day, mice had their brains removed for the immunoassays analyses (Exp. 1). For experiments 2 and 3, on the 23rd day, the cagemates received guide cannula implantation bilaterally in the ACC or InC and, on the 28th day, they received local injections of saline or CoCl2, and then were exposed to the EPM. Results showed that cohabitation with a conspecific with chronic pain decreases and increases neuronal activation (FosB) within the ACC and InC, respectively. Intra-ACC or InC injection of CoCl2 reversed the anxiogenic effect in those animals that cohabited with a conspecific in chronic pain. ACC and InC seem to modulate anxiety induced by emotional contagion in animals cohabitating with a conspecific suffering pain.

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Objetivo: Describir la anatomía quirúrgica de la fisura silviana (FS) a través de disecciones cadavéricas y neuroimágenes; desarrollar su aplicación microquirúrgica. Materiales y métodos: Se estudiaron 10 hemisferios cadavéricos humanos fijados y un cráneo humano en seco, a través de la disección de fibras blancas y de la anatomía arterial y neural, utilizando un microscopio quirúrgico. Las arterias cerebrales fueron inyectadas con silicona coloreada. La anatomía quirúrgica fue correlacionada con la anatomía neuroimagenológica. Finalmente, se recolectó la experiencia microquirúrgica adquirida y, a su vez, la anatomía del Complejo Silviano, fue revisada. Resultados: La FS se extiende desde la cara basal a la lateral del cerebro. Cada superficie tiene una parte superficial (tronco silviano y sus ramos), intermedia (compartimientos anterior y opercular lateral) y profunda (compartimiento esfenoidal, hendidura insular anterior y lateral y la región retroinsular). En 7 de los 10 hemisferios, el surco central no se intersectó con la FS en la superficie lateral del cerebro. En el 80% de los hemisferios, la principal bifurcación de la arteria cerebral media se localizó en o proximal al limen insular. Debajo de la pars triangularis se localiza el punto más ancho de la superficie lateral de la FS. Los autores comienzan la disección de la misma en o proximalmente a este punto. Conclusiones: El conocimiento anatómico profundo y su aplicación a las neuroimágenes, son herramientas esenciales para el planeamiento prequirúrgico y son requisitos mandatorios para operar con seguridad a través y alrededor de la FS

Objective: The aim of this study is to describe the microsurgical anatomy of the sylvian fissure, through cadaveric dissections and neuroimaging and to elucidate its clinical application for microsurgery. Methods: One human skull and ten cadaveric human hemispheres were studied through white matter fiber dissections and arterial and neural anatomy of the sylvian fissure and insular dissections under the microscope. The cerebral arteries were perfused with colored latex. The surgical anatomy was correlated with neuroimaging anatomy. Finally, the microsurgical experienced gained applying this anatomical knowledge was gathered, and the literature about the anatomy of the sylvian complex was revised, as well. Results: The Sylvian fissure extends from the basal to the lateral surface of the brain. Each surface has a superficial (sylvian stem and its rami), intermediate (anterior and lateral opercular compartments) and deep parts (sphenoidal compartment, anterior and lateral insular clefts and retroinsular region). In 7 out of 10 hemispheres, the central sulcus did not intersect with the sylvian fissure on the lateral surface of the brain. In 80% of the hemispheres, the middle cerebral artery main bifurcation was localized at or proximal to the limen insulae. Beneath the pars triangularis, the widest point of the lateral surface of the sylvian fissure is located. The authors start dissecting the sylvian fissure at this point. Conclusion: The thorough anatomical knowledge with its clinical application in modern neuroimaging are essential tools for preoperative planning and are mandatory requisites to safely operate through and around the sylvian fissure anatomical complex.

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Introducción: El conocimiento profundo de la anatomía microquirúrgica del lóbulo de la ínsula es crucial para operar pacientes con tumores en esta región. Objetivo: El objetivo de la segunda parte de este estudio es correlacionar la anatomía microquirúrgica con casos ilustrativos retirados de nuestra casuística de 35 pacientes en los cuales fueron realizados 44 cirugías de tumores en relación con el lóbulo de la ínsula. Material y Métodos: A lo largo de marzo de 2007 y agosto de 2014, 44 microcirugías fueron realizadas en 35 pacientes portadores de tumores insulares y los hallazgos de las cirugías y mapeo cerebral se correlacionaron con la anatomía microquirúrgica. Resultados: De una serie de 44 pacientes con tumores de la ínsula, la mayoría de los casos eran gliomas de bajo grado de malignidad (29 casos). El inicio de los síntomas en 34 pacientes fue epilepsia, siendo esta refractaria al tratamiento medicamentoso en 12 casos. El grado de resección fue subtotal o total en la mayoría de los casos de la serie. La mejoría en la calidad de vida (epilepsia, etc.) estuvo presente en más de la mitad de los pacientes. El déficit neurológico permanente estuvo presente en tres pacientes. Conclusión: En los tumores insulares, es tan importante el conocimiento profundo de la anatomía, como el saber utilizar e interpretar en tiempo real las observaciones de la monitorización neurofisiológica intraoperatoria.

Introduction: The deep knowledge of the microsurgical anatomy of the insular lobe is crucial to operate patients with tumors in this region. Objectives: Our purpose in this second part is to correlate insular surgical anatomy with illustrative cases from 4 surgeries performed on 35 patients with insular tumors. Materials and Methods: From March 2007 to August 2014, 44 microsurgeries were performed on 35 patients with insular glioma tumors. Of these, 29 cases were low-grade gliomas. Seizures were the first symptom in most cases. Total, or near total tumor resection was achieved in most of the patients. Improvement in quality of life was achieved in more than half of the patients after surgery. Moderate and permanent neurological deficits were present in 3 patients. Results: The majority of cases were low grade malignancy gliomas (29 cases). The onset of symptoms in 34 patients was epilepsy, being refractory to drug treatment in 12 cases. The degree of resection was subtotal or total in most cases of this series. The improvement in the quality of life (epilepsy, etc.) was present in more than half of the patients. Permanent neurological deficit was present in three patients. Conclusion: For insular tumors, microsurgical anatomy knowledge is as important as cortical and subcortical mapping

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Damage to the insular cortex (IC) results in serious cardiovascular consequences and evidence indicates that the characteristics are lateralized. However, a study comparing the effects of focal experimental hemorrhage between IC sides was never performed. We compared the cardiovascular, autonomic and cardiac changes produced by focal experimental hemorrhage (ICH) into the left (L) or right (R) IC. Wistar rats were submitted to microinjection of autologous blood (ICH) or saline (n = 6 each side/group) into the R or L IC. Blood pressure (BP), heart rate (HR) and renal sympathetic activity (RSNA) were recorded. Measurements of calcium transient and sarcoplasmic Ca2+ ATPase expression in cardiomyocytes were performed. ICH increased baseline HR (Δ:L-ICH 452 ± 13 vs saline 407 ± 11 bpm; R-ICH 450 ± 7 vs saline 406 ± 8 bpm, P < 0.05) without changing BP. HR was restored to baseline levels after i.v. atenolol. Strikingly, ICH rats presented a reduced baseline RSNA (Δ:L-ICH 122 ± 4 vs saline 148 ± 11 spikes/s; R-ICH 112 ± 5 vs saline 148 ± 7 spikes/s, P < 0.05). After 24 h of ICH we observed a marked increase in cardiac ectopies and this number was greater after ICH R-IC. Heart weight, calcium amplitude and SERCA expression were reduced only in ICH R-IC. Focal stroke into IC can alter the cardiac and renal autonomic control. Damage to the R-IC produces a greater number of arrhythmias and changes in calcium dynamics in cardiac cells indicating that the cardiovascular consequences are hemisphere-dependent. These findings confirm asymmetry for cardiac autonomic control at the IC and help to understand the cardiac and renal implications observed after specific side cortical damage.

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Pranayama refers to a set of yoga breathing exercises. Recent evidence suggests that the practice of pranayama has positive effects on measures of clinical stress and anxiety. This study explored the impact of a Bhastrika pranayama training program on emotion processing, anxiety, and affect. We used a randomized controlled trial design with thirty healthy young adults assessed at baseline and after 4 weeks of pranayama practices. Two functional magnetic resonance imaging (MRI) protocols were used both at baseline and post-intervention: an emotion task as well as a resting-state acquisition. Our results suggest that pranayama significantly decreased states of anxiety and negative affect. The practice of pranayama also modulated the activity of brain regions involved in emotional processing, particularly the amygdala, anterior cingulate, anterior insula, and prefrontal cortex. Resting-state functional MRI (fMRI) showed significantly reduced functional connectivity involving the anterior insula and lateral portions of the prefrontal cortex. Correlation analysis revealed that changes in connectivity between the ventrolateral prefrontal cortex and the right anterior insula were associated with changes in anxiety. Although it should be noted that these analyses were preliminary and exploratory, it provides the first evidence that 4 weeks of B. pranayama significantly reduce the levels of anxiety and negative affect, and that these changes are associated with the modulation of activity and connectivity in brain areas involved in emotion processing, attention, and awareness. The study was registered at https://www.ensaiosclinicos.gov.br/rg/RBR-2gv5c2/(RBR-2gv5c2).

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Introducción: El lóbulo de la ínsula, o ínsula, se encuentra oculto en la superficie lateral del cerebro. La ínsula está localizada profundamente en el surco lateral o cisura silviana, recubierta por los opérculos frontal, parietal y temporal. Objetivo: Estudiar la compleja anatomía del lóbulo de la ínsula, una de las regiones de mayor complejidad quirúrgica del cerebro humano, y su correlación anatómica con casos quirúrgicos. Material y Métodos: En la primera parte de este estudio presentamos los resultados de nuestras disecciones microquirúrgicas en fotografías 2 D y 3D; en la segunda parte de nuestro trabajo, la correlación anatómica con una serie de 44 cirugías en pacientes con tumores de la ínsula, principalmente gliomas, operados entre 2007 y 2014. Resultados: Extenso conjunto de fibras subcorticales, incluyendo el fascículo uncinado, fronto-occipital inferior y el fascículo arcuato, conectan la ínsula a las regiones vecinas. Varias estructuras anatómicas responsables por déficits neurológicos severos están íntimamente relacionadas con la cirugía de la ínsula, tales como lesiones de la arteria cerebral media, cápsula interna, áreas del lenguaje en el hemisferio dominante y arterias lenticuloestriadas. Conclusión: El entrenamiento en laboratorio de neuroanatomía, estudio de material impreso en 3D, el conocimiento sobre neurofisiología intra-operatoria y el uso de armamento neuroquirúrgico moderno son factores que influencian en los resultados quirúrgicos

Introduction: The insular lobe, or insula, is the cerebral lobe sitting deep in the sylvian fissure and hidden by the lateral surface of the brain. It is covered by the frontal, parietal and temporal operculum. Objectives: To study the anatomy of the insular lobe, one of the most complex parts of the human brain, and to correlate this anatomy with intraoperative findings. Materials and Methods: In the first part of this article we show the results of our dissections, documented in 2D and 3D, and focus on microsurgical anatomy. In the second part we correlate the anatomical structures with intraoperative findings from 44 insular tumor surgeries, mainly gliomas, of patients operated on from 2007 to 2014. Results: Huge bundles of subcortical fibers, like uncinate, inferior fronto-occipital and arcuate fascicles, connect the insula to the neighboring structures. Several anatomical structures related to neurological disabilities are closely related to insular surgery, like the middle cerebral artery, internal capsule, lenticulostriate arteries and cortical and subcortical language circuits. Conclusions: Microsurgical laboratory training, 3D documentation, knowledge of brain mapping and modern neurosurgical armamentarium are important factors in achieving good results with insular glioma tumors.

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