This, from a surgical point of view, the most important fissure of the brain, is represented as follows: A point is taken in the median antero-posterior line which lies 1⁄2 inch behind the mid-point between nasion and inion, and from this point a line is drawn, for 31⁄2 to 4 inches, towards the mid-point of the zygoma. This line is inclined to the median antero-posterior line at an angle of 671⁄2° (three-quarters of a right angle).
The parieto-occipital and first temporo-sphenoidal fissures.
In the representation of these two fissures, two points require to be determined—the malar tubercle and the lambda. Allusion has already been made to the former; the latter is usually readily located as the point of intersection of the sagittal and lambdoid sutures. A line uniting these two points corresponds in its middle third to the temporo-sphenoidal fissure, and in its posterior inch or so to the external parieto-occipital sulcus, a fissure separating the occipital and parietal lobes of the brain.
The cortical motor and sensory areas.
The researches of Sherrington and Grünbaum,[2] Campbell,[3] and others tend to show that the cortical motor areas are situated entirely anterior to the central fissure or fissure of Rolando, extending above well over on to the mesial aspect of the brain, though not so far as the calloso-marginal fissure, and in the downward direction to within a short distance of the fissure of Sylvius. In the posterior direction the motor area includes the anterior boundary and part of the bottom of the fissure of Rolando, whilst in front it spreads, by means of gyri annectantes, on to that part of the brain which lies anterior to the precentral sulcus. The anterior termination is indefinite, but the motor strip is, on an average, not more than 3⁄4 inch in breadth.
The genua of the Rolandic fissure are said to bear a more or less definite relation to the motor areas. In my experience, however, they are too variable, and any importance which might obtain is further diminished by the fact that the surgeon should never rest content with that limited exposure of the brain which was so much in vogue till recent years. The suspected region is widely exposed by osteoplastic flap, and if doubt exists as to the particular part of cortex exposed the question is accurately settled by faradization.
This motor strip corresponds, from above downwards, to the movements of the contralateral lower extremity (toe to hip), trunk, upper extremity (shoulder to fingers), neck and face. It is a point of some general utility to bear in mind that the temporal crest intervenes approximately between the regions responsible for the movements of the upper extremity (above the crest) and those for the movements of the head and face (below the crest).
Fig. 3. The Cortical Motor and Sensory Areas.
On the left side of the head—in normal right-handed individuals—the motor speech area of Broca corresponds to the third left frontal convolution, in the angle between the anterior and posterior horizontal limbs of the Sylvian fissure.