The recent article by Hamasaki et al. in Volume 19 Issue 1 of the Journal of Clinical Neuroscience on MRI variations of the central sulcus (CS) reinforces the importance of redefining human surface anatomy using modern imaging techniques. The surface marking of the CS is not described in some major anatomical reference texts whereas in others it is stated to correspond "to a line drawn dSwnwards and forwards from a point 0.5 in (1 cm) behind the midpoint between the nasion and the inion". With ethical approval, we recently analyzed cranial MRI scans in 45 adults from New Zealand (20 males, mean age 56 years, range 24-84 years) with no distorting pathology to record the position of the CS at its junction with the interhemispheric fissure relative to the nasion and inion (Table 1). Scans were reviewed by dual consensus reporting. Our results showed that the left and right CS were symmetrical (within 5 mm of each other) in 40 (89%) subjects. The CS was a mean of 2 +- 0.9 cm (range 0.3-4 cm) behind the midpoint between nasion and inion, equivalent to 56% of the distance along this line. These data are similar to those reported by Hamasaki et al. in older Japanese subjects, although these authors found that the right CS was located slightly more anteriorly than the left, and that the CS was generally slightly further posterior in their subjects. These differences may be related to ethnicity or age. Our data show that the rule of thumb proposed by Poirier in 1891 , that the CS lies approximately 2 cm behind the midpoint between nasion and inion, is still a reasonable surface landmark.
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