Medial cerebral sulci variability for surgical corridors and MRI interpretation: a PRISMA-ScR scoping review of cadaveric evidence

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These structures serve as essential neuroanatomical landmarks and surgical corridors in microneurosurgical procedures, yet they exhibit considerable morphological variability. This scoping review consolidates cadaveric morphology and morphometry to define reliable vs variable medial sulcal features that guide surgical corridors and radiologic localization. Methods: Methods followed JBI and PRISMA‑ScR; protocol preregistered (OSF: https://osf.io/9c5av); databases searched (PubMed/MEDLINE, Embase, Scopus, Google Scholar); dual independent screening and data charting; details in Supplement. A comprehensive literature search identified 4,440 records, of which 60 duplicates were removed. Screening of titles and abstracts excluded 3911 records, leaving 469 for full-text review. After applying eligibility criteria, eight cadaveric studies were included. Data were extracted on sample characteristics, morphological classification, and quantitative morphometry for the medial sulci. Findings were synthesized narratively and tabulated by sulcus type. Results: Across 422 hemispheres, the cingulate sulcus was consistent, while the paracingulate sulcus was variable; we map sulcal configurations to interhemispheric approach planning and MRI identification cues. The cingulate sulcus was consistently present in all examined specimens, whereas the paracingulate sulcus displayed marked variability. The calcarine sulcus demonstrated relatively stable morphometry, with mean anterior and posterior segment lengths ranging from 2.3 to 3.5 cm, yet exhibited variable bifurcation patterns and lunate sulcus connections. The parieto-occipital sulcus was a reliable boundary between the cuneus and precuneus, with mean lengths around 4.0 cm. The subparietal sulcus was described less frequently, highlighting a gap in detailed morphometric literature. Conclusion: Cadaveric evidence confirms both consistent and highly variable features in the medial cerebral sulci. Recommendations specify stable landmarks vs variable patterns for intraoperative navigation and radiologic localization to reduce misidentification risk. The paucity of detailed morphometric descriptions for certain sulci, especially the subparietal, callosal, rostral and supra-rostral sulcus, underscores the need for further targeted anatomical research. clinical anatomy surgical corridors interhemispheric approach radiologic anatomy MRI medial cerebral sulci morphometry Figures Figure 1 Figure 2 Introduction The medial surface of the human cerebral cortex contains several prominent sulci that serve as fundamental landmarks for cortical organization and functional localization. The cingulate sulcus (CS) runs parallel to the corpus callosum and defines the superior border of the cingulate gyrus, a core limbic region involved in cognition and emotion [ 1 – 6 ]. The paracingulate sulcus (PCS), when present, lies dorsal to the CS and separates the medial superior frontal gyrus from the paracingulate gyrus [ 4 , 6 – 14 ]. Posteriorly, the parieto-occipital sulcus (POS) demarcates the boundary between the parietal and occipital lobes [ 15 – 21 ], while the calcarine sulcus (CalS) divides the occipital lobe into the cuneus and lingual gyrus and houses the primary visual cortex [ 22 – 27 ]. Collectively, these sulci provide essential anatomical landmarks used in neuroimaging, functional mapping, and neurosurgical planning. Despite their clinical importance, considerable variability exists in the morphology and morphometry of these sulci. The PCS, in particular, exhibits striking hemispheric and sex differences: it is more often present and prominent in the left hemisphere, while frequently absent in the right [ 6 , 9 ]. Quantitative morphometric studies confirm that males often demonstrate greater left-sided fissurization, whereas females tend toward greater sulcal symmetry [ 6 , 20 ]. Such differences extend beyond normal variation; recent work indicates that reduced PCS length is associated with visual hallucinations in Parkinson’s disease [ 28 ] and with altered cognition in schizophrenia [ 3 , 8 , 11 ]. Similarly, the CS, POS, and CalS show individual variability in continuity, branching patterns, and depth, with implications for functional mapping and structural interpretation [ 1 , 29 ]. Cadaveric studies remain the gold standard for defining sulcal morphology, yet the literature is fragmented. Early anatomical reports were descriptive and based on small samples, whereas more recent neuroimaging studies often lack direct validation against dissection findings [ 6 , 29 ]. A systematic review of sulci and gyri morphology identified only a handful of cadaveric studies, most of which were methodologically limited and provided incomplete morphometric data [ 21 ]. No comprehensive synthesis exists that consolidates cadaveric evidence on the cingulate, paracingulate, rostral, callosal, parieto-occipital, and calcarine sulci. This absence of structured evidence mapping hinders the development of reliable anatomical reference standards. This scoping review charts cadaveric morphology and morphometry to specify which medial sulcal features are reliable versus variable for surgical planning and MRI interpretation. Specifically, it will extract and synthesize quantitative and qualitative data, including sulcal length, depth, width, branching, laterality, and sex differences. A consolidated understanding of sulcal variability holds direct clinical significance. Sulci serve as fundamental surgical corridors and orientation markers in neurosurgery [ 21 ], and their anatomical variability influences both functional localization and structural neuroimaging interpretation [ 1 , 28 ]. By mapping available cadaveric evidence, this review will provide a foundational anatomical reference, inform the creation of more accurate brain atlases, and guide future clinical and neuroimaging research. Methods Protocol and Reporting Framework This scoping review strictly adhered to the Joanna Briggs Institute (JBI) methodological framework for scoping reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The review protocol was registered on the Open Science Framework: https://osf.io/9c5av [ 30 ] Eligibility Criteria We included original cadaveric anatomical studies that described the morphology and/or morphometry of the cingulate, paracingulate, calcarine, parieto-occipital, or subparietal sulci in human brains. Both descriptive and quantitative studies were included. We focused on cadaveric studies to define gold-standard morphology; radiologic correlates are synthesized narratively in Discussion to guide MRI interpretation. Information Sources and Search Strategy Databases: PubMed/MEDLINE, Embase, Scopus, and Google Scholar; full search strings, date ranges, and last search date are provided in the Supplement; reference lists and forward citations were screened. The search strategy combined terms for each sulcus of interest with keywords related to cadaveric studies and neuroanatomy e.g. ("cingulate sulcus" OR "paracingulate sulcus" OR "calcarine sulcus" OR "parieto-occipital sulcus") AND ("cadaveric study" OR "gross anatomy" OR "dissection") AND ("morphometry" OR "morphological" OR "measurement" OR "depth" OR "length"). The reference lists of included studies were screened to identify additional eligible publications. Study Selection The studies considered eligible for inclusion in this scoping review were human cadaveric studies evaluating the adult cadaveric brain specimens. Radiological studies of Paediatric and any clinical conditions, as well as studies in other species and articles without full text available, were excluded from this scoping review. Data Charting Process Data extraction was performed independently by two reviewers using a standardized charting form. Extracted variables included: Author(s) and year of publication, Country of study, Sample size and number of hemispheres examined, Population characteristics (age, sex, laterality if available), Sulci examined, Morphological classifications, Morphometric measurements (length, branching patterns, distances to landmarks), Notable anatomical variations, and Key conclusions and clinical relevance. Data Synthesis Findings were synthesized descriptively and grouped by sulcus type. Morphometric results were summarized in tables with ranges, means, and standard deviations where available. Morphological patterns were reported as frequencies or proportions. Due to the descriptive nature of the data and variability in measurement methods, no meta-analysis was performed. Results A total of 4,440 records were retrieved, of which 60 duplicates were removed. After title and abstract screening, 3,911 records were excluded. Full-text review was performed for 469 articles, resulting in the exclusion of 461 papers for reasons including non-cadaveric methodology, pediatric or pathological specimens, non-medial sulci, and lack of full text. Ultimately, eight cadaveric studies met inclusion criteria, collectively examining 422 hemispheres. The study selection process is summarized in Figure 1. The included studies were conducted in diverse populations (European, Indian, Japanese). However, demographic information such as age and sex was incompletely reported, limiting subgroup analysis. The findings are organized below by sulcus. Cingulate and Paracingulate Sulci The cingulate sulcus was universally present and forms a dependable intraoperative landmark, whereas paracingulate variability mandates preoperative MRI correlation for medial frontal approaches. There is a lack of specific morphometric and morphological data on cadaveric studies reporting the average length of the cingulate sulcus in adult cadavers. Selahi et al. stated that the PCS was present/prominent in roughly 25% of specimens, whereas the intralimbic sulcus was seen in about 15%. These dissection results align with the MRI findings that PCS prominence is a minority variant and support observed sex differences (males showed more prominent PCS)[12]. Imada et al. (2021) performed detailed morphological observations and classified the medial frontal cortex (excluding the cingulate gyrus) into 2-4 gyri, with 56.6% of hemispheres showing 3 gyri [31]. These sulcal and gyral arrangements were considered reliable intraoperative landmarks for anterior interhemispheric approaches. Calcarine Sulcus (CalS) Mandal et al. (2014) examined 106 cadaveric brain hemispheres and found bifurcation of the calcarine sulcus into two rami in 59.43% of specimens. Direct continuation to the lunate sulcus occurred in 31.13% of cases, with notable morphological variations including “S” and “f” shaped terminations [32]. Chandra et al. (2018) reported mean lengths of the anterior and posterior CalS segments as 23 ± 0.4 mm and 35 ± 0.3 mm, respectively and Morphometric differences between right and left hemispheres were noted, but were statistically not significant (n=100 hemispheres) [27]. Malikovic et al. (2012) classified four morphological types: Type I (single apex), Type II (two apexes), Type III (S-shaped), and Type IV (horizontal)[33]. Approximately 80% of hemispheres demonstrated posterior bifurcation into upper and lower branches (n=30 hemispheres). In 13.3%, the posterior CalS was separated from the middle portion by a cuneolingual gyrus. These patterns are directly relevant to the localization of the primary visual area (V1). Parieto-Occipital Sulcus (POS) The POS originated from the CalS and ran upwards and posteriorly towards the superomedial border. Nayak et al. (2023) described the POS as originating from the CalS and extending toward the superomedial border in which the mean distance from CalS bifurcation to POS termination was 40 mm (n=31 hemispheres, 17 right and 14 left with unknown sex) [34]. Table 1 shows quantitative evidence of length of sulci present on medial cerebral cortex. Table 1: Morphometric Evidence on sulci presents on medial surface Sulcus Author Year Sample (Hemispheres) Measurement methodology Mean± SD Coefficient variance Calcarine Chandra et al [27] 2018 100 Length Rt 100.24 mm, Lt 103.12 mm NA Malikovic et al [33] 2012 30 Length 104.6 ± 29.7 mm 28.4 % POS Nayak et al [34] 2023 53 Length 40 ±0.3 mm NA Malikovic et al [33] 2012 30 Length 51.9 ± 15.7 mm 30.3 % Mandal et al [32] 2014 106 Lenght 34 ± 0.7 mm NA Malikovic et al. (2012) identified three morphotypes: Type I (straight, unbranched), Type II (Y-shaped, more frequent in the left hemisphere), and Type III (T-shaped with horizontal superolateral branch, longest in right hemisphere). Across studies, the POS reliably demarcated the cuneus from the precuneus, serving as a robust anatomical landmark for visual cortical mapping. POS consistently connects with the calcarine sulcus at a junction known as the cuneal point, serving as a reliable anatomical landmark for mapping visual cortical areas. While its length varies slightly between hemispheres, type 3 tends to be the longest, and type 1 was the shortest [34]. Table 2 provides detailed summary of morphologicalevidences. Table 2: Morphological Evidences of sulci present on medial surface Sulcus Authors Year Demography Sample (Hemispheres) Morphological findings Variability Cingulate Selahi et al [12] 2022 Turkey 20 Present in all cases. Associated with intralimbic sulcus (15%) Paracingulate Selahi et al [12] 2022 Turkey 20 Prominent (10%), Present (15%), Absent (75%) Leftward asymmetry, more prominent in males. Calcarine Mandal et al [32] 2014 India 106 Bifurcation in (59.43 %), Continuation to lunate sulcus (31.13%) “S” and “F” shaped terminations Parieto-occipital Nayak et al [34] 2023 India 31 Originates from Calcarine sulcus; distinct boundary between cuneus & precuneus Morphology consistent Subparietal Gurer et al [17] 2013 USA 56 Consistent location relative to marginal ramus and POS Lacks morphometric details Subparietal, Callosal, and Rostral sulci The subparietal sulcus was consistently located relative to the marginal ramus of the cingulate sulcus and the POS [17], but no detailed morphometric data were available. The callosal and rostral sulci were rarely described in cadaveric studies; available reports provided only qualitative anatomical description without measurements. Overall, quantitative data on these sulci remain a major gap in cadaveric neuroanatomical literature. Discussion This scoping review provides a clinically oriented atlas of medial sulcal consistency and variability, specifying implications for interhemispheric approaches and radiologic localization. This synthesizes cadaveric morphological and morphometric evidence for the medial cerebral sulci-specifically the cingulate, paracingulate, calcarine, parieto-occipital, Rostral and subparietal sulci-based on eight anatomical studies published between 1995 and 2025. By consolidating these findings, we highlight consistent sulcal patterns that serve as reliable intraoperative landmarks, as well as notable anatomical variations with potential surgical implications. Morphological Consistency and Variability The cingulate sulcus emerged as a highly consistent structure, present in all examined hemispheres across included studies. In contrast, the paracingulate sulcus demonstrated substantial variability, with absence in up to 75% of hemispheres, and a tendency for greater prominence on the left, particularly in males. This asymmetry has been observed in neuroimaging literature and may influence approaches to the medial frontal lobe, where identification of a prominent paracingulate sulcus can alter surgical corridors [ 12 ]. In our study, we color-coded all mentioned sulci to study their morphological variations, which is depicted in Fig. 2 . Calcarine sulcus morphology exhibited less variation in presence but notable variability in branching patterns and terminal morphology. Mandal et al. (2014) documented bifurcation into two rami in over half of specimens and reported unusual terminations such as “S” and “f” shapes, which may pose challenges for surgical localization of the primary visual cortex [ 33 ]. POS reliably demarcates cuneus from precuneus and anchors posterior interhemispheric navigation; provide intraoperative length expectations (40 mm) with morphotypes noted [ 34 ]. In contrast, the subparietal sulcus remains underdescribed in cadaveric literature, despite its relevance to the posterior cingulate and retrosplenial cortex. Comparison With Previous Literature Radiological studies have also reported variability in paracingulate sulcus prevalence and morphology, often citing rates of 30–60% [ 1 , 6 , 21 ]. Our cadaveric synthesis shows a lower prevalence of prominent paracingulate sulci, which may reflect population-specific differences or methodological variation. Similarly, while imaging-based morphometry of the CalS often reports more symmetric lengths between hemispheres, cadaveric evidence confirms small but measurable asymmetries [ 24 ]. In neurosurgery, accurate identification of medial sulci is essential for safe entry into interhemispheric fissures and deep cortical structures. The cingulate and paracingulate sulci guide access to the anterior cingulate gyrus and supplementary motor area, regions implicated in tumor resections and epilepsy surgery [ 32 ]. Variability in paracingulate sulcus presence necessitates careful preoperative imaging correlation to avoid misinterpretation of cortical boundaries. The calcarine and parieto-occipital sulci are critical for visual pathway preservation. Misidentification of CalS bifurcation or POS origin during posterior approaches could increase the risk of postoperative visual field deficits. Morphometric data from cadaveric studies provide intraoperative measurement benchmarks when sulci are obscured by pathology or distortion. The relative lack of quantitative data for the subparietal sulcus suggests an important avenue for future anatomical research. Given its proximity to the posterior cingulate cortex-a target in functional neurosurgery-detailed morphometric characterization is warranted. Radiologic correlation: For each sulcus, we summarize MRI cues for identification (e.g., cuneal point at CalS–POS junction; posterior CalS bifurcation) and note variants requiring preoperative verification to minimize misidentification Limitations The included studies varied in sample size, population demographics, and measurement techniques, limiting direct quantitative synthesis. Most lacked comprehensive demographic data, making it difficult to assess sex- or age-related variation. Furthermore, the predominance of studies from single geographic regions may reduce generalizability. Conclusion Practice recommendations specify when to rely on CS vs anticipate PCS variability, how to use CalS–POS junction (cuneal point) for posterior navigation, and where cadaveric gaps (subparietal, rostral, callosal) limit intraoperative measurement cues. Declarations Funding: No Conflict of interest: No Author Contribution G.P. performed data extraction and charting and wrote the main manuscript text, and S.P. and J.K. performed data extraction and charting. V.H guided figures and tables. All authors reviewed the manuscript. Data Availability scoping review protocol has been submitted to the OSF and data can be find by this URL : https://osf.io/y8ec7/ References Amiez C, Petrides M Neuroimaging Evidence of the Anatomo-Functional Organization of the Human Cingulate Motor Areas. Cereb Cortex 20141, 24:563–578. 10.1093/cercor/bhs329 Oane I, Barborica A, Mindruta IR (2023) Cingulate Cortex: Anatomy, Structural and Functional Connectivity. J Clin Neurophysiol 40(6):482–490. 10.1097/WNP.0000000000000970 Provost JBL, Bartrés-Faz D, Paillère-Martinot ML et al (2003) Paracingulate sulcus morphology in men with early-onset schizophrenia. 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Neurol Med Chir:302 – 11 Mandal L, Mandal SK, Dutta S, Ghosh S, Singh R, Chakraborty SS (2014) Variation of the major sulci of the occipital lobe - A morphological study. 7 Malikovic A, Vucetic B, Milisavljevic M et al (2012) Occipital sulci of the human brain: variability and morphometry. Anat Sci Int 87:61–70. 10.1007/s12565-011-0118-6 Nayak S, Gupta C, Hebbar KD, Pandey AK (2023) Morphometric analysis of the main brain sulci and clinical implications: Radiological and cadaveric study. J Taibah Univ Med Sci 18:676–686 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7655696","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":531111274,"identity":"6656a726-052b-44bb-891d-68d90988ff89","order_by":0,"name":"Priyanka R Gohil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYDCCA0CcAMQSQMzMYGAhBxZ8QIIWCWOwYAIhLQxwLQwSiQ0MUENwAb7bZ499eNhmlyfZfvzi44ICifT5YYcfAm2xk9NtwK5F8lxe8ozEtuRiaZ6cYuMZBhK5G2+nGQC1JBubHcCuxeAMjzFDYhtz4jyGnDRpHpCW2QkgLQcSt+HXUp84j/8NWEu64ez0D8RoOZw4WyL9GEhLgrx0Dn5bJM/wJTMknDueOHPGG2ZjoBbDDdI5BQcSDHD7he8M72HGH2XViTPOpz98zPPHRl5+dvrmDx8q7ORwaWFg4GFgYGQDMwwgTgWrNMClHKqF4Q+Iwf4AzJdvwKd6FIyCUTAKRiIAAIgAYIzspInaAAAAAElFTkSuQmCC","orcid":"","institution":"Suamandeep Vidyapeeth University","correspondingAuthor":true,"prefix":"","firstName":"Priyanka","middleName":"R","lastName":"Gohil","suffix":""},{"id":531111275,"identity":"dcfee60b-b15c-402e-89aa-a6750d0fe377","order_by":1,"name":"Priyanka N Sharma","email":"","orcid":"","institution":"Suamandeep Vidyapeeth University","correspondingAuthor":false,"prefix":"","firstName":"Priyanka","middleName":"N","lastName":"Sharma","suffix":""},{"id":531111276,"identity":"05add858-da02-40f4-beba-72d257c52e75","order_by":2,"name":"Hetal V Vaishnani","email":"","orcid":"","institution":"Suamandeep Vidyapeeth University","correspondingAuthor":false,"prefix":"","firstName":"Hetal","middleName":"V","lastName":"Vaishnani","suffix":""},{"id":531111277,"identity":"a36adb78-0da2-4e04-8c25-00b28c5f19dd","order_by":3,"name":"Kinjal V Jethva","email":"","orcid":"","institution":"Suamandeep Vidyapeeth University","correspondingAuthor":false,"prefix":"","firstName":"Kinjal","middleName":"V","lastName":"Jethva","suffix":""}],"badges":[],"createdAt":"2025-09-19 07:38:09","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7655696/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7655696/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93946978,"identity":"5058aacb-50b0-4378-8599-0e308792f5b4","added_by":"auto","created_at":"2025-10-20 14:25:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":217027,"visible":true,"origin":"","legend":"\u003cp\u003eStudy selection process (PRISMA-ScR Checklist)\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-7655696/v1/1b8b1ff7d3f14c17f6dbd40b.png"},{"id":93946977,"identity":"fed4b583-7e1f-4be8-8a8a-795c159edccb","added_by":"auto","created_at":"2025-10-20 14:25:11","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":196669,"visible":true,"origin":"","legend":"\u003cp\u003eColour-coded sulci on the Medial Cerebral Cortex showing their morphology.\u003c/p\u003e","description":"","filename":"image3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7655696/v1/cdb75ae04ab0a9e07c8a2409.jpeg"},{"id":93947885,"identity":"331aeaaf-d545-46b9-9cfe-c6feb4f35a2e","added_by":"auto","created_at":"2025-10-20 14:33:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1006851,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7655696/v1/c4f85eaa-ea50-4fdf-bd1b-1eb2a8889348.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Medial cerebral sulci variability for surgical corridors and MRI interpretation: a PRISMA-ScR scoping review of cadaveric evidence","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe medial surface of the human cerebral cortex contains several prominent sulci that serve as fundamental landmarks for cortical organization and functional localization. The cingulate sulcus (CS) runs parallel to the corpus callosum and defines the superior border of the cingulate gyrus, a core limbic region involved in cognition and emotion [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The paracingulate sulcus (PCS), when present, lies dorsal to the CS and separates the medial superior frontal gyrus from the paracingulate gyrus [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Posteriorly, the parieto-occipital sulcus (POS) demarcates the boundary between the parietal and occipital lobes [\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19 CR20\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], while the calcarine sulcus (CalS) divides the occipital lobe into the cuneus and lingual gyrus and houses the primary visual cortex [\u003cspan additionalcitationids=\"CR23 CR24 CR25 CR26\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e–\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Collectively, these sulci provide essential anatomical landmarks used in neuroimaging, functional mapping, and neurosurgical planning.\u003c/p\u003e\u003cp\u003eDespite their clinical importance, considerable variability exists in the morphology and morphometry of these sulci. The PCS, in particular, exhibits striking hemispheric and sex differences: it is more often present and prominent in the left hemisphere, while frequently absent in the right [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Quantitative morphometric studies confirm that males often demonstrate greater left-sided fissurization, whereas females tend toward greater sulcal symmetry [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Such differences extend beyond normal variation; recent work indicates that reduced PCS length is associated with visual hallucinations in Parkinson’s disease [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and with altered cognition in schizophrenia [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Similarly, the CS, POS, and CalS show individual variability in continuity, branching patterns, and depth, with implications for functional mapping and structural interpretation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCadaveric studies remain the gold standard for defining sulcal morphology, yet the literature is fragmented. Early anatomical reports were descriptive and based on small samples, whereas more recent neuroimaging studies often lack direct validation against dissection findings [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A systematic review of sulci and gyri morphology identified only a handful of cadaveric studies, most of which were methodologically limited and provided incomplete morphometric data [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. No comprehensive synthesis exists that consolidates cadaveric evidence on the cingulate, paracingulate, rostral, callosal, parieto-occipital, and calcarine sulci. This absence of structured evidence mapping hinders the development of reliable anatomical reference standards.\u003c/p\u003e\u003cp\u003eThis scoping review charts cadaveric morphology and morphometry to specify which medial sulcal features are reliable versus variable for surgical planning and MRI interpretation. Specifically, it will extract and synthesize quantitative and qualitative data, including sulcal length, depth, width, branching, laterality, and sex differences.\u003c/p\u003e\u003cp\u003eA consolidated understanding of sulcal variability holds direct clinical significance. Sulci serve as fundamental surgical corridors and orientation markers in neurosurgery [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and their anatomical variability influences both functional localization and structural neuroimaging interpretation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. By mapping available cadaveric evidence, this review will provide a foundational anatomical reference, inform the creation of more accurate brain atlases, and guide future clinical and neuroimaging research.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch3\u003eProtocol and Reporting Framework\u003c/h3\u003e\u003cp\u003eThis scoping review strictly adhered to the Joanna Briggs Institute (JBI) methodological framework for scoping reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The review protocol was registered on the Open Science Framework: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/9c5av\u003c/span\u003e\u003cspan address=\"https://osf.io/9c5av\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e\u003ch2\u003eEligibility Criteria\u003c/h2\u003e\u003cp\u003eWe included original cadaveric anatomical studies that described the morphology and/or morphometry of the cingulate, paracingulate, calcarine, parieto-occipital, or subparietal sulci in human brains. Both descriptive and quantitative studies were included. We focused on cadaveric studies to define gold-standard morphology; radiologic correlates are synthesized narratively in Discussion to guide MRI interpretation.\u003c/p\u003e\u003ch3\u003eInformation Sources and Search Strategy\u003c/h3\u003e\u003cp\u003eDatabases: PubMed/MEDLINE, Embase, Scopus, and Google Scholar; full search strings, date ranges, and last search date are provided in the Supplement; reference lists and forward citations were screened. The search strategy combined terms for each sulcus of interest with keywords related to cadaveric studies and neuroanatomy e.g. (\"cingulate sulcus\" OR \"paracingulate sulcus\" OR \"calcarine sulcus\" OR \"parieto-occipital sulcus\") AND (\"cadaveric study\" OR \"gross anatomy\" OR \"dissection\") AND (\"morphometry\" OR \"morphological\" OR \"measurement\" OR \"depth\" OR \"length\"). The reference lists of included studies were screened to identify additional eligible publications.\u003c/p\u003e\u003ch3\u003eStudy Selection\u003c/h3\u003e\u003cp\u003eThe studies considered eligible for inclusion in this scoping review were human cadaveric studies evaluating the adult cadaveric brain specimens. Radiological studies of Paediatric and any clinical conditions, as well as studies in other species and articles without full text available, were excluded from this scoping review.\u003c/p\u003e\u003ch3\u003eData Charting Process\u003c/h3\u003e\u003cp\u003eData extraction was performed independently by two reviewers using a standardized charting form. Extracted variables included: Author(s) and year of publication, Country of study, Sample size and number of hemispheres examined, Population characteristics (age, sex, laterality if available), Sulci examined, Morphological classifications, Morphometric measurements (length, branching patterns, distances to landmarks), Notable anatomical variations, and Key conclusions and clinical relevance.\u003c/p\u003e\u003ch3\u003eData Synthesis\u003c/h3\u003e\u003cp\u003eFindings were synthesized descriptively and grouped by sulcus type. Morphometric results were summarized in tables with ranges, means, and standard deviations where available. Morphological patterns were reported as frequencies or proportions. Due to the descriptive nature of the data and variability in measurement methods, no meta-analysis was performed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 4,440 records were retrieved, of which 60 duplicates were removed. After title and abstract screening, 3,911 records were excluded. Full-text review was performed for 469 articles, resulting in the exclusion of 461 papers for reasons including non-cadaveric methodology, pediatric or pathological specimens, non-medial sulci, and lack of full text. Ultimately, eight cadaveric studies met inclusion criteria, collectively examining 422 hemispheres. The study selection process is summarized in Figure 1.\u003c/p\u003e\n\u003cp\u003eThe included studies were conducted in diverse populations (European, Indian, Japanese). However, demographic information such as age and sex was incompletely reported, limiting subgroup analysis. The findings are organized below by sulcus.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCingulate and Paracingulate Sulci\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe cingulate sulcus was universally present and forms a dependable intraoperative landmark, whereas paracingulate variability mandates preoperative MRI correlation for medial frontal approaches. There is a lack of specific morphometric and morphological data on cadaveric studies reporting the average length of the cingulate sulcus in adult cadavers. Selahi et al. stated that the PCS was present/prominent in roughly 25% of specimens, whereas the intralimbic sulcus was seen in about 15%. These dissection results align with the MRI findings that PCS prominence is a minority variant and support observed sex differences (males showed more prominent PCS)[12].\u0026nbsp;Imada et al. (2021) performed detailed morphological observations and classified the medial frontal cortex (excluding the cingulate gyrus) into 2-4 gyri, with 56.6% of hemispheres showing 3 gyri [31]. These sulcal and gyral arrangements were considered reliable intraoperative landmarks for anterior interhemispheric approaches.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCalcarine Sulcus (CalS)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMandal et al. (2014) examined 106 cadaveric brain hemispheres and found bifurcation of the calcarine sulcus into two rami in 59.43% of specimens. Direct continuation to the lunate sulcus occurred in 31.13% of cases, with notable morphological variations including \u0026ldquo;S\u0026rdquo; and \u0026ldquo;f\u0026rdquo; shaped terminations [32].\u0026nbsp;Chandra et al. (2018) reported mean lengths of the anterior and posterior CalS segments as 23 \u0026plusmn; 0.4 mm and 35 \u0026plusmn; 0.3 mm, respectively and Morphometric differences between right and left hemispheres were noted, but were statistically not significant (n=100 hemispheres) [27]. Malikovic et al. (2012) classified four morphological types: Type I (single apex), Type II (two apexes), Type III (S-shaped), and Type IV (horizontal)[33]. Approximately 80% of hemispheres demonstrated posterior bifurcation into upper and lower branches (n=30 hemispheres). In 13.3%, the posterior CalS was separated from the middle portion by a cuneolingual gyrus.\u0026nbsp;These patterns are directly relevant to the localization of the primary visual area (V1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParieto-Occipital Sulcus (POS)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe POS originated from the CalS and ran upwards and posteriorly towards the superomedial border. Nayak et al. (2023) described the POS as originating from the CalS and extending toward the superomedial border in which the mean distance from CalS bifurcation to POS termination was 40 mm (n=31 hemispheres, 17 right and 14 left with unknown sex) [34].\u0026nbsp;Table 1\u0026nbsp;shows quantitative evidence of length of sulci present on medial cerebral cortex.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003e\u0026nbsp;Table 1: Morphometric Evidence on sulci presents on medial surface\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"564\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eSulcus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eAuthor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eSample (Hemispheres)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eMeasurement methodology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eMean\u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eCoefficient\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;variance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003eCalcarine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eChandra et al [27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eRt 100.24 mm, Lt 103.12 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eMalikovic et al [33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e104.6 \u0026plusmn; 29.7 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e28.4 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003ePOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eNayak et al [34]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLength\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e40 \u0026plusmn;0.3 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eMalikovic et al [33]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e51.9 \u0026plusmn; 15.7 mm\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e30.3 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eMandal et al [32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eLenght\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e34 \u0026plusmn; 0.7 mm\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eMalikovic et al. (2012) identified three morphotypes: Type I (straight, unbranched), Type II (Y-shaped, more frequent in the left hemisphere), and Type III (T-shaped with horizontal superolateral branch, longest in right hemisphere). Across studies, the POS reliably demarcated the cuneus from the precuneus, serving as a robust anatomical landmark for visual cortical mapping. POS consistently connects with the calcarine sulcus at a junction known as the cuneal point, serving as a reliable anatomical landmark for mapping visual cortical areas. While its length varies slightly between hemispheres, type 3 tends to be the longest, and type 1 was the shortest [34]. Table 2\u0026nbsp;provides detailed summary of morphologicalevidences.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 2: Morphological Evidences of sulci present on medial surface\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSulcus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemography\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample (Hemispheres)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMorphological findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eCingulate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSelahi et al [12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eTurkey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003ePresent in all cases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eAssociated with intralimbic sulcus (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eParacingulate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eSelahi et al [12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eTurkey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eProminent (10%), Present (15%), Absent (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eLeftward asymmetry, more prominent in males.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eCalcarine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eMandal et al [32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eBifurcation in (59.43 %), Continuation to lunate sulcus (31.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026ldquo;S\u0026rdquo; and \u0026ldquo;F\u0026rdquo; shaped terminations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eParieto-occipital\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eNayak et al [34]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eIndia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eOriginates from Calcarine sulcus; distinct boundary between cuneus \u0026amp; precuneus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eMorphology consistent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eSubparietal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eGurer et al [17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eConsistent location relative to marginal ramus and POS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eLacks morphometric details\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSubparietal, Callosal, and Rostral sulci\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe subparietal sulcus was consistently located relative to the marginal ramus of the cingulate sulcus and the POS [17], but no detailed morphometric data were available. The callosal and rostral sulci were rarely described in cadaveric studies; available reports provided only qualitative anatomical description without measurements. Overall, quantitative data on these sulci remain a major gap in cadaveric neuroanatomical literature.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review provides a clinically oriented atlas of medial sulcal consistency and variability, specifying implications for interhemispheric approaches and radiologic localization. This synthesizes cadaveric morphological and morphometric evidence for the medial cerebral sulci-specifically the cingulate, paracingulate, calcarine, parieto-occipital, Rostral and subparietal sulci-based on eight anatomical studies published between 1995 and 2025. By consolidating these findings, we highlight consistent sulcal patterns that serve as reliable intraoperative landmarks, as well as notable anatomical variations with potential surgical implications.\u003c/p\u003e\u003cp\u003eMorphological Consistency and Variability\u003c/p\u003e\u003cp\u003eThe cingulate sulcus emerged as a highly consistent structure, present in all examined hemispheres across included studies. In contrast, the paracingulate sulcus demonstrated substantial variability, with absence in up to 75% of hemispheres, and a tendency for greater prominence on the left, particularly in males. This asymmetry has been observed in neuroimaging literature and may influence approaches to the medial frontal lobe, where identification of a prominent paracingulate sulcus can alter surgical corridors [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In our study, we color-coded all mentioned sulci to study their morphological variations, which is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eCalcarine sulcus morphology exhibited less variation in presence but notable variability in branching patterns and terminal morphology. Mandal et al. (2014) documented bifurcation into two rami in over half of specimens and reported unusual terminations such as \u0026ldquo;S\u0026rdquo; and \u0026ldquo;f\u0026rdquo; shapes, which may pose challenges for surgical localization of the primary visual cortex [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePOS reliably demarcates cuneus from precuneus and anchors posterior interhemispheric navigation; provide intraoperative length expectations (40 mm) with morphotypes noted [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In contrast, the subparietal sulcus remains underdescribed in cadaveric literature, despite its relevance to the posterior cingulate and retrosplenial cortex.\u003c/p\u003e\u003cp\u003eComparison With Previous Literature\u003c/p\u003e\u003cp\u003eRadiological studies have also reported variability in paracingulate sulcus prevalence and morphology, often citing rates of 30\u0026ndash;60% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Our cadaveric synthesis shows a lower prevalence of prominent paracingulate sulci, which may reflect population-specific differences or methodological variation. Similarly, while imaging-based morphometry of the CalS often reports more symmetric lengths between hemispheres, cadaveric evidence confirms small but measurable asymmetries [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In neurosurgery, accurate identification of medial sulci is essential for safe entry into interhemispheric fissures and deep cortical structures. The cingulate and paracingulate sulci guide access to the anterior cingulate gyrus and supplementary motor area, regions implicated in tumor resections and epilepsy surgery [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Variability in paracingulate sulcus presence necessitates careful preoperative imaging correlation to avoid misinterpretation of cortical boundaries. The calcarine and parieto-occipital sulci are critical for visual pathway preservation. Misidentification of CalS bifurcation or POS origin during posterior approaches could increase the risk of postoperative visual field deficits. Morphometric data from cadaveric studies provide intraoperative measurement benchmarks when sulci are obscured by pathology or distortion. The relative lack of quantitative data for the subparietal sulcus suggests an important avenue for future anatomical research. Given its proximity to the posterior cingulate cortex-a target in functional neurosurgery-detailed morphometric characterization is warranted.\u003c/p\u003e\u003cp\u003eRadiologic correlation: For each sulcus, we summarize MRI cues for identification (e.g., cuneal point at CalS\u0026ndash;POS junction; posterior CalS bifurcation) and note variants requiring preoperative verification to minimize misidentification\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eThe included studies varied in sample size, population demographics, and measurement techniques, limiting direct quantitative synthesis. Most lacked comprehensive demographic data, making it difficult to assess sex- or age-related variation. Furthermore, the predominance of studies from single geographic regions may reduce generalizability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePractice recommendations specify when to rely on CS vs anticipate PCS variability, how to use CalS\u0026ndash;POS junction (cuneal point) for posterior navigation, and where cadaveric gaps (subparietal, rostral, callosal) limit intraoperative measurement cues.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eG.P. performed data extraction and charting and wrote the main manuscript text, and S.P. and J.K. performed data extraction and charting. V.H guided figures and tables. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003escoping review protocol has been submitted to the OSF and data can be find by this URL : https://osf.io/y8ec7/\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmiez C, Petrides M Neuroimaging Evidence of the Anatomo-Functional Organization of the Human Cingulate Motor Areas. Cereb Cortex 20141, 24:563\u0026ndash;578. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/cercor/bhs329\u003c/span\u003e\u003cspan address=\"10.1093/cercor/bhs329\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOane I, Barborica A, Mindruta IR (2023) Cingulate Cortex: Anatomy, Structural and Functional Connectivity. 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J Taibah Univ Med Sci 18:676\u0026ndash;686\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"clinical anatomy, surgical corridors, interhemispheric approach, radiologic anatomy, MRI, medial cerebral sulci, morphometry","lastPublishedDoi":"10.21203/rs.3.rs-7655696/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7655696/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nMedial sulci are key intraoperative landmarks and radiologic boundaries that determine safe interhemispheric approaches and accurate MRI interpretation - cingulate, paracingulate, calcarine, parieto-occipital, callosal, Rostral, supra-rostral and subparietal sulci – are the principal surgical corridors and radiologic boundaries on the medial surface. These structures serve as essential neuroanatomical landmarks and surgical corridors in microneurosurgical procedures, yet they exhibit considerable morphological variability. This scoping review consolidates cadaveric morphology and morphometry to define reliable vs variable medial sulcal features that guide surgical corridors and radiologic localization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nMethods followed JBI and PRISMA‑ScR; protocol preregistered (OSF: https://osf.io/9c5av); databases searched (PubMed/MEDLINE, Embase, Scopus, Google Scholar); dual independent screening and data charting; details in Supplement. A comprehensive literature search identified 4,440 records, of which 60 duplicates were removed. Screening of titles and abstracts excluded 3911 records, leaving 469 for full-text review. After applying eligibility criteria, eight cadaveric studies were included. Data were extracted on sample characteristics, morphological classification, and quantitative morphometry for the medial sulci. Findings were synthesized narratively and tabulated by sulcus type.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nAcross 422 hemispheres, the cingulate sulcus was consistent, while the paracingulate sulcus was variable; we map sulcal configurations to interhemispheric approach planning and MRI identification cues. The cingulate sulcus was consistently present in all examined specimens, whereas the paracingulate sulcus displayed marked variability. The calcarine sulcus demonstrated relatively stable morphometry, with mean anterior and posterior segment lengths ranging from 2.3 to 3.5 cm, yet exhibited variable bifurcation patterns and lunate sulcus connections. The parieto-occipital sulcus was a reliable boundary between the cuneus and precuneus, with mean lengths around 4.0 cm. The subparietal sulcus was described less frequently, highlighting a gap in detailed morphometric literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nCadaveric evidence confirms both consistent and highly variable features in the medial cerebral sulci. Recommendations specify stable landmarks vs variable patterns for intraoperative navigation and radiologic localization to reduce misidentification risk. The paucity of detailed morphometric descriptions for certain sulci, especially the subparietal, callosal, rostral and supra-rostral sulcus, underscores the need for further targeted anatomical research.\u003c/p\u003e","manuscriptTitle":"Medial cerebral sulci variability for surgical corridors and MRI interpretation: a PRISMA-ScR scoping review of cadaveric evidence","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-20 14:25:07","doi":"10.21203/rs.3.rs-7655696/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a4ba7e7-122b-404c-aa83-34f5436ce8ce","owner":[],"postedDate":"October 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T14:25:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-20 14:25:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7655696","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7655696","identity":"rs-7655696","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}