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Mavrovounis G, Skouroliakou A, Kalatzis I, Stranjalis G, Kalamatianos T. Over 30 Years of DiI Use for Human Neuroanatomical Tract Tracing: A Scoping Review. Biomolecules 2024; 14:536. [PMID: 38785943 PMCID: PMC11117484 DOI: 10.3390/biom14050536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
In the present study, we conducted a scoping review to provide an overview of the existing literature on the carbocyanine dye DiI, in human neuroanatomical tract tracing. The PubMed, Scopus, and Web of Science databases were systematically searched. We identified 61 studies published during the last three decades. While studies incorporated specimens across human life from the embryonic stage onwards, the majority of studies focused on adult human tissue. Studies that utilized peripheral nervous system (PNS) tissue were a minority, with the majority of studies focusing on the central nervous system (CNS). The most common topic of interest in previous tract tracing investigations was the connectivity of the visual pathway. DiI crystals were more commonly applied. Nevertheless, several studies utilized DiI in a paste or dissolved form. The maximum tracing distance and tracing speed achieved was, respectively, 70 mm and 1 mm/h. We identified studies that focused on optimizing tracing efficacy by varying parameters such as fixation, incubation temperature, dye re-application, or the application of electric fields. Additional studies aimed at broadening the scope of DiI use by assessing the utility of archival tissue and compatibility of tissue clearing in DiI applications. A combination of DiI tracing and immunohistochemistry in double-labeling studies have been shown to provide the means for assessing connectivity of phenotypically defined human CNS and PNS neuronal populations.
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Affiliation(s)
- Georgios Mavrovounis
- Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (G.M.); (G.S.)
| | - Aikaterini Skouroliakou
- Department of Biomedical Engineering, The University of West Attica, 12243 Athens, Greece; (A.S.); (I.K.)
| | - Ioannis Kalatzis
- Department of Biomedical Engineering, The University of West Attica, 12243 Athens, Greece; (A.S.); (I.K.)
| | - George Stranjalis
- Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (G.M.); (G.S.)
- Hellenic Centre for Neurosurgery Research “Professor Petros S. Kokkalis”, 10675 Athens, Greece
| | - Theodosis Kalamatianos
- Department of Neurosurgery, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece; (G.M.); (G.S.)
- Hellenic Centre for Neurosurgery Research “Professor Petros S. Kokkalis”, 10675 Athens, Greece
- Clinical and Experimental Neuroscience Research Group, Department of Neurosurgery, National and Kapodistrian University of Athens, 10675 Athens, Greece
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Mignucci-Jiménez G, Xu Y, On TJ, Abramov I, Houlihan LM, Rahmani R, Koskay G, Hanalioglu S, Meybodi AT, Lawton MT, Preul MC. Toward an optimal cadaveric brain model for neurosurgical education: assessment of preservation, parenchyma, vascular injection, and imaging. Neurosurg Rev 2024; 47:190. [PMID: 38658446 DOI: 10.1007/s10143-024-02363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/13/2024] [Accepted: 03/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE We assessed types of cadaveric head and brain tissue specimen preparations that are used in a high throughput neurosurgical research laboratory to determine optimal preparation methods for neurosurgical anatomical research, education, and training. METHODS Cadaveric specimens (N = 112) prepared using different preservation and vascular injection methods were imaged, dissected, and graded by 11 neurosurgeons using a 21-point scale. We assessed the quality of tissue and preservation in both the anterior and posterior circulations. Tissue quality was evaluated using a 9-point magnetic resonance imaging (MRI) scale. RESULTS Formalin-fixed specimens yielded the highest scores for assessment (mean ± SD [17.0 ± 2.8]) vs. formalin-flushed (17.0 ± 3.6) and MRI (6.9 ± 2.0). Cadaver assessment and MRI scores were positively correlated (P < 0.001, R2 0.60). Analysis showed significant associations between cadaver assessment scores and specific variables: nonformalin fixation (β = -3.3), preservation within ≤72 h of death (β = 1.8), and MRI quality score (β = 0.7). Formalin-fixed specimens exhibited greater hardness than formalin-flushed and nonformalin-fixed specimens (P ≤ 0.006). Neurosurgeons preferred formalin-flushed specimens injected with colored latex. CONCLUSION For better-quality specimens for neurosurgical education and training, formalin preservation within ≤72 h of death was preferable, as was injection with colored latex. Formalin-flushed specimens more closely resembled live brain parenchyma. Assessment scores were lower for preparation techniques performed > 72 h postmortem and for nonformalin preservation solutions. The positive correlation between cadaver assessment scores and our novel MRI score indicates that donation organizations and institutional buyers should incorporate MRI as a screening tool for the selection of high-quality specimens.
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Affiliation(s)
- Giancarlo Mignucci-Jiménez
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Yuan Xu
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Thomas J On
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Irakliy Abramov
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Lena Mary Houlihan
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Redi Rahmani
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Grant Koskay
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Sahin Hanalioglu
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Ali Tayebi Meybodi
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Michael T Lawton
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
- Robert F. Spetzler Chair in Neuroscience, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA
| | - Mark C Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
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Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Nardi L, Schmeisser MJ, Schumann S. Fixation and staining methods for macroscopical investigation of the brain. Front Neuroanat 2023; 17:1200196. [PMID: 37426902 PMCID: PMC10323195 DOI: 10.3389/fnana.2023.1200196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
Abstract
The proper preservation of human brain tissue is an indispensable requirement for post-mortem investigations. Neuroanatomical teaching, neuropathological examination, neurosurgical training, basic and clinical neuroscientific research are some of the possible downstream applications of brain specimens and, although much apart from one another, proper tissue fixation and preservation is a common denominator to all of them. In this review, the most relevant procedures to fixate brain tissue are described. In situ and immersion fixation approaches have been so far the most widespread ways to deliver the fixatives inside the skull. Although most of them rely on the use of formalin, alternative fixative solutions containing lower amounts of this compound mixed with other preservative agents, have been attempted. The combination of fixation and freezing paved the way for fiber dissection, particularly relevant for the neurosurgical practice and clinical neuroscience. Moreover, special techniques have been developed in neuropathology to tackle extraordinary problems, such as the examination of highly infective specimens, as in the case of the Creutzfeldt-Jakob encephalopathy, or fetal brains. Fixation is a fundamental prerequisite for further staining of brain specimens. Although several staining techniques have been developed for the microscopical investigation of the central nervous system, numerous approaches are also available for staining macroscopic brain specimens. They are mostly relevant for neuroanatomical and neuropathological teaching and can be divided in white and gray matter staining techniques. Altogether, brain fixation and staining techniques are rooted in the origins of neuroscience and continue to arouse interest in both preclinical and clinical neuroscientists also nowadays.
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Affiliation(s)
- Leonardo Nardi
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Michael J. Schmeisser
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Focus Program Translational Neurosciences, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sven Schumann
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Duque ACM, Cuesta TAC, Melo ADS, Lima Maldonado I. Right hemisphere and metaphor comprehension: A connectionist perspective. Neuropsychologia 2023; 187:108618. [PMID: 37321404 DOI: 10.1016/j.neuropsychologia.2023.108618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/11/2023] [Accepted: 06/10/2023] [Indexed: 06/17/2023]
Abstract
Metaphor comprehension is a cognitively complex task, with evidence pointing to the engagement of multiple cerebral areas. In addition, the involvement of the right hemisphere appears to vary with cognitive effort. Therefore, the interconnecting pathways of such distributed cortical centers should be taken into account when studying this topic. Despite this, the potential contribution of white matter fasciculi has received very little attention in the literature to date and is not mentioned in most metaphor comprehension studies. To highlight the probable implications of the right inferior fronto-occipital fasciculus, right superior longitudinal system, and callosal radiations, we bring together findings from different research fields. The aim is to describe important insights enabled by the cross-fertilization of functional neuroimaging, clinical findings, and structural connectivity.
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Affiliation(s)
- Anna Clara Mota Duque
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Taryn Ariadna Castro Cuesta
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Ailton de Souza Melo
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Igor Lima Maldonado
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil; Dep. Biomorfologia, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.
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Kuzucu P, Türkmen T, Demirtaş OK, Güngör A, Yaman ME, Aykol Ş. Suprafloccular transhorizontal fissure approach to the cerebellopontine angle: an anatomical study with case series. Neurosurg Rev 2023; 46:62. [PMID: 36856827 DOI: 10.1007/s10143-023-01961-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 03/02/2023]
Abstract
The suprafloccular transhorizontal fissure approach is a modified variant of the classical retrosigmoid approach option to be chosen for cerebellopontine angle lesions. In this study, we aimed to demonstrate a previously described but not widely used method, the suprafloccular transhorizontal fissure approach with anatomical dissection on the cadaver, accompanied by a case presentation with the largest clinical series in the literature. Klingler's protocol was used to prepare 8 silicone injected and 8 non-silicone injected human hemispheres. A total of 210 patients who underwent surgery in the cerebellopontine angle between 2019 and 2022 were evaluated in our clinic. Of these, the suprafloccular transhorizontal fissure approach was applied in 33 patient, and it was successful in 26 patient, but this approach could not be achieved in 7 patients. The transhorizontal fissure is a fissure in the cerebellum located between the superior semilunar lobule and the inferior semilunar lobule. In the 26 patients we operated with the suprafloccular transhorizontal fissure approach, there was no need for retraction and no complications developed. However, in 7 patients, this fissure could not be dissected due to adhesions. Suprafloccular approach is an alternative to the classical retrosigmoid approach in tumours smaller than 2 cm, medially localised with little cerebellar oedema and neurovascular compression syndrome. Because in this approach, no cerebellum retraction is required, vascular structures are better preserved and the surgical time is shortened. This approach can be applied in smaller tumours than 2 cm when the sulcal anatomy is appropriate.
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Affiliation(s)
- Pelin Kuzucu
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Tolga Türkmen
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Oğuz Kağan Demirtaş
- Department of Neurosurgery, Sincan Dr. Nafiz Körez State Hospital, Ankara, Türkiye
| | - Abuzer Güngör
- Department of Neurosurgery, Faculty of Medicine, Yeditepe University, İstanbul, Türkiye.,Department of Neurosurgery, Bakırköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, İstanbul, Türkiye
| | - Mesut Emre Yaman
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Türkiye.
| | - Şükrü Aykol
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Türkiye
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Aydin SO, Barut O, Yilmaz MO, Sahin B, Akyoldas G, Akgun MY, Baran O, Tanriover N. Use of 3-Dimensional Modeling and Augmented/Virtual Reality Applications in Microsurgical Neuroanatomy Training. Oper Neurosurg (Hagerstown) 2023; 24:318-323. [PMID: 36701556 DOI: 10.1227/ons.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Understanding the microsurgical neuroanatomy of the brain is challenging yet crucial for safe and effective surgery. Training on human cadavers provides an opportunity to practice approaches and learn about the brain's complex organization from a surgical view. Innovations in visual technology, such as virtual reality (VR) and augmented reality (AR), have immensely added a new dimension to neuroanatomy education. In this regard, a 3-dimensional (3D) model and AR/VR application may facilitate the understanding of the microsurgical neuroanatomy of the brain and improve spatial recognition during neurosurgical procedures by generating a better comprehension of interrelated neuroanatomic structures. OBJECTIVE To investigate the results of 3D volumetric modeling and AR/VR applications in showing the brain's complex organization during fiber dissection. METHODS Fiber dissection was applied to the specimen, and the 3D model was created with a new photogrammetry method. After photogrammetry, the 3D model was edited using 3D editing programs and viewed in AR. The 3D model was also viewed in VR using a head-mounted display device. RESULTS The 3D model was viewed in internet-based sites and AR/VR platforms with high resolution. The fibers could be panned, rotated, and moved freely on different planes and viewed from different angles on AR and VR platforms. CONCLUSION This study demonstrated that fiber dissections can be transformed and viewed digitally on AR/VR platforms. These models can be considered a powerful teaching tool for improving the surgical spatial recognition of interrelated neuroanatomic structures. Neurosurgeons worldwide can easily avail of these models on digital platforms.
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Affiliation(s)
- Serdar Onur Aydin
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Ozan Barut
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Ozgur Yilmaz
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Balkan Sahin
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Goktug Akyoldas
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | | | - Oguz Baran
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Necmettin Tanriover
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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The connectivity-based parcellation of the angular gyrus: fiber dissection and MR tractography study. Brain Struct Funct 2023; 228:121-130. [PMID: 36056938 DOI: 10.1007/s00429-022-02555-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/14/2022] [Indexed: 01/07/2023]
Abstract
The angular gyrus (AG) wraps the posterior end of the superior temporal sulcus (STS), so it is considered a continuation of the superior temporal gyrus (STG)/ middle temporal gyrus (MTG) and forms the inferior parietal lobule (IPL) with the supramarginal gyrus (SMG). The AG was functionally divided in the literature, but there is no fiber dissection study in this context. This study divided AG into superior (sAG) and inferior (iAG) parts by focusing on STS. Red, blue silicone-injected eight and four non-silicone-injected human cadaveric cerebrums were dissected via the Klingler method focusing on the AG. White matter (WM) tracts identified during dissection were then reconstructed on the Human Connectome Project 1065 individual template for validation. According to this study, superior longitudinal fasciculus (SLF) II and middle longitudinal fasciculus (MdLF) are associated with sAG; the anterior commissure (AC), optic radiation (OR) with iAG; the arcuate fasciculus (AF), inferior frontooccipital fasciculus (IFOF), and tapetum (Tp) with both parts. In cortical parcellation of AG based on STS, sAG and iAG were associated with different fiber tracts. Although it has been shown in previous studies that there are functionally different subunits with AG parcellation, here, for the first time, other functions of the subunits have been revealed with cadaveric dissection and tractography images.
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Dziedzic TA, Bala A, Balasa A, Olejnik A, Marchel A. Cortical and white matter anatomy relevant for the lateral and superior approaches to resect intraaxial lesions within the frontal lobe. Sci Rep 2022; 12:21402. [PMID: 36496517 PMCID: PMC9741612 DOI: 10.1038/s41598-022-25375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
Despite being associated with high-order neurocognitive functions, the frontal lobe plays an important role in core neurological functions, such as motor and language functions. The aim of this study was to present a neurosurgical perspective of the cortical and subcortical anatomy of the frontal lobe in terms of surgical treatment of intraaxial frontal lobe lesions. We also discuss the results of direct brain mapping when awake craniotomy is performed. Ten adult cerebral hemispheres were prepared for white matter dissection according to the Klingler technique. Intraaxial frontal lobe lesions are approached with a superior or lateral trajectory during awake conditions. The highly eloquent cortex within the frontal lobe is identified within the inferior frontal gyrus (IFG) and precentral gyrus. The trajectory of the approach is mainly related to the position of the lesion in relation to the arcuate fascicle/superior longitudinal fascicle complex and ventricular system. Knowledge of the cortical and subcortical anatomy and its function within the frontal lobe is essential for preoperative planning and predicting the risk of immediate and long-term postoperative deficits. This allows surgeons to properly set the extent of the resection and type of approach during preoperative planning.
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Affiliation(s)
- Tomasz Andrzej Dziedzic
- grid.13339.3b0000000113287408Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097 Warszawa, Poland
| | - Aleksandra Bala
- grid.13339.3b0000000113287408Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097 Warszawa, Poland ,grid.12847.380000 0004 1937 1290Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Artur Balasa
- grid.13339.3b0000000113287408Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097 Warszawa, Poland
| | - Agnieszka Olejnik
- grid.13339.3b0000000113287408Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097 Warszawa, Poland ,grid.12847.380000 0004 1937 1290Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- grid.13339.3b0000000113287408Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097 Warszawa, Poland
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Wu Y, Liu J, Yu G, Jv R, Wang Y, Zang P. Association fiber tracts related to Broca’s area: A comparative study based on diffusion spectrum imaging and fiber dissection. Front Neurosci 2022; 16:978912. [PMID: 36419463 PMCID: PMC9676966 DOI: 10.3389/fnins.2022.978912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022] Open
Abstract
Broca’s area, made up of Brodmann areas (BA) 44 and 45 in the ventrolateral frontal region, is associated with language production and articulation. A comprehensive network analysis of Broca’s area is necessary for understanding language function, which is still lacking. In this study, we attempted to investigate the association fiber tracts related to Broca’s area using both diffusion spectrum imaging (DSI) and postmortem fiber dissection. DSI was performed on 10 healthy subjects and an atlas comprising the average data of 842 healthy subjects from the Human Connectome Project. Fiber dissection was implemented in 10 cerebral hemispheres of cadaver donors. The following five association fiber tracts related to Broca’s area were identified: first, the distinct fasciculus of the inferior fronto-occipital fasciculus (IFOF), from Broca’s area (BA44, BA45) and pars orbitalis (BA47) to the parietal and occipital lobes; second, the ventral superior longitudinal fasciculus (SLF-III), from the supramarginal gyrus (BA40) to the ventral precentral gyrus (PreG, BA6) and posterior Broca’s area (BA44); third, the arcuate fascicle (AF), from the superior, middle, and inferior temporal gyrus (BA20, BA21, BA22) to Broca’s area (BA44, BA45) and ventral PreG; fourth, the frontal aslant tract (FAT), from Broca’s area (BA44, BA45) to the lateral superior frontal gyrus (SFG), medial SFG, and supplementary motor area (BA6, BA8, BA9); and fifth, the frontal longitudinal fasciculus (FLF), a novel intralobar frontal association fiber tract, from the anterior part of the middle frontal gyrus (MFG, BA46) and Broca’s area (BA45) to the caudal MFG (BA8), caudal SFG, and dorsal PreG (BA6). Moreover, compared with the left FAT, the right FAT covered almost the entire inferior frontal gyrus (BA44, BA45, BA47). The cross validation between DSI and fiber dissection revealed a good consistence in the association fiber tracts of Broca’s area. Combining DSI and fiber dissection, this study first identified five association fiber tracts related to Broca’s area and characterized their structure and anatomy comprehensively. The frameworks provided key elements for functional research in Broca’s area.
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Affiliation(s)
- Yupeng Wu
- Third Department of Neurosurgery, The People’s Hospital of China Medical University and the People’s Hospital of Liaoning Province, Shenyang, China
| | - Jihui Liu
- Third Department of Neurosurgery, The People’s Hospital of China Medical University and the People’s Hospital of Liaoning Province, Shenyang, China
| | - Guoning Yu
- The People’s Hospital of China Medical University and the People’s Hospital of Liaoning Province, Shenyang, China
| | - Ronghui Jv
- Department of Radiology, The People’s Hospital of China Medical University and the People’s Hospital of Liaoning Province, Shenyang, China
| | - Yibao Wang
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Peizhuo Zang
- Third Department of Neurosurgery, The People’s Hospital of China Medical University and the People’s Hospital of Liaoning Province, Shenyang, China
- *Correspondence: Peizhuo Zang,
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11
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Axer M, Amunts K. Scale matters: The nested human connectome. Science 2022; 378:500-504. [DOI: 10.1126/science.abq2599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A comprehensive description of how neurons and entire brain regions are interconnected is fundamental for a mechanistic understanding of brain function and dysfunction. Neuroimaging has shaped the way to approaching the human brain’s connectivity on the basis of diffusion magnetic resonance imaging and tractography. At the same time, polarization, fluorescence, and electron microscopy became available, which pushed spatial resolution and sensitivity to the axonal or even to the synaptic level. New methods are mandatory to inform and constrain whole-brain tractography by regional, high-resolution connectivity data and local fiber geometry. Machine learning and simulation can provide predictions where experimental data are missing. Future interoperable atlases require new concepts, including high-resolution templates and directionality, to represent variants of tractography solutions and estimates of their accuracy.
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Affiliation(s)
- Markus Axer
- Institute of Neurosciences and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
- Department of Physics, School of Mathematics and Natural Sciences, Bergische Universität Wuppertal, Wuppertal, Germany
| | - Katrin Amunts
- Institute of Neurosciences and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
- Cécile and Oskar Vogt Institute for Brain Research, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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12
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Gurses ME, Gungor A, Rahmanov S, Gökalp E, Hanalioglu S, Berker M, Cohen-Gadol AA, Türe U. Three-Dimensional Modeling and Augmented Reality and Virtual Reality Simulation of Fiber Dissection of the Cerebellum and Brainstem. Oper Neurosurg (Hagerstown) 2022; 23:345-354. [DOI: 10.1227/ons.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/24/2022] [Indexed: 11/07/2022] Open
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13
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Yendiki A, Aggarwal M, Axer M, Howard AF, van Cappellen van Walsum AM, Haber SN. Post mortem mapping of connectional anatomy for the validation of diffusion MRI. Neuroimage 2022; 256:119146. [PMID: 35346838 PMCID: PMC9832921 DOI: 10.1016/j.neuroimage.2022.119146] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 01/13/2023] Open
Abstract
Diffusion MRI (dMRI) is a unique tool for the study of brain circuitry, as it allows us to image both the macroscopic trajectories and the microstructural properties of axon bundles in vivo. The Human Connectome Project ushered in an era of impressive advances in dMRI acquisition and analysis. As a result of these efforts, the quality of dMRI data that could be acquired in vivo improved substantially, and large collections of such data became widely available. Despite this progress, the main limitation of dMRI remains: it does not image axons directly, but only provides indirect measurements based on the diffusion of water molecules. Thus, it must be validated by methods that allow direct visualization of axons but that can only be performed in post mortem brain tissue. In this review, we discuss methods for validating the various features of connectional anatomy that are extracted from dMRI, both at the macro-scale (trajectories of axon bundles), and at micro-scale (axonal orientations and other microstructural properties). We present a range of validation tools, including anatomic tracer studies, Klingler's dissection, myelin stains, label-free optical imaging techniques, and others. We provide an overview of the basic principles of each technique, its limitations, and what it has taught us so far about the accuracy of different dMRI acquisition and analysis approaches.
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Affiliation(s)
- Anastasia Yendiki
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States,Corresponding author (A. Yendiki)
| | - Manisha Aggarwal
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Markus Axer
- Forschungszentrum Jülich, Institute of Neuroscience and Medicine, Jülich, Germany,Department of Physics, University of Wuppertal Germany
| | - Amy F.D. Howard
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Anne-Marie van Cappellen van Walsum
- Department of Medical Imaging, Anatomy, Radboud University Medical Center, Nijmegen, the Netherland,Cognition and Behaviour, Donders Institute for Brain, Nijmegen, the Netherland
| | - Suzanne N. Haber
- Department of Pharmacology and Physiology, University of Rochester, Rochester, NY, United States,McLean Hospital, Belmont, MA, United States
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14
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Superficial white matter bundle atlas based on hierarchical fiber clustering over probabilistic tractography data. Neuroimage 2022; 262:119550. [DOI: 10.1016/j.neuroimage.2022.119550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/20/2022] Open
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15
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Akeret K, Forkel SJ, Buzzi RM, Vasella F, Amrein I, Colacicco G, Serra C, Krayenbühl N. Multimodal anatomy of the human forniceal commissure. Commun Biol 2022; 5:742. [PMID: 35879431 PMCID: PMC9314404 DOI: 10.1038/s42003-022-03692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
Ambiguity surrounds the existence and morphology of the human forniceal commissure. We combine advanced in-vivo tractography, multidirectional ex-vivo fiber dissection, and multiplanar histological analysis to characterize this structure’s anatomy. Across all 178 subjects, in-vivo fiber dissection based on the Human Connectome Project 7 T MRI data identifies no interhemispheric connections between the crura fornicis. Multidirectional ex-vivo fiber dissection under the operating microscope demonstrates the psalterium as a thin soft-tissue membrane spanning between the right and left crus fornicis, but exposes no commissural fibers. Multiplanar histological analysis with myelin and Bielchowsky silver staining, however, visualizes delicate cruciform fibers extending between the crura fornicis, enclosed by connective tissue, the psalterium. The human forniceal commissure is therefore much more delicate than previously described and presented in anatomical textbooks. This finding is consistent with the observed phylogenetic trend of a reduction of the forniceal commissure in non-human primates compared to non-primate eutherian mammals. Anatomical dissection and tractography elucidate the delicate nature of the human forniceal commissure, an interhemispheric white matter circuit.
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Affiliation(s)
- Kevin Akeret
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephanie J Forkel
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France.,Donders Centre for Cognition, Radboud University, Thomas van Aquinostraat 4, 6525 GD, Nijmegen, the Netherlands.,Centre for Neuroimaging Sciences, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Departments of Neurosurgery, Technical University of Munich School of Medicine, Munich, Germany
| | - Raphael M Buzzi
- Division of Internal Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Flavio Vasella
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Irmgard Amrein
- Institute of Anatomy, University of Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH, Zurich, Switzerland
| | | | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland. .,Division of Pediatric Neurosurgery, University Children's Hospital, Zurich, Switzerland.
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16
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A stepwise laboratory manual for the dissection and illustration of limbic and paralimbic structures: lessons learned from the Klingler's technique. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1045-1061. [PMID: 35790536 DOI: 10.1007/s00276-022-02981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Three-dimensional relationships within the limbic and paralimbic areas are often hard to grasp. Relevant anatomical structures exhibit a complicated architecture and connectivity and therefore surgical approaches targeting lesions or functional resections in this area pose a distinct challenge. PURPOSE To provide an educational, comprehensive, systematic and stepwise manual for the dissection and illustration of major limbic structures since there is a gap in the pertinent literature. Further, we aim to offer a thorough yet simplified roadmap for laboratory and intraoperative dissections. METHODS Twenty (20) normal adult, formalin-fixed cerebral hemispheres were studied through the fiber dissection technique and under the microscope. Stepwise and in tandem medial to lateral and lateral to medial dissections were performed in all specimens aiming to reveal the morphology and spatial relationships of major limbic and paralimbic areas. RESULTS Fourteen (14) consecutive, discrete and easily reproducible laboratory anatomical steps are systematically described to reveal the intricate anatomy of the limbic and paralimbic structures and their main connections. CONCLUSION This study offers for the first time in the pertinent literature a focused, step-by-step laboratory manual for the dissection and illustration of the limbic and paralimbic structures. The overreaching goal is to supplement the novice and experienced anatomist and neurosurgeon with a thorough and systematic reference to facilitate laboratory or intraoperative dissections.
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17
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Becker Y, Loh KK, Coulon O, Meguerditchian A. The Arcuate Fasciculus and language origins: Disentangling existing conceptions that influence evolutionary accounts. Neurosci Biobehav Rev 2021; 134:104490. [PMID: 34914937 DOI: 10.1016/j.neubiorev.2021.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022]
Abstract
The Arcuate Fasciculus (AF) is of considerable interdisciplinary interest, because of its major implication in language processing. Theories about language brain evolution are based on anatomical differences in the AF across primates. However, changing methodologies and nomenclatures have resulted in conflicting findings regarding interspecies AF differences: Historical knowledge about the AF originated from human blunt dissections and later from monkey tract-tracing studies. Contemporary tractography studies reinvestigate the fasciculus' morphology, but remain heavily bound to unclear anatomical priors and methodological limitations. First, we aim to disentangle the influences of these three epistemological steps on existing AF conceptions, and to propose a contemporary model to guide future work. Second, considering the influence of various AF conceptions, we discuss four key evolutionary changes that propagated current views about language evolution: 1) frontal terminations, 2) temporal terminations, 3) greater Dorsal- versus Ventral Pathway expansion, 4) lateralisation. We conclude that new data point towards a more shared AF anatomy across primates than previously described. Language evolution theories should incorporate this continuous AF evolution across primates.
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Affiliation(s)
- Yannick Becker
- Laboratoire de Psychologie Cognitive, Aix-Marseille Univ, CNRS UMR 7290, Marseille, France; Institut de Neurosciences de la Timone, Aix-Marseille Univ, CNRS UMR 7289, Marseille, France.
| | - Kep Kee Loh
- Laboratoire de Psychologie Cognitive, Aix-Marseille Univ, CNRS UMR 7290, Marseille, France; Institut de Neurosciences de la Timone, Aix-Marseille Univ, CNRS UMR 7289, Marseille, France; Institute for Language, Communication, and the Brain, Aix-Marseille Univ, Marseille, France
| | - Olivier Coulon
- Institut de Neurosciences de la Timone, Aix-Marseille Univ, CNRS UMR 7289, Marseille, France; Institute for Language, Communication, and the Brain, Aix-Marseille Univ, Marseille, France
| | - Adrien Meguerditchian
- Laboratoire de Psychologie Cognitive, Aix-Marseille Univ, CNRS UMR 7290, Marseille, France; Institute for Language, Communication, and the Brain, Aix-Marseille Univ, Marseille, France; Station de Primatologie CNRS, Rousset, France
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18
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Dziedzic TA, Bala A, Marchel A. Cortical and Subcortical Anatomy of the Parietal Lobe From the Neurosurgical Perspective. Front Neurol 2021; 12:727055. [PMID: 34512535 PMCID: PMC8426580 DOI: 10.3389/fneur.2021.727055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The anatomical structures of the parietal lobe at the cortical and subcortical levels are related mainly to sensory, visuospatial, visual and language function. The aim of this study was to present an intraoperative perspective of these critical structures in terms of the surgical treatment of intra-axial lesions. The study also discusses the results of the technique and the results of direct brain stimulation under awake conditions. Materials and Methods: Five adult brains were prepared according to the Klingler technique. Cortical assessments and all measurements were performed with the naked eye, while white matter dissection was performed with microscopic magnification. Results: Intra-axial lesions within the parietal lobe can be approached through a lateral or superior trajectory. This decision is based on the location of the lesions in relation to the arcuate fascicle/superior longitudinal fascicle (AF/SLF) complex and ventricular system. Regardless of the approach, the functional borders of the resection are defined by the postcentral gyrus anteriorly and Wernicke's speech area inferiorly. On the subcortical level, active identification of the AF/SLF complex and of the optic radiation within the sagittal stratum should be performed. The intraparietal sulcus (IPS) is a reliable landmark for the AF/SLF complex in ~60% of cases. Conclusion: Knowledge of the cortical and subcortical anatomical and functional borders of the resection is crucial in preoperative planning, prediction of the risk of postoperative deficits, and intraoperative decision making.
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Affiliation(s)
| | - Aleksandra Bala
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.,Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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19
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Dziedzic TA, Bala A, Marchel A. Anatomical aspects of the insula, opercula and peri-insular white matter for a transcortical approach to insular glioma resection. Neurosurg Rev 2021; 45:793-806. [PMID: 34292438 PMCID: PMC8827298 DOI: 10.1007/s10143-021-01602-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 11/01/2022]
Abstract
The insula is a lobe located deep in each hemisphere of the brain and is surrounded by eloquent cortical, white matter, and basal ganglia structures. The aim of this study was to provide an anatomical description of the insula and white matter tracts related to surgical treatment of gliomas through a transcortical approach. The study also discusses surgical implications in terms of intraoperative brain mapping. Five adult brains were prepared according to the Klingler technique. Cortical anatomy was evaluated with the naked eye, whereas white matter dissection was performed with the use of a microscope. The widest exposure of the insular surface was noted through the temporal operculum, mainly in zones III and IV according to the Berger-Sanai classification. By going through the pars triangularis in all cases, the anterior insular point and most of zone I were exposed. The narrowest and deepest operating field was observed by going through the parietal operculum. This method provided a suitable approach to zone II, where the corticospinal tract is not covered by the basal ganglia and is exposed just under the superior limiting sulcus. At the subcortical level, the identification of the inferior frontoocipital fasciculus at the level of the limen insulae is critical in terms of preserving the lenticulostriate arteries. Detailed knowledge of the anatomy of the insula and subcortical white matter that is exposed through each operculum is essential in preoperative planning as well as in the intraoperative decision-making process in terms of intraoperative brain mapping.
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Affiliation(s)
- Tomasz Andrzej Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097, Warszawa, Poland.
| | - Aleksandra Bala
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097, Warszawa, Poland.,Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097, Warszawa, Poland
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20
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Revisiting the Morphology and Classification of the Paracingulate Gyrus with Commentaries on Ambiguous Cases. Brain Sci 2021; 11:brainsci11070872. [PMID: 34210078 PMCID: PMC8301833 DOI: 10.3390/brainsci11070872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022] Open
Abstract
The anterior cingulate cortex is considered to play a crucial role in cognitive and affective regulation. However, this area shows a high degree of morphological interindividual variability and asymmetry. It is especially true regarding the paracingulate sulcus and paracingulate gyrus (PCG). Since the reports described in the literature are mainly based on imaging techniques, the goal of this study was to verify the classification of the PCG based on anatomical material. Special attention was given to ambiguous cases. The PCG was absent in 26.4% of specimens. The gyrus was classified as present in 28.3% of cases. The prominent type of the PCG was observed in 37.7% of the total. Occasionally, the gyrus was well-developed and roughly only a few millimeters were missing for classifying the gyrus as prominent, as it ended slightly anterior the level of the VAC. The remaining four cases involved two inconclusive types. We observed that the callosomarginal artery ran within the cingulate sulcus and provided branches that crossed the PCG. Based on Klingler’s dissection technique, we observed a close relationship of the PCG with the superior longitudinal fascicle. The awareness of the anatomical variability observed within the brain cortex is an essential starting point for in-depth research.
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