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Herlin B, Uszynski I, Chauvel M, Poupon C, Dupont S. Cross-subject variability of the optic radiation anatomy in a cohort of 1065 healthy subjects. Surg Radiol Anat 2023:10.1007/s00276-023-03161-4. [PMID: 37195302 DOI: 10.1007/s00276-023-03161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Optic radiations are tracts of particular interest for neurosurgery, especially for temporal lobe resection, because their lesion is responsible for visual field defects. However, histological and MRI studies found a high inter-subject variability of the optic radiation anatomy, especially for their most rostral extent inside the Meyer's temporal loop. We aimed to better assess inter-subject anatomical variability of the optic radiations, in order to help to reduce the risk of postoperative visual field deficiencies. METHODS Using an advanced analysis pipeline relying on a whole-brain probabilistic tractography and fiber clustering, we processed the diffusion MRI data of the 1065 subjects of the HCP cohort. After registration in a common space, a cross-subject clustering on the whole cohort was performed to reconstruct the reference optic radiation bundle, from which all optic radiations were segmented on an individual scale. RESULTS We found a median distance between the rostral tip of the temporal pole and the rostral tip of the optic radiation of 29.2 mm (standard deviation: 2.1 mm) for the right side and 28.8 mm (standard deviation: 2.3 mm) for the left side. The difference between both hemispheres was statistically significant (p = 1.10-8). CONCLUSION We demonstrated inter-individual variability of the anatomy of the optic radiations on a large-scale study, especially their rostral extension. In order to better guide neurosurgical procedures, we built a MNI-based reference atlas of the optic radiations that can be used for fast optic radiation reconstruction from any individual diffusion MRI tractography.
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Affiliation(s)
- B Herlin
- BAOBAB, NeuroSpin, Université Paris-Saclay, CNRS, CEA, Gif-Sur-Yvette, France.
- AP-HP, Epilepsy Unit, GH Pitié-Salpêtrière-Charles Foix, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
- Sorbonne Université, Paris, France.
| | - I Uszynski
- BAOBAB, NeuroSpin, Université Paris-Saclay, CNRS, CEA, Gif-Sur-Yvette, France
| | - M Chauvel
- BAOBAB, NeuroSpin, Université Paris-Saclay, CNRS, CEA, Gif-Sur-Yvette, France
| | - C Poupon
- BAOBAB, NeuroSpin, Université Paris-Saclay, CNRS, CEA, Gif-Sur-Yvette, France
| | - S Dupont
- AP-HP, Epilepsy Unit, GH Pitié-Salpêtrière-Charles Foix, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Sorbonne Université, Paris, France
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Rodrigues EM, Isolan GR, Becker LG, Dini LI, Vaz MAS, Frigeri TM. Anatomy of the optic radiations from the white matter fiber dissection perspective: A literature review applied to practical anatomical dissection. Surg Neurol Int 2022; 13:309. [PMID: 35928310 PMCID: PMC9345124 DOI: 10.25259/sni_1157_2021] [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: 11/19/2021] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Knowledge of the anatomical course of the optic radiations and its relationship to medial temporal lobe structures is of great relevance in preoperative planning for surgery involving the temporal lobe to prevent damage that may result in postsurgical visual field deficits. Methods: In this anatomical study, we reviewed the literature on this topic and applied the information to practical anatomical dissection. The three-dimensional relationship between the course of the optic radiations and structures accessed in the main microneurosurgical approaches to the medial temporal lobe was examined by applying Klingler’s white matter fiber dissection technique to five formalin-fixed human brains. The dissections were performed with an operating microscope at magnifications of ×3–×40. High-resolution images were acquired during dissection for identification of the anatomical structures, focusing on the characterization of the course of the optic radiations in relation to medial temporal lobe structures. Results: In all five dissected brains, we could expose and clearly define the relationship between the optic radiations and medial temporal lobe structures, improving our understanding of these complex structures. Conclusion: The knowledge gained by studying these relationships will help neurosurgeons to develop risk-adjusted approaches to prevent damage to the optic radiations in the medial temporal region, which may result in a disabling visual field deficit.
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Affiliation(s)
- Eduardo Mello Rodrigues
- Department of Neurosurgery, The Center For Advanced Neurology and Neurosurgery, Brazil (CEANNE),
| | - Gustavo Rassier Isolan
- Department of Neurosurgery, The Center For Advanced Neurology and Neurosurgery, Brazil (CEANNE),
| | - Lia Grub Becker
- Department of Neurosurgery, The Center For Advanced Neurology and Neurosurgery, Brazil (CEANNE),
| | - Leandro Infantini Dini
- Department of Neurosurgery, The Center For Advanced Neurology and Neurosurgery, Brazil (CEANNE),
| | | | - Thomas More Frigeri
- Department of Neurosurgery, Hospital São Lucas - PUCRS, Porto Alegre, Brazil
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Reid LB, Martínez‐Heras E, Manjón JV, Jeffree RL, Alexander H, Trinder J, Solana E, Llufriu S, Rose S, Prior M, Fripp J. Fully automated delineation of the optic radiation for surgical planning using clinically feasible sequences. Hum Brain Mapp 2021; 42:5911-5926. [PMID: 34547147 PMCID: PMC8596983 DOI: 10.1002/hbm.25658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/21/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
Quadrantanopia caused by inadvertent severing of Meyer's Loop of the optic radiation is a well-recognised complication of temporal lobectomy for conditions such as epilepsy. Dissection studies indicate that the anterior extent of Meyer's Loop varies considerably between individuals. Quantifying this for individual patients is thus an important step to improve the safety profile of temporal lobectomies. Previous attempts to delineate Meyer's Loop using diffusion MRI tractography have had difficulty estimating its full anterior extent, required manual ROI placement, and/or relied on advanced diffusion sequences that cannot be acquired routinely in most clinics. Here we present CONSULT: a pipeline that can delineate the optic radiation from raw DICOM data in a completely automated way via a combination of robust pre-processing, segmentation, and alignment stages, plus simple improvements that bolster the efficiency and reliability of standard tractography. We tested CONSULT on 696 scans of predominantly healthy participants (539 unique brains), including both advanced acquisitions and simpler acquisitions that could be acquired in clinically acceptable timeframes. Delineations completed without error in 99.4% of the scans. The distance between Meyer's Loop and the temporal pole closely matched both averages and ranges reported in dissection studies for all tested sequences. Median scan-rescan error of this distance was 1 mm. When tested on two participants with considerable pathology, delineations were successful and realistic. Through this, we demonstrate not only how to identify Meyer's Loop with clinically feasible sequences, but also that this can be achieved without fundamental changes to tractography algorithms or complex post-processing methods.
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Affiliation(s)
- Lee B. Reid
- The Australian e‐Health Research CentreCSIROBrisbaneQueenslandAustralia
| | - Eloy Martínez‐Heras
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaInstitut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de BarcelonaBarcelonaSpain
| | - Jose V. Manjón
- Instituto de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de ValènciaValenciaSpain
| | - Rosalind L. Jeffree
- Royal Brisbane and Women's HospitalMetro NorthQueenslandAustralia
- School of Clinical MedicineUniversity of QueenslandHerstonQueenslandAustralia
| | - Hamish Alexander
- Royal Brisbane and Women's HospitalMetro NorthQueenslandAustralia
| | - Julie Trinder
- The Australian e‐Health Research CentreCSIROBrisbaneQueenslandAustralia
| | - Elisabeth Solana
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaInstitut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de BarcelonaBarcelonaSpain
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic BarcelonaInstitut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS) and Universitat de BarcelonaBarcelonaSpain
| | - Stephen Rose
- The Australian e‐Health Research CentreCSIROBrisbaneQueenslandAustralia
| | - Marita Prior
- Royal Brisbane and Women's HospitalMetro NorthQueenslandAustralia
| | - Jurgen Fripp
- The Australian e‐Health Research CentreCSIROBrisbaneQueenslandAustralia
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Atar M, Kızmazoglu C, Kaya I, Cıngoz ID, Uzunoglu I, Kalemcı O, Eroglu A, Pusat S, Atabey C, Yuceer N. The importance of preoperative planning to perform safely temporal lobe surgery. J Clin Neurosci 2021; 93:61-69. [PMID: 34656263 DOI: 10.1016/j.jocn.2021.09.007] [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: 05/11/2021] [Revised: 08/11/2021] [Accepted: 09/04/2021] [Indexed: 02/07/2023]
Abstract
Neurosurgeons should know the anatomy required for safe temporal lobe surgery approaches. The present study aimed to determine the angles and distances necessary to reach the temporal stem and temporal horn in surgical approaches for safe temporal lobe surgery by using a 3.0 T magnetic resonance imaging technique in post-mortem human brain hemispheres fixed by the Klingler method. In our study, 10 post-mortem human brain hemisphere specimens were fixed according to the Klingler method. Magnetic resonance images were obtained using a 3.0 T magnetic resonance imaging scanner after fixation. Surgical measurements were conducted for the temporal stem and temporal horn by magnetic resonance imaging, and dissection was then performed under a surgical microscope for the temporal stem. Each stage of dissection was achieved in high-quality three-dimensional images. The angles and distances to reach the temporal stem and temporal horn were measured in transcortical T1, trans-sulcal T1-2, transcortical T2, trans-sulcal T2-3, transcortical T3, and subtemporal trans-collateral sulcus approaches. The safe maximum posterior entry point for anterior temporal lobectomy was measured as 47.16 ± 5.00 mm. Major white-matter fibers in this region and their relations with each other are shown. The distances to the temporal stem and temporal horn, which are important in temporal lobe surgical interventions, were measured radiologically, and safe borders were determined. Surgical strategy and preoperative planning should consider the relationship of the lesion and white-matter pathways.
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Affiliation(s)
- Murat Atar
- Sultan Abdulhamid Han Training and Research Hospital, Department of Neurosurgery , Istanbul, Turkey.
| | - Ceren Kızmazoglu
- Dokuz Eylul University School of Medicine, Department of Neurosurgery, Izmir, Turkey
| | - Ismail Kaya
- Usak University School of Medicine, Department of Neurosurgery, Usak, Turkey
| | - Ilker Deniz Cıngoz
- Usak University School of Medicine, Department of Neurosurgery, Usak, Turkey
| | - Inan Uzunoglu
- Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Neurosurgery, Izmir, Turkey
| | - Orhan Kalemcı
- Dokuz Eylul University School of Medicine, Department of Neurosurgery, Izmir, Turkey
| | - Ahmet Eroglu
- Sultan Abdulhamid Han Training and Research Hospital, Department of Neurosurgery , Istanbul, Turkey
| | - Serhat Pusat
- Sultan Abdulhamid Han Training and Research Hospital, Department of Neurosurgery , Istanbul, Turkey
| | - Cem Atabey
- Sultan Abdulhamid Han Training and Research Hospital, Department of Neurosurgery , Istanbul, Turkey
| | - Nurullah Yuceer
- Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Neurosurgery, Izmir, Turkey
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Wang Z, Wang H, Mwansisya TE, Sheng Y, Shan B, Liu Z, Xue Z, Chen X. The integrity of the white matter in first-episode schizophrenia patients with auditory verbal hallucinations: An atlas-based DTI analysis. Psychiatry Res Neuroimaging 2021; 315:111328. [PMID: 34260985 DOI: 10.1016/j.pscychresns.2021.111328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/31/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
Auditory verbal hallucination (AVH) is one of the most remarkable symptoms of schizophrenia, with great impact on patients' lives and unclear pathogenesis. Neuroimaging studies have indicated that the development of AVHs is associated with white matter alteration, however, there are still inconsistencies in specific findings across previous investigations. The present study aimed to investigate the characteristics of the microstructural integrity of white matter (WM) in first-episode schizophrenia patients who experience auditory hallucinations. Atlas-based Diffusion Tensor Imaging (DTI) analysis was performed to evaluate the white matter integrity in 37 first-episode schizophrenia patients with AVH, 60 schizophrenia patients without AVH, and 50 healthy controls. Compared with the healthy controls group, AVH showed decreased mean fractional anisotropy (FA) in the genu and body of corpus callosum, right posterior corona radiata, left superior corona radiata, left external capsule, right superior fronto-occipital fasciculus, and higher mean diffusivity (MD) in genu of corpus callosum and left fornix and stria terminalis; whereas the nAVH group showed a much more significant reduction of FA and increased MD in broader brain regions. In addition, a significant positive correlation between FA and the severity of AVHs was observed in right posterior corona radiate. These observations collectively demonstrated that a certain degree of preserved fronto-temporal and interhemispheric connectivity in the early stage of schizophrenia might be associated with the brain capability to generate AVHs.
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Affiliation(s)
- Zhiyu Wang
- School of Public Health, Central South University, Changsha, China; Department of Communicable Disease Prevention and Management, Centers for Disease Control and Prevention(CDC) of Changsha City, Changsha, China
| | - Hui Wang
- Department of Geriatrics, The First Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
| | | | - Yaoyao Sheng
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Baoci Shan
- Key Laboratory of Nuclear Analysis, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Zhening Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; Hunan Key Laboratory of Psychiatry and Mental Health, National Technology Institute of Psychiatry, Changsha, China; Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhimin Xue
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; Hunan Key Laboratory of Psychiatry and Mental Health, National Technology Institute of Psychiatry, Changsha, China; Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xudong Chen
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; Hunan Key Laboratory of Psychiatry and Mental Health, National Technology Institute of Psychiatry, Changsha, China; Institute of Mental Health, Second Xiangya Hospital, Central South University, Changsha, China.
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6
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Li M, Ribas EC, Zhang Z, Wu X, Wang X, Liu X, Liang J, Chen G, Li M. Tractography of the ansa lenticularis in the human brain. Clin Anat 2021; 35:269-279. [PMID: 34535922 DOI: 10.1002/ca.23788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 12/31/2022]
Abstract
The aim of this study was to make a thorough investigation of the trajectory of the ansa lenticularis (AL) and its subcomponents using high-resolution fiber-tracking tractography. The subcomponents of the AL were reconstructed from one region of interest (ROI) in the area of the globus pallidus combined with another ROI in the red nucleus, substantia nigra, subthalamic nucleus, or thalamus. This fiber-tracking protocol was tested in an HCP-1065 template, 35 healthy subjects from Massachusetts General Hospital (MGH), and 20 healthy subjects from the human connectome project (HCP) using generalized q-sampling imaging (GQI)-based tractography. Quantitative anisotropy and fractional anisotropy were also computed for the AL subcomponents. The subcomponents of the AL could be reconstructed in the HCP-1065 template, 35 MGH healthy subjects, and 20 HCP healthy subjects. The AL descends from the globus pallidus and joins the ansa peduncularis for a short distance, subdividing later into fibers that continue separately to the red nucleus, substantia nigra, subthalamic nucleus, and thalamus. The study demonstrated the trajectory of the ansa lenticularis and its subcomponents using GQI-based tractography, improving our understanding of the anatomical connectivity between the globus pallidus and the thalamo-subthalamic region in the human brain. One Sentence Summary The investigation of the ansa lenticularis and its subcomponents using high-resolution diffusion images based tractography.
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Affiliation(s)
- Mengjun Li
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Eduardo Carvalhal Ribas
- Division of Neurosurgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Zhiping Zhang
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Xiaolong Wu
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Xiaohai Liu
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Samii Clinical Neuroanatomy Research & Education Center, Capital Medical University Xuanwu Hospital, China International Neuroscience Institute (China-INI), Beijing, China
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Liakos F, Komaitis S, Drosos E, Neromyliotis E, Skandalakis GP, Gerogiannis AI, Kalyvas AV, Troupis T, Stranjalis G, Koutsarnakis C. The Topography of the Frontal Terminations of the Uncinate Fasciculus Revisited Through Focused Fiber Dissections: Shedding Light on a Current Controversy and Introducing the Insular Apex as a Key Anatomoclinical Area. World Neurosurg 2021; 152:e625-e634. [PMID: 34144169 DOI: 10.1016/j.wneu.2021.06.012] [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: 05/02/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent studies advocate a connectivity pattern wider than previously believed of the uncinate fasciculus that extends to the ventrolateral and dorsolateral prefrontal cortices. These new percepts on the connectivity of the tract suggest a more expansive role for the uncinate fasciculus. Our aim was to shed light on this controversy through fiber dissections. METHODS Twenty normal adult human formalin-fixed cerebral hemispheres were used. Focused dissections on the insular, orbitofrontal, ventromedial, ventrolateral, and dorsolateral prefrontal areas were performed to record the topography of the frontal terminations of the uncinate fasciculus. RESULTS Three discrete fiber layers were consistently disclosed: the first layer was recorded to terminate at the posterior orbital gyrus and pars orbitalis, the second layer at the posterior two thirds of the gyrus rectus, and the last layer at the posterior one third of the paraolfactory gyrus. The insular apex was documented as a crucial landmark regarding the topographic differentiation of the uncinate and occipitofrontal fasciculi (i.e., fibers that travel ventrally belong to the uncinate fasciculus whereas those traveling dorsally are occipitofrontal fibers). CONCLUSIONS The frontal terminations of the uncinate fasciculus were consistently documented to project to the posterior orbitofrontal area. The area of the insular apex is introduced for the first time as a crucial surface landmark to effectively distinguish the stems of the uncinate and occipitofrontal fasciculi. This finding could refine the spatial resolution of awake subcortical mapping, especially for insular lesions, and improve the accuracy of in vivo diffusion tensor imaging protocols.
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Affiliation(s)
- Faidon Liakos
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Drosos
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Neromyliotis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece
| | | | | | - Aristotelis V Kalyvas
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Troupis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece; Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece; Edinburgh Microneurosurgery Education Laboratory, Department of Clinical Neurosciences, Edinburgh, United Kingdom; Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece.
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8
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Neudorfer C, Elias GJB, Jakobs M, Boutet A, Germann J, Narang K, Loh A, Paff M, Horn A, Kucharczyk W, Deeb W, Salvato B, Almeida L, Foote KD, Rosenberg PB, Tang-Wai DF, Anderson WS, Mari Z, Ponce FA, Wolk DA, Burke AD, Salloway S, Sabbagh MN, Chakravarty MM, Smith GS, Lyketsos CG, Okun MS, Lozano AM. Mapping autonomic, mood, and cognitive effects of hypothalamic region deep brain stimulation. Brain 2021; 144:2837-2851. [PMID: 33905474 DOI: 10.1093/brain/awab170] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/12/2022] Open
Abstract
Due to its involvement in a wide variety of cardiovascular, metabolic, and behavioral functions, the hypothalamus constitutes a potential target for neuromodulation in a number of treatment-refractory conditions. The precise neural substrates and circuitry subserving these responses, however, are poorly characterized to date. We sought to retrospectively explore the acute sequalae of hypothalamic region deep brain stimulation and characterize their neuroanatomical correlates. To this end we studied at multiple international centers 58 patients (mean age: 68.5 ± 7.9 years, 26 females) suffering from mild Alzheimer's disease who underwent stimulation of the fornix region between 2007 and 2019. We catalogued the diverse spectrum of acutely induced clinical responses during electrical stimulation and interrogated their neural substrates using volume of tissue activated modelling, voxel-wise mapping, and supervised machine learning techniques. In total 627 acute clinical responses to stimulation - including tachycardia, hypertension, flushing, sweating, warmth, coldness, nausea, phosphenes, and fear - were recorded and catalogued across patients using standard descriptive methods. The most common manifestations during hypothalamic region stimulation were tachycardia (30.9%) and warmth (24.6%) followed by flushing (9.1%) and hypertension (6.9%). Voxel-wise mapping identified distinct, locally separable clusters for all sequelae that could be mapped to specific hypothalamic and extrahypothalamic gray- and white-matter structures. K-nearest neighbor classification further validated the clinico-anatomical correlates emphasizing the functional importance of identified neural substrates with area under the receiving operating characteristic curves (AUROC) between 0.67 - 0.91. Overall, we were able to localize acute effects of hypothalamic region stimulation to distinct tracts and nuclei within the hypothalamus and the wider diencephalon providing clinico-anatomical insights that may help to guide future neuromodulation work.
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Affiliation(s)
- Clemens Neudorfer
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martin Jakobs
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Keshav Narang
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michelle Paff
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Walter Kucharczyk
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Wissam Deeb
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida Health, Gainesville, FL, USA
| | | | - Leonardo Almeida
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida Health, Gainesville, FL, USA
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida Health, Gainesville, FL, USA
| | - Paul B Rosenberg
- Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - David F Tang-Wai
- Department of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna D Burke
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Stephen Salloway
- Department of Psychiatry and Human Behavior and Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Marwan N Sabbagh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Research Centre, Montreal QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gwenn S Smith
- Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida Health, Gainesville, FL, USA
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Wang P, Hameed NUF, Chong ST, Fan W, Zhu K, Li W, Lin CP, Feng R, Wu J. The basal turning point of optic radiation (bTPOR): The location of optic radiation in the cerebral basal surface. Clin Neurol Neurosurg 2021; 203:106562. [PMID: 33631507 DOI: 10.1016/j.clineuro.2021.106562] [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: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUNDS Optic radiation protection is crucial in the basal temporal approach to the mesial temporal lobe. Clear description of the optic radiation in the basal brain surface is lacking. Our aim is to describe the anatomy of optic radiation in the basal cerebral surface and define safety zone of basal temporal approach avoiding of optic radiation injury. METHODS Five brain specimens (10 hemispheres) were dissected using Klingler method to observe the course of the optic radiation. Diffusion tensor imaging data of 25 volunteers were used to verify the fiber dissection results. The relationship of the optic radiation to nearby structures were illustrated and measured. RESULTS The optic radiation bends from the lateral wall of the lateral ventricle to its bottom at a basal turning point of optic radiation (bTPOR). The bTPOR is at the plane crossing the center point of the splenium of corpus callosum. MRI measurements showed no significant difference in the distance from the center of the splenium of corpus callosum and the bTPOR to the occipital pole (59.46 ± 4.338 mm vs 59.54 ± 3.805 mm, p = 0.95). Anterior to bTPOR, no optic radiation fibers were found at the basal brain surface. CONCLUSIONS The bTPOR was found as a landmark of the optic radiation in the cerebral basal surface. With neuronavigation, the splenium of corpus callosum can be a landmark of the bTPOR. By approaching mesial temporal lesions using the basal temporal approach anterior to bTPOR, optic radiation injury can be prevented.
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Affiliation(s)
- Peng Wang
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - N U Farrukh Hameed
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shin Tai Chong
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Wenke Fan
- Department of Human Anatomy and Histoembryology, School of Basic Medical Science, Fudan University, Shanghai, China
| | - Keming Zhu
- Department of Human Anatomy and Histoembryology, School of Basic Medical Science, Fudan University, Shanghai, China
| | - Wensheng Li
- Department of Human Anatomy and Histoembryology, School of Basic Medical Science, Fudan University, Shanghai, China
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Rui Feng
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Jinsong Wu
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; Brain Function Laboratory, Department of Neurosurgery, Fudan University, Shanghai, China; Institute of Brain-Intelligence Technology, Zhangjiang Lab, Shanghai, China
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10
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Weiss A, Di Carlo DT, Di Russo P, Weiss F, Castagna M, Cosottini M, Perrini P. Microsurgical anatomy of the amygdaloid body and its connections. Brain Struct Funct 2021; 226:861-874. [PMID: 33528620 DOI: 10.1007/s00429-020-02214-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/30/2020] [Indexed: 12/14/2022]
Abstract
The amygdaloid body is a limbic nuclear complex characterized by connections with the thalamus, the brainstem and the neocortex. The recent advances in functional neurosurgery regarding the treatment of refractory epilepsy and several neuropsychiatric disorders renewed the interest in the study of its functional Neuroanatomy. In this scenario, we felt that a morphological study focused on the amygdaloid body and its connections could improve the understanding of the possible implications in functional neurosurgery. With this purpose we performed a morfological study using nine formalin-fixed human hemispheres dissected under microscopic magnification by using the fiber dissection technique originally described by Klingler. In our results the amygdaloid body presents two divergent projection systems named dorsal and ventral amygdalofugal pathways connecting the nuclear complex with the septum and the hypothalamus. Furthermore, the amygdaloid body is connected with the hippocampus through the amygdalo-hippocampal bundle, with the anterolateral temporal cortex through the amygdalo-temporalis fascicle, the anterior commissure and the temporo-pulvinar bundle of Arnold, with the insular cortex through the lateral olfactory stria, with the ambiens gyrus, the para-hippocampal gyrus and the basal forebrain through the cingulum, and with the frontal cortex through the uncinate fascicle. Finally, the amygdaloid body is connected with the brainstem through the medial forebrain bundle. Our description of the topographic anatomy of the amygdaloid body and its connections, hopefully represents a useful tool for clinicians and scientists, both in the scope of application and speculation.
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Affiliation(s)
- Alessandro Weiss
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. .,, Pisa, Italy.
| | - Davide Tiziano Di Carlo
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Paolo Di Russo
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Weiss
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Maura Castagna
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mirco Cosottini
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Paolo Perrini
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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11
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Dziedzic TA, Balasa A, Jeżewski MP, Michałowski Ł, Marchel A. White matter dissection with the Klingler technique: a literature review. Brain Struct Funct 2020; 226:13-47. [PMID: 33165658 PMCID: PMC7817571 DOI: 10.1007/s00429-020-02157-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022]
Abstract
The aim of this literature review is to present a summary of the published literature relating the details of the different modifications of specimen preparation for white matter dissection with the Klingler technique. For this review, 3 independent investigators performed an electronic literature search that was carried out in the Pubmed, Scopus and Web of Science databses up to December 2019. Furthermore, we performed citation tracking for the articles missed in the initial search. Studies were eligible for inclusion when they reported details of at least the first 2 main steps of Klingler's technique: fixation and freezing. A total of 37 full-text articles were included in the analysis. We included original anatomical studies in which human white matter dissection was performed for study purposes. The main three steps of preparation are the same in each laboratory, but the details of each vary between studies. Ten percent formalin is the most commonly used (34 studies) solution for fixation. The freezing time varied between 8 h and a month, and the temperature varied from - 5 to - 80 °C. After thawing and during dissections, the specimens were most often kept in formalin solution (13), and the concentration varied from 4 to 10%. Klingler's preparation technique involves three main steps: fixation, freezing and thawing. Even though the details of the technique are different in most of the studies, all provide subjectively good quality specimens for anatomical dissections and studies.
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Affiliation(s)
- Tomasz A Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
| | - Artur Balasa
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz P Jeżewski
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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12
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Mangalore S, Mukku SSR, Vankayalapati S, Sivakumar PT, Varghese M. Shape Profile of Corpus Callosum As a Signature to Phenotype Different Dementia. J Neurosci Rural Pract 2020; 12:185-192. [PMID: 33531781 PMCID: PMC7846348 DOI: 10.1055/s-0040-1716805] [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] [Indexed: 10/28/2022] Open
Abstract
Background Phenotyping dementia is always a complex task for a clinician. There is a need for more practical biomarkers to aid clinicians. Objective The aim of the study is to investigate the shape profile of corpus callosum (CC) in different phenotypes of dementia. Materials and Methods Our study included patients who underwent neuroimaging in our facility as a part of clinical evaluation for dementia referred from Geriatric Clinic (2017-2018). We have analyzed the shape of CC and interpreted the finding using a seven-segment division. Results The sample included MPRAGE images of Alzheimer' dementia (AD) ( n = 24), posterior cortical atrophy- Alzheimer' dementia (PCA-AD) ( n = 7), behavioral variant of frontotemporal dementia (Bv-FTD) ( n = 17), semantic variant frontotemporal dementia (Sv-FTD) ( n = 11), progressive nonfluent aphasia (PNFA) ( n = 4), Parkinson's disease dementia (PDD) ( n = 5), diffuse Lewy body dementia ( n = 7), progressive supranuclear palsy (PSP) ( n = 3), and corticobasal degeneration (CBD) ( n = 3). We found in posterior dementias such as AD and PCA-AD that there was predominant atrophy of splenium of CC. In Bv-FTD, the genu and anterior half of the body of CC was atrophied, whereas in PNFA, PSP, PDD, and CBD there was atrophy of the body of CC giving a dumbbell like profile. Conclusion Our study findings were in agreement with the anatomical cortical regions involved in different phenotypes of dementia. Our preliminary study highlighted potential usefulness of CC in the clinical setting for phenotyping dementia in addition to clinical history and robust biomarkers.
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Affiliation(s)
- Sandhya Mangalore
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shiva Shanker Reddy Mukku
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sriharish Vankayalapati
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mathew Varghese
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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13
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The ansa peduncularis in the human brain: A tractography and fiber dissection study. Brain Res 2020; 1746:146978. [PMID: 32535175 DOI: 10.1016/j.brainres.2020.146978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The ansa peduncularis is a composite of white matter fiber bundles closely packed together that sweeps around the cerebral peduncle. The exact components of the ansa peduncularis and their anatomical trajectories are still not established firmly in the literature. OBJECTIVE The aim of this study was to examine the topographical anatomy of the ansa peduncularis and its subcomponents using the fiber dissection and tractography techniques. METHODS Ten formalin-fixed brains were prepared according to Klingler's method and dissected by the fiber dissection technique from the lateral, medial and inferior surfaces. The ansa peduncularis was also traced using high definition fiber tracking (HDFT) from the MRI data of twenty healthy adults and a 1021-subject template from the Human Connectome Project. RESULTS The ventral amygdalofugal pathway system includes white matter fiber bundles with a topographically close relation as they sweep around the cerebral peduncle and contribute to form the ansa peduncularis: amygdaloseptal fibers connect the amygdala and anterior temporal cortex to the septal region and amygdalohypothalamic fibers project from the amygdala to the hypothalamus. Additionally, from the amygdala and anterior temporal cortex, amygdalothalamic fibers project to the medial thalamic region. The ansa lenticularis, which connects the globus pallidus to the thalamus, was not shown in our study. CONCLUSION The study demonstrated the trajectory of the ansa peduncularis and its subcomponents, based on fiber dissection and tractography, improving our understanding of human brain anatomical connectivity.
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14
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Nachtergaele P, Radwan A, Swinnen S, Decramer T, Uytterhoeven M, Sunaert S, van Loon J, Theys T. The temporoinsular projection system: an anatomical study. J Neurosurg 2020; 132:615-623. [DOI: 10.3171/2018.11.jns18679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 11/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEConnections between the insular cortex and the amygdaloid complex have been demonstrated using various techniques. Although functionally well connected, the precise anatomical substrate through which the amygdaloid complex and the insula are wired remains unknown. In 1960, Klingler briefly described the “fasciculus amygdaloinsularis,” a white matter tract connecting the posterior insula with the amygdala. The existence of such a fasciculus seems likely but has not been firmly established, and the reported literature does not include a thorough description and documentation of its anatomy. In this fiber dissection study the authors sought to elucidate the pathway connecting the insular cortex and the mesial temporal lobe.METHODSFourteen brain specimens obtained at routine autopsy were dissected according to Klingler’s fiber dissection technique. After fixation and freezing, anatomical dissections were performed in a stepwise progressive fashion.RESULTSThe insula is connected with the opercula of the frontal, parietal, and temporal lobes through the extreme capsule, which represents a network of short association fibers. At the limen insulae, white matter fibers from the extreme capsule converge and loop around the uncinate fasciculus toward the temporal pole and the mesial temporal lobe, including the amygdaloid complex.CONCLUSIONSThe insula and the mesial temporal lobe are directly connected through white matter fibers in the extreme capsule, resulting in the appearance of a single amygdaloinsular fasciculus. This apparent fasciculus is part of the broader network of short association fibers of the extreme capsule, which connects the entire insular cortex with the temporal pole and the amygdaloid complex. The authors propose the term “temporoinsular projection system” (TIPS) for this complex.
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Affiliation(s)
- Pieter Nachtergaele
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Ahmed Radwan
- 2Department of Imaging & Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | - Stijn Swinnen
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Thomas Decramer
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Mats Uytterhoeven
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Stefan Sunaert
- 2Department of Imaging & Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Tom Theys
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
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15
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Sufianov AA, Cossu G, Iakimov IA, Sufianov RA, Markin ES, Stefanov SZ, Zemmoura I, Messerer M, Daniel RT. Endoscopic Interhemispheric Disconnection for Intractable Multifocal Epilepsy: Surgical Technique and Functional Neuroanatomy. Oper Neurosurg (Hagerstown) 2020; 18:145-157. [PMID: 31140570 DOI: 10.1093/ons/opz121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/11/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Callosotomy represents a palliative procedure for intractable multifocal epilepsy. The extent of callosotomy and the benefits of adding anterior and posterior commissurotomy are debated. OBJECTIVE To describe a new technique of a purely endoscopic procedure to disconnect the corpus callosum, the anterior, posterior, and habenular commissures through the use of a single burr hole via a transfrontal transventricular route. METHODS Our surgical series was retrospectively reviewed in terms of seizure control (Engel's class) and complication rate. Five cadaveric specimens were used to demonstrate the surgical anatomy of commissural fibers and third ventricle. RESULTS The procedure may be divided into 3 steps: (1) endoscopic transventricular transforaminal anterior commissure disconnection; (2) disconnection of posterior and habenular commissures; and (3) total callosotomy. Fifty-seven patients were included in the analysis. A favorable outcome in terms of epilepsy control (Engel class 1 to 3) was found in 71.4% of patients undergoing callosotomy coupled with anterior, posterior, and habenular commissure disconnection against 53% of patients with isolated callosotomy (P = .26). Patients with drop attacks had better epilepsy outcome independently from the surgical procedure used. CONCLUSION The full endoscopic callosotomy coupled with disconnection of anterior, posterior and habenular commissures is a safe alternative to treat multifocal refractory epilepsy. A gain in seizure outcome might be present in this cohort of patients treated with total interhemispheric disconnection when compared with isolated callosotomy. Larger studies are required to confirm these findings.
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Affiliation(s)
- Albert A Sufianov
- Federal Centre of Neurosurgery, Ministry of Health of the Russian Federation, Tyumen, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Giulia Cossu
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Iurii A Iakimov
- Federal Centre of Neurosurgery, Ministry of Health of the Russian Federation, Tyumen, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Rinat A Sufianov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Egor S Markin
- Federal Centre of Neurosurgery, Ministry of Health of the Russian Federation, Tyumen, Russia
| | - Stefan Z Stefanov
- Federal Centre of Neurosurgery, Ministry of Health of the Russian Federation, Tyumen, Russia
| | | | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Roy T Daniel
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
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16
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Shan YZ, Wang ZM, Fan XT, Zhang HQ, Ren LK, Wei PH, Zhao GG. Automatic labeling of the fanning and curving shape of Meyer's loop for epilepsy surgery: an atlas extracted from high-definition fiber tractography. BMC Neurol 2019; 19:302. [PMID: 31779601 PMCID: PMC6882219 DOI: 10.1186/s12883-019-1537-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Visual field defects caused by injury to Meyer's loop (ML) are common in patients undergoing anterior temporal lobectomy during epilepsy surgery. Evaluation of the anatomical shapes of the curving, fanning and sharp angles of ML to guide surgeries is important but still challenging for diffusion tensor imaging. We present an advanced diffusion data-based ML atlas and labeling protocol to reproduce anatomical features in individuals within a short time. METHODS Thirty Massachusetts General Hospital-Human Connectome Project (MGH-HCP) diffusion datasets (ultra-high magnetic gradient & 512 directions) were warped to standard space. The resulting fibers were projected together to create an atlas. The anatomical features and the tractography correspondence rates were evaluated in 30 MGH-HCP individuals and local diffusion spectrum imaging data (eight healthy subjects and six hippocampal sclerosis patients). RESULTS In the atlas, features of curves, sharp angles and fanning shapes were adequately reproduced. The distances from the anterior tip of the temporal lobe to the anterior ridge of Meyer's loop were 23.1 mm and 26.41 mm on the left and right sides, respectively. The upper and lower divisions of the ML were revealed to be twisting. Eighty-eight labeled sides were achieved, and the correspondence rates were 87.44% ± 6.92, 80.81 ± 10.62 and 72.83% ± 14.03% for MGH-HCP individuals, DSI-healthy individuals and DSI-patients, respectively. CONCLUSION Atlas-labeled ML is comparable to high angular resolution tractography in healthy or hippocampal sclerosis patients. Therefore, rapid identification of the ML location with a single modality of T1 is practical. This protocol would facilitate functional studies and visual field protection during neurosurgery.
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Affiliation(s)
- Yong-Zhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China
| | - Zhen-Ming Wang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xiao-Tong Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China
| | - Hua-Qiang Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China
| | - Lian-Kun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Peng-Hu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China.
| | - Guo-Guang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xuanwu District, Beijing, 100053, China.
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17
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Yang JYM, Beare R, Wu MH, Barton SM, Malpas CB, Yeh CH, Harvey AS, Anderson V, Maixner WJ, Seal M. Optic Radiation Tractography in Pediatric Brain Surgery Applications: A Reliability and Agreement Assessment of the Tractography Method. Front Neurosci 2019; 13:1254. [PMID: 31824251 PMCID: PMC6879599 DOI: 10.3389/fnins.2019.01254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background Optic radiation (OR) tractography may help predict and reduce post-neurosurgical visual field deficits. OR tractography methods currently lack pediatric and surgical focus. Purpose We propose a clinically feasible OR tractography strategy in a pediatric neurosurgery setting and examine its intra-rater and inter-rater reliability/agreements. Methods Preoperative and intraoperative MRI data were obtained from six epilepsy and two brain tumor patients on 3 Tesla MRI scanners. Four raters with different clinical experience followed the proposed strategy to perform probabilistic OR tractography with manually drawing anatomical landmarks to reconstruct the OR pathway, based on fiber orientation distributions estimated from high angular resolution diffusion imaging data. Intra- and inter-rater reliabilities/agreements of tractography results were assessed using intraclass correlation coefficient (ICC) and dice similarity coefficient (DSC) across various tractography and OR morphological metrics, including the lateral geniculate body positions, tract volumes, and Meyer's loop position from temporal anatomical landmarks. Results Good to excellent intra- and inter-rater reproducibility was demonstrated for the majority of OR reconstructions (ICC = 0.70-0.99; DSC = 0.84-0.89). ICC was higher for non-lesional (0.82-0.99) than lesional OR (0.70-0.99). The non-lesional OR's mean volume was 22.66 cm3; the mean Meyer's loop position was 29.4 mm from the temporal pole, 5.89 mm behind of and 10.26 mm in front of the temporal ventricular horn. The greatest variations (± 1.00-3.00 mm) were observed near pathology, at the tract edges or at cortical endpoints. The OR tractography were used to assist surgical planning and guide lesion resection in all cases, no patient had new visual field deficits postoperatively. Conclusion The proposed tractography strategy generates reliable and reproducible OR tractography images that can be reliably implemented in the routine, non-emergency pediatric neurosurgical setting.
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Affiliation(s)
- Joseph Yuan-Mou Yang
- Department of Neurosurgery, The Royal Children's Hospital, Melbourne, VIC, Australia.,Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Richard Beare
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Michelle Hao Wu
- Medical Imaging, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sarah M Barton
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Neurology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Charles B Malpas
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Clinical Outcomes Research Unit, Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Chun-Hung Yeh
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - A Simon Harvey
- Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Neurology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Vicki Anderson
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Brain and Mind, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Psychology, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Wirginia J Maixner
- Department of Neurosurgery, The Royal Children's Hospital, Melbourne, VIC, Australia.,Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Marc Seal
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
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18
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Microsurgical anatomy of the sagittal stratum. Acta Neurochir (Wien) 2019; 161:2319-2327. [PMID: 31363919 DOI: 10.1007/s00701-019-04019-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The sagittal stratum (SS) is a critical neural crossroad traversed by several white matter tracts that connect multiple areas of the ipsilateral hemisphere. Scant information about the anatomical organization of this structure is available in literature. The goal of this study was to provide a detailed anatomical description of the SS and to discuss the functional implications of the findings when a surgical approach through this structure is planned. METHODS Five formalin-fixed human brains were dissected under the operating microscope by using the fiber dissection technique originally described by Ludwig and Klingler. RESULTS The SS is a polygonal crossroad of associational fibers situated deep on the lateral surface of the hemisphere, medial to the arcuate/superior longitudinal fascicle complex, and laterally to the tapetal fibers of the atrium. It is organized in three layers: a superficial layer formed by the middle and inferior longitudinal fascicles, a middle layer corresponding to the inferior fronto-occipital fascicle, and a deep layer formed by the optic radiation, intermingled with fibers of the anterior commissure. It originates posteroinferiorly to the inferior limiting sulcus of the insula, contiguous with the fibers of the temporal stem, and ends into the posterior temporo-occipito-parietal cortex. CONCLUSION The white matter fiber dissection reveals the tridimensional architecture of the SS and the relationship between its fibers. A detailed understanding of the anatomy of the SS is essential to decrease the operative risks when a surgical approach within this area is undertaken.
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19
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Cocquyt EM, Lanckmans E, van Mierlo P, Duyck W, Szmalec A, Santens P, De Letter M. The white matter architecture underlying semantic processing: A systematic review. Neuropsychologia 2019; 136:107182. [PMID: 31568774 DOI: 10.1016/j.neuropsychologia.2019.107182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 12/23/2022]
Abstract
From a holistic point of view, semantic processes are subserved by large-scale subcortico-cortical networks. The dynamic routing of information between grey matter structures depends on the integrity of subcortical white matter pathways. Nonetheless, controversy remains on which of these pathways support semantic processing. Therefore, a systematic review of the literature was performed with a focus on anatomo-functional correlations obtained from direct electrostimulation during awake tumor surgery, and conducted between diffusion tensor imaging metrics and behavioral semantic performance in healthy and aphasic individuals. The 43 included studies suggest that the left inferior fronto-occipital fasciculus contributes to the essential connectivity that allows semantic processing. However, it remains uncertain whether its contributive role is limited to the organization of semantic knowledge or extends to the level of semantic control. Moreover, the functionality of the left uncinate fasciculus, inferior longitudinal fasciculus and the posterior segment of the indirect arcuate fasciculus in semantic processing has to be confirmed by future research.
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Affiliation(s)
- E-M Cocquyt
- Department of Rehabilitation Sciences, Ghent University, Belgium; Research Group BrainComm, Ghent University, Belgium.
| | - E Lanckmans
- Department of Rehabilitation Sciences, Ghent University, Belgium; Research Group BrainComm, Ghent University, Belgium
| | - P van Mierlo
- Research Group BrainComm, Ghent University, Belgium; Department of Electronics and Information Systems, Medical Image and Signal Processing Group, Ghent University, Belgium
| | - W Duyck
- Faculty of Psychology and Educational Sciences, Department of Experimental Psychology, Ghent University, Belgium
| | - A Szmalec
- Faculty of Psychology and Educational Sciences, Department of Experimental Psychology, Ghent University, Belgium; Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - P Santens
- Research Group BrainComm, Ghent University, Belgium; Department of Neurology, Ghent University Hospital, Belgium
| | - M De Letter
- Department of Rehabilitation Sciences, Ghent University, Belgium; Research Group BrainComm, Ghent University, Belgium
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Lee JB, Affeldt BM, Gamboa Y, Hamer M, Dunn JF, Pardo AC, Obenaus A. Repeated Pediatric Concussions Evoke Long-Term Oligodendrocyte and White Matter Microstructural Dysregulation Distant from the Injury. Dev Neurosci 2018; 40:358-375. [PMID: 30466074 DOI: 10.1159/000494134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/30/2018] [Indexed: 11/19/2022] Open
Abstract
Concussion or mild traumatic brain injury (mTBI) is often accompanied by long-term behavioral and neuropsychological deficits. Emerging data suggest that these deficits can be exacerbated following repeated injuries. However, despite the overwhelming prevalence of mTBI in children due to falls and sports-related activities, the effects of mTBI on white matter (WM) structure and its development in children have not been extensively examined. Moreover, the effect of repeated mTBI (rmTBI) on developing WM has not yet been studied, despite the possibility of exacerbated outcomes with repeat injuries. To address this knowledge gap, we investigated the long-term effects of single (s)mTBI and rmTBI on the WM in the pediatric brain, focusing on the anterior commissure (AC), a WM structure distant to the injury site, using diffusion tensor imaging (DTI) and immunohistochemistry (IHC). We hypothesized that smTBI and rmTBI to the developing mouse brain would lead to abnormalities in microstructural integrity and impaired oligodendrocyte (OL) development. We used a postnatal day 14 Ascl1-CreER: ccGFP mouse closed head injury (CHI) model with a bilateral repeated injury. We demonstrate that smTBI and rmTBI differentially lead to myelin-related diffusion changes in the WM and to abnormal OL development in the AC, which are accompanied by behavioral deficits 2 months after the initial injury. Our results suggest that mTBIs elicit long-term behavioral alterations and OL-associated WM dysregulation in the developing brain. These findings warrant additional research into the development of WM and OL as key components of pediatric TBI pathology and potential therapeutic targets.
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Affiliation(s)
- Jeong Bin Lee
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Bethann M Affeldt
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Yaritxa Gamboa
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Mary Hamer
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Jeff F Dunn
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea C Pardo
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andre Obenaus
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California, USA, .,Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California, USA,
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Mandonnet E, Sarubbo S, Petit L. The Nomenclature of Human White Matter Association Pathways: Proposal for a Systematic Taxonomic Anatomical Classification. Front Neuroanat 2018; 12:94. [PMID: 30459566 PMCID: PMC6232419 DOI: 10.3389/fnana.2018.00094] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022] Open
Abstract
The heterogeneity and complexity of white matter (WM) pathways of the human brain were discretely described by pioneers such as Willis, Stenon, Malpighi, Vieussens and Vicq d'Azyr up to the beginning of the 19th century. Subsequently, novel approaches to the gross dissection of brain internal structures have led to a new understanding of WM organization, notably due to the works of Reil, Gall and Burdach highlighting the fascicular organization of WM. Meynert then proposed a definitive tripartite organization in association, commissural and projection WM pathways. The enduring anatomical work of Dejerine at the turn of the 20th century describing WM pathways in detail has been the paramount authority on this topic (including its terminology) for over a century, enriched sporadically by studies based on blunt Klingler dissection. Currently, diffusion-weighted magnetic resonance imaging (DWI) is used to reveal the WM fiber tracts of the human brain in vivo by measuring the diffusion of water molecules, especially along axons. It is then possible by tractography to reconstitute the WM pathways of the human brain step by step at an unprecedented level of precision in large cohorts. However, tractography algorithms, although powerful, still face the complexity of the organization of WM pathways, and there is a crucial need to benefit from the exact definitions of the trajectories and endings of all WM fascicles. Beyond such definitions, the emergence of DWI-based tractography has mostly revealed strong heterogeneity in naming the different bundles, especially the long-range association pathways. This review addresses the various terminologies known for the WM association bundles, aiming to describe the rules of arrangements followed by these bundles and to propose a new nomenclature based on the structural wiring diagram of the human brain.
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Affiliation(s)
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Laurent Petit
- Groupe d’Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives—UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
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Ribas EC, Yağmurlu K, de Oliveira E, Ribas GC, Rhoton A. Microsurgical anatomy of the central core of the brain. J Neurosurg 2018; 129:752-769. [DOI: 10.3171/2017.5.jns162897] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe purpose of this study was to describe in detail the cortical and subcortical anatomy of the central core of the brain, defining its limits, with particular attention to the topography and relationships of the thalamus, basal ganglia, and related white matter pathways and vessels.METHODSThe authors studied 19 cerebral hemispheres. The vascular systems of all of the specimens were injected with colored silicone, and the specimens were then frozen for at least 1 month to facilitate identification of individual fiber tracts. The dissections were performed in a stepwise manner, locating each gray matter nucleus and white matter pathway at different depths inside the central core. The course of fiber pathways was also noted in relation to the insular limiting sulci.RESULTSThe insular surface is the most superficial aspect of the central core and is divided by a central sulcus into an anterior portion, usually containing 3 short gyri, and a posterior portion, with 2 long gyri. It is bounded by the anterior limiting sulcus, the superior limiting sulcus, and the inferior limiting sulcus. The extreme capsule is directly underneath the insular surface and is composed of short association fibers that extend toward all the opercula. The claustrum lies deep to the extreme capsule, and the external capsule is found medial to it. Three fiber pathways contribute to form both the extreme and external capsules, and they lie in a sequential anteroposterior disposition: the uncinate fascicle, the inferior fronto-occipital fascicle, and claustrocortical fibers. The putamen and the globus pallidus are between the external capsule, laterally, and the internal capsule, medially. The internal capsule is present medial to almost all insular limiting sulci and most of the insular surface, but not to their most anteroinferior portions. This anteroinferior portion of the central core has a more complex anatomy and is distinguished in this paper as the “anterior perforated substance region.” The caudate nucleus and thalamus lie medial to the internal capsule, as the most medial structures of the central core. While the anterior half of the central core is related to the head of the caudate nucleus, the posterior half is related to the thalamus, and hence to each associated portion of the internal capsule between these structures and the insular surface. The central core stands on top of the brainstem. The brainstem and central core are connected by several white matter pathways and are not separated from each other by any natural division. The authors propose a subdivision of the central core into quadrants and describe each in detail. The functional importance of each structure is highlighted, and surgical approaches are suggested for each quadrant of the central core.CONCLUSIONSAs a general rule, the internal capsule and its vascularization should be seen as a parasagittal barrier with great functional importance. This is of particular importance in choosing surgical approaches within this region.
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Affiliation(s)
- Eduardo Carvalhal Ribas
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida
- 3Hospital Israelita Albert Einstein; and
| | - Kaan Yağmurlu
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Evandro de Oliveira
- 4Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida
- 5Institute of Neurological Sciences, São Paulo, São Paulo, Brazil; and
| | - Guilherme Carvalhal Ribas
- 3Hospital Israelita Albert Einstein; and
- 6Department of Surgery, University of São Paulo Medical School
| | - Albert Rhoton
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida
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Chamberland M, Tax CMW, Jones DK. Meyer's loop tractography for image-guided surgery depends on imaging protocol and hardware. Neuroimage Clin 2018; 20:458-465. [PMID: 30128284 PMCID: PMC6096050 DOI: 10.1016/j.nicl.2018.08.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 12/19/2022]
Abstract
Introduction Surgical resection is an effective treatment for temporal lobe epilepsy but can result in visual field defects. This could be minimized if surgeons knew the exact location of the anterior part of the optic radiation (OR), the Meyer's loop. To this end, there is increasing prevalence of image-guided surgery using diffusion MRI tractography. Despite considerable effort in developing analysis methods, a wide discrepancy in Meyer's loop reconstructions is observed in the literature. Moreover, the impact of differences in image acquisition on Meyer's loop tractography remains unclear. Here, while employing the same state-of-the-art analysis protocol, we explored the extent to which variance in data acquisition leads to variance in OR reconstruction. Methods Diffusion MRI data were acquired for the same thirteen healthy subjects using standard and state-of-the-art protocols on three scanners with different maximum gradient amplitudes (MGA): Siemens Connectom (MGA = 300 mT/m); Siemens Prisma (MGA = 80 mT/m) and GE Excite-HD (MGA = 40 mT/m). Meyer's loop was reconstructed on all subjects and its distance to the temporal pole (ML-TP) was compared across protocols. Results A significant effect of data acquisition on the ML-TP distance was observed between protocols (p < .01 to 0.0001). The biggest inter-acquisition discrepancy for the same subject across different protocols was 16.5 mm (mean: 9.4 mm, range: 3.7-16.5 mm). Conclusion We showed that variance in data acquisition leads to substantive variance in OR tractography. This has direct implications for neurosurgical planning, where part of the OR is at risk due to an under-estimation of its location using conventional acquisition protocols.
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Affiliation(s)
- Maxime Chamberland
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom.
| | - Chantal M W Tax
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Derek K Jones
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom; School of Psychology, Faculty of Health Sciences, Australian Catholic University, Victoria, Australia
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White matter tract anatomy in the rhesus monkey: a fiber dissection study. Brain Struct Funct 2018; 223:3681-3688. [PMID: 30022250 DOI: 10.1007/s00429-018-1718-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/12/2018] [Indexed: 01/31/2023]
Abstract
Brain connectivity in non-human primates (NHPs) has been mainly investigated using tracer techniques and functional connectivity studies. Data on structural connections are scarce and come from diffusion tensor imaging (DTI), since gross anatomical white matter dissection studies in the NHP are lacking. The current study aims to illustrate the course and topography of the major white matter tracts in the macaque using Klingler's fiber dissection. 10 hemispheres obtained from 5 primate brains (Macaca mulatta) were studied according to Klingler's fiber dissection technique. Dissection was performed in a stepwise mesial and lateral fashion exposing the course and topography of the major white matter bundles. Major white matter tracts in the NHP include the corona radiata, tracts of the sagittal stratum, the uncinate fasciculus, the cingulum and the fornix. Callosal fiber topography was homologous to the human brain with leg motor fibers running in the posterior half of the corpus callosum. The relative size of the anterior commissure was larger in the NHP. NHPs and humans share striking homologies with regard to the course and topography of the major white matter tracts.
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De Benedictis A, Nocerino E, Menna F, Remondino F, Barbareschi M, Rozzanigo U, Corsini F, Olivetti E, Marras CE, Chioffi F, Avesani P, Sarubbo S. Photogrammetry of the Human Brain: A Novel Method for Three-Dimensional Quantitative Exploration of the Structural Connectivity in Neurosurgery and Neurosciences. World Neurosurg 2018; 115:e279-e291. [PMID: 29660551 DOI: 10.1016/j.wneu.2018.04.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Anatomic awareness of the structural connectivity of the brain is mandatory for neurosurgeons, to select the most effective approaches for brain resections. Although standard microdissection is a validated technique to investigate the different white matter (WM) pathways and to verify the results of tractography, the possibility of interactive exploration of the specimens and reliable acquisition of quantitative information has not been described. Photogrammetry is a well-established technique allowing an accurate metrology on highly defined three-dimensional (3D) models. The aim of this work is to propose the application of the photogrammetric technique for supporting the 3D exploration and the quantitative analysis on the cerebral WM connectivity. METHODS The main perisylvian pathways, including the superior longitudinal fascicle and the arcuate fascicle were exposed using the Klingler technique. The photogrammetric acquisition followed each dissection step. The point clouds were registered to a reference magnetic resonance image of the specimen. All the acquisitions were coregistered into an open-source model. RESULTS We analyzed 5 steps, including the cortical surface, the short intergyral fibers, the indirect posterior and anterior superior longitudinal fascicle, and the arcuate fascicle. The coregistration between the magnetic resonance imaging mesh and the point clouds models was highly accurate. Multiple measures of distances between specific cortical landmarks and WM tracts were collected on the photogrammetric model. CONCLUSIONS Photogrammetry allows an accurate 3D reproduction of WM anatomy and the acquisition of unlimited quantitative data directly on the real specimen during the postdissection analysis. These results open many new promising neuroscientific and educational perspectives and also optimize the quality of neurosurgical treatments.
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Affiliation(s)
- Alessandro De Benedictis
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.
| | - Erica Nocerino
- Theoretical Physics ETH Zürich, Zurich, Switzerland; LSIS Laboratory-Laboratoire des Sciences de l'Information et des Systèmes, I&M Team, Images & Models AMU, Aix-Marseille Université POLYTECH, Marseille, France
| | - Fabio Menna
- 3D Optical Metrology (3DOM) Unit, Bruno Kessler Foundation (FBK), Trento, Italy
| | - Fabio Remondino
- 3D Optical Metrology (3DOM) Unit, Bruno Kessler Foundation (FBK), Trento, Italy
| | | | - Umberto Rozzanigo
- Department of Radiology, Neuroradiology Unit, "S. Chiara" Hospital, Trento APSS, Italy
| | - Francesco Corsini
- Division of Neurosurgery, Structural and Functional Connectivity (SFC) Lab Project, "S. Chiara" Hospital, Trento APSS, Italy
| | - Emanuele Olivetti
- Neuroinformatics Laboratory (NILab), Bruno Kessler Foundation, Trento, Italy; Center for Mind/Brain Science (CIMeC), University of Trento, Mattarello (TN), Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Franco Chioffi
- Division of Neurosurgery, Structural and Functional Connectivity (SFC) Lab Project, "S. Chiara" Hospital, Trento APSS, Italy
| | - Paolo Avesani
- Neuroinformatics Laboratory (NILab), Bruno Kessler Foundation, Trento, Italy; Center for Mind/Brain Science (CIMeC), University of Trento, Mattarello (TN), Italy
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity (SFC) Lab Project, "S. Chiara" Hospital, Trento APSS, Italy
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Gonçalves-Ferreira A, Rainha-Campos A, Franco A, Pimentel J, Bentes C, Peralta AR, Morgado C. Amygdalohippocampotomy for mesial temporal lobe sclerosis: Epilepsy outcome 5 years after surgery. Acta Neurochir (Wien) 2017; 159:2443-2448. [PMID: 28849383 DOI: 10.1007/s00701-017-3305-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of the present study is the evaluation of the long-term clinical outcome of epilepsy in patients with mesial temporal lobe sclerosis (MTLS) submitted to amygdalohippocampotomy (AHCo). AHCo consists of the lateral ablation of the amygdala and the peri-hippocampal disconnection instead of amygdalohippocampectomy (AHC), which involves the removal of both structures. We previously reported the short-term results of AHCo, so we here present the long-term results (> 5 years of follow-up) of the patients operated on with AHCo. METHOD Since 2007, 35 patients (22 females) aged 20-61 years (mean: 42 years) were operated on with the AHCo technique, 17 patients on the left side and 18 on the right. Of these patients, 21 (14 females) have been followed up > 5 years (5 to 7.5 years, mean 6.5 years). We compare the present results with those observed shortly after surgery and with the patients operated on with AHC. FINDINGS In all 21 cases, the diagnosis was mesial temporal lobe sclerosis (histology confirmed in 20), 11 on the left side and 10 on the right. Epilepsy results after 5 years were good/very good in 18 patients (85.7%), with Engel class IA-B in 15 (71.4%) and II in 3 (14.3%), and bad in 3 patients, with Engel Class III in 2 (9.5%) and class IV in 1 (4.8%). Concerning morbidity, one patient had hemiparesis (hypertensive capsular hemorrhage 24 h after surgery), two verbal memory worsening, two quadrantanopia and three late depression that was reversed with medication. Comparatively, the AHC long-term results were 87% Engel class I, 8% Engel class II and 5% Engel class III-IV. The morbidity was equally small. CONCLUSIONS The good/very good results of AHCo 5 years after surgery are 86%, which is not distinct from the AHC results. So AHCo seems to be effective and potentially safer than AHC in long-term follow-up.
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Affiliation(s)
- Antonio Gonçalves-Ferreira
- Department of Neurosurgery, Refractory Epilepsy Reference Center, Department of Neurosciences, University Hospital Santa Maria (CHLN-EPE), Lisbon, Portugal.
| | - Alexandre Rainha-Campos
- Department of Neurosurgery, Refractory Epilepsy Reference Center, Department of Neurosciences, University Hospital Santa Maria (CHLN-EPE), Lisbon, Portugal
| | - Ana Franco
- Department of Neurology, EEG Laboratory, Refractory Epilepsy Reference Center, Department of Neurosciences, University Hospital Santa Maria (CHLN-EPE), Lisbon, Portugal
| | - Jose Pimentel
- Department of Neurology, Neuropathology Laboratory, Refractory Epilepsy Reference Center, Department of Neurosciences, University Hospital Santa Maria (CHLN-EPE), Lisbon, Portugal
| | - Carla Bentes
- Department of Neurology, EEG Laboratory, Refractory Epilepsy Reference Center, Department of Neurosciences, University Hospital Santa Maria (CHLN-EPE), Lisbon, Portugal
| | - Ana-Rita Peralta
- Department of Neurology, EEG Laboratory, Refractory Epilepsy Reference Center, Department of Neurosciences, University Hospital Santa Maria (CHLN-EPE), Lisbon, Portugal
| | - Carlos Morgado
- Department of Neurological Imaging, Refractory Epilepsy Reference Center, Department of Neurosciences, University Hospital Santa Maria (CHLN-EPE), Lisbon, Portugal
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Chamberland M, Scherrer B, Prabhu SP, Madsen J, Fortin D, Whittingstall K, Descoteaux M, Warfield SK. Active delineation of Meyer's loop using oriented priors through MAGNEtic tractography (MAGNET). Hum Brain Mapp 2017; 38:509-527. [PMID: 27647682 PMCID: PMC5333642 DOI: 10.1002/hbm.23399] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 08/04/2016] [Accepted: 08/31/2016] [Indexed: 12/19/2022] Open
Abstract
Streamline tractography algorithms infer connectivity from diffusion MRI (dMRI) by following diffusion directions which are similarly aligned between neighboring voxels. However, not all white matter (WM) fascicles are organized in this manner. For example, Meyer's loop is a highly curved portion of the optic radiation (OR) that exhibits a narrow turn, kissing and crossing pathways, and changes in fascicle dispersion. From a neurosurgical perspective, damage to Meyer's loop carries a potential risk of inducing vision deficits to the patient, especially during temporal lobe resection surgery. To prevent such impairment, achieving an accurate delineation of Meyer's loop with tractography is thus of utmost importance. However, current algorithms tend to under-estimate the full extent of Meyer's loop, mainly attributed to the aforementioned rule for connectivity which requires a direction to be chosen across a field of orientations. In this article, it was demonstrated that MAGNEtic Tractography (MAGNET) can benefit Meyer's loop delineation by incorporating anatomical knowledge of the expected fiber orientation to overcome local ambiguities. A new ROI-mechanism was proposed which supplies additional information to streamline reconstruction algorithms by the means of oriented priors. Their results showed that MAGNET can accurately generate Meyer's loop in all of our 15 child subjects (8 males; mean age 10.2 years ± 3.1). It effectively improved streamline coverage when compared with deterministic tractography, and significantly reduced the distance between the anterior-most portion of Meyer's loop and the temporal pole by 16.7 mm on average, a crucial landmark used for preoperative planning of temporal lobe surgery. Hum Brain Mapp 38:509-527, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Maxime Chamberland
- Centre de Recherche CHUSUniversity of SherbrookeSherbrookeCanada
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Faculty of ScienceUniversity of SherbrookeSherbrookeCanada
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health ScienceUniversity of SherbrookeSherbrookeCanada
| | - Benoit Scherrer
- Department of RadiologyBoston Children's Hospital and Harvard Medical School300 Longwood AvenueBostonMassachusettsUSA
| | - Sanjay P. Prabhu
- Department of RadiologyBoston Children's Hospital and Harvard Medical School300 Longwood AvenueBostonMassachusettsUSA
| | - Joseph Madsen
- Department of RadiologyBoston Children's Hospital and Harvard Medical School300 Longwood AvenueBostonMassachusettsUSA
| | - David Fortin
- Centre de Recherche CHUSUniversity of SherbrookeSherbrookeCanada
- Division of Neurosurgery and Neuro‐Oncology, Faculty of Medicine and Health ScienceUniversity of SherbrookeSherbrookeCanada
| | - Kevin Whittingstall
- Centre de Recherche CHUSUniversity of SherbrookeSherbrookeCanada
- Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health ScienceUniversity of SherbrookeSherbrookeCanada
- Department of Diagnostic Radiology, Faculty of Medicine and Health ScienceUniversity of SherbrookeSherbrookeCanada
| | - Maxime Descoteaux
- Centre de Recherche CHUSUniversity of SherbrookeSherbrookeCanada
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Faculty of ScienceUniversity of SherbrookeSherbrookeCanada
| | - Simon K. Warfield
- Department of RadiologyBoston Children's Hospital and Harvard Medical School300 Longwood AvenueBostonMassachusettsUSA
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Kadri PAS, de Oliveira JG, Krayenbühl N, Türe U, de Oliveira EPL, Al-Mefty O, Ribas GC. Surgical Approaches to the Temporal Horn: An Anatomic Analysis of White Matter Tract Interruption. Oper Neurosurg (Hagerstown) 2016; 13:258-270. [DOI: 10.1093/ons/opw011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/20/2016] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Surgical access to the temporal horn is necessary to treat tumors and vascular lesions, but is used mainly in patients with mediobasal temporal epilepsy. The surgical approaches to this cavity fall into 3 primary categories: lateral, inferior, and transsylvian. The current neurosurgical literature has underestimated the interruption of involved fiber bundles and the correlated clinical manifestations.
OBJECTIVE: To delineate the interruption of fiber bundles during the different approaches to the temporal horn.
METHODS: We simulated the lateral (trans-middle temporal gyrus), inferior (transparahippocampal gyrus), and transsylvian approaches in 20 previously frozen, formalin-fixed human brains (40 hemispheres). Fiber dissection was then done along the lateral and inferior aspects under the operating microscope. Each stage of dissection and its respective fiber tract interruption were defined.
RESULTS: The lateral (trans-middle temporal gyrus) approach interrupted “U” fibers, the superior longitudinal fasciculus (inferior arm), occipitofrontal fasciculus (ventral segment), uncinate fasciculus (dorsolateral segment), anterior commissure (posterior segment), temporopontine, inferior thalamic peduncle (posterior fibers), posterior thalamic peduncle (anterior portion), and tapetum fibers. The inferior (transparahippocampal gyrus) approach interrupted “U” fibers, the cingulum (inferior arm), and fimbria, and transected the hippocampal formation. The transsylvian approach interrupted “U” fibers (anterobasal region of the extreme capsule), the uncinate fasciculus (ventromedial segment), and anterior commissure (anterior segment), and transected the anterosuperior aspect of the amygdala.
CONCLUSION: White matter dissection improves our knowledge of the complex anatomy surrounding the temporal horn. Identifying the fiber bundles at risk during each surgical approach adds important information for choosing the appropriate surgical strategy.
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Affiliation(s)
- Paulo A. S. Kadri
- Division of Neurosurgery, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande-MS, Brazil
- Clinical Anatomy Discipline, Department of Surgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Jean G. de Oliveira
- Division of Cerebrovas-cular and Skull Base Surgery, Center of Neurology and Neurosurgery Associates (CENNA), Hospital Beneficência Por-tuguesa de São Paulo-SP, Brazil
| | | | - Uğur Türe
- Department of Neurosurgery, Yeditepe University, Istanbul, Turkey
| | - Evandro P. L. de Oliveira
- Institute of Neuro-logical Sciences (ICNE), São Paulo-SP, Brazil
- Adjunct Professor of Neurosurgery, Mayo Clinic College of Medicine, Jacksonville, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guilherme C. Ribas
- Clinical Anatomy Discipline, Department of Surgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
- Neurosurgeon Albert Einstein Hospital, São Paulo - SP, Brazil
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Neuroanatomy: The added value of the Klingler method. Ann Anat 2016; 208:187-193. [DOI: 10.1016/j.aanat.2016.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/10/2016] [Accepted: 06/01/2016] [Indexed: 11/24/2022]
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30
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Callosotopy: leg motor connections illustrated by fiber dissection. Brain Struct Funct 2015; 222:661-667. [PMID: 26666531 DOI: 10.1007/s00429-015-1167-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/30/2015] [Indexed: 12/31/2022]
Abstract
Precise anatomical knowledge of the structure of the corpus callosum is important in split-brain research and during neurosurgical procedures sectioning the callosum. According to the classic literature, commissural fibers connecting the motor cortex are situated in the anterior part of the corpus callosum. On the other hand, more recent imaging studies using diffusion tensor imaging indicate a more posterior topography of callosal fibers connecting motor areas. Topographical knowledge is especially critical when performing disconnective callosotomies in epilepsy patients who experience sudden loss of leg motor control, so-called epileptic drop attacks. In the current study, we aim to precisely delineate the topography of the leg motor connections of the corpus callosum. Of 20 hemispheres obtained at autopsy, 16 were dissected according to Klingler's fiber dissection technique to study the course and topography of callosal fibers connecting the most medial part of the precentral gyrus. Fibers originating from the anterior bank of the central sulcus were invariably found to be located in the isthmus of the corpus callosum, and no leg motor fibers were found in the anterior part of the callosum. The current results suggest that the disconnection of the pre-splenial fibers, located in the posterior one-third of the corpus callosum, is paramount in obtaining a good outcome after callosotomy.
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31
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Diffusion MRI properties of the human uncinate fasciculus correlate with the ability to learn visual associations. Cortex 2015; 72:65-78. [DOI: 10.1016/j.cortex.2015.01.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/25/2014] [Accepted: 01/29/2015] [Indexed: 01/14/2023]
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Koutsarnakis C, Liakos F, Liouta E, Themistoklis K, Sakas D, Stranjalis G. The cerebral isthmus: fiber tract anatomy, functional significance, and surgical considerations. J Neurosurg 2015; 124:450-62. [PMID: 26361277 DOI: 10.3171/2015.3.jns142680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The cerebral isthmus is the white matter area located between the periinsular sulcus and the lateral ventricle. Studies demonstrating the fiber tract and topographic anatomy of this entity are lacking in current neurosurgical literature. Hence, the authors' primary aim was to describe the microsurgical white matter anatomy of the cerebral isthmus by using the fiber dissection technique, and they discuss its functional significance. In addition, they sought to investigate its possible surgical utility in approaching lesions located in or adjacent to the lateral ventricle. METHODS This study was divided into 2 parts and included 30 formalin-fixed cerebral hemispheres, 5 of which were injected with colored silicone. In the first part, 15 uncolored specimens underwent the Klinger's procedure and were dissected in a lateromedial direction at the level of the superior, inferior, and anterior isthmuses, and 10 were used for coronal and axial cuts. In the second part, the injected specimens were used to investigate the surgical significance of the superior isthmus in accessing the frontal horn of the lateral ventricle. RESULTS The microsurgical anatomy of the anterior, superior, and inferior cerebral isthmuses was carefully studied and recorded both in terms of topographic and fiber tract anatomy. In addition, the potential role of the proximal part of the superior isthmus as an alternative safe surgical corridor to the anterior part of the lateral ventricle was investigated. CONCLUSIONS Using the fiber dissection technique along with coronal and axial cuts in cadaveric brain specimens remains a cornerstone in the acquisition of thorough anatomical knowledge of narrow white matter areas such as the cerebral isthmus. The surgical significance of the superior isthmus in approaching the frontal horn of the lateral ventricle is stressed, but further studies must be carried out to elucidate its role in ventricular surgery.
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Affiliation(s)
- Christos Koutsarnakis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital;,Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece
| | - Faidon Liakos
- Department of Neurosurgery, University of Athens, Evangelismos Hospital;,Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece
| | - Evangelia Liouta
- Hellenic Center for Neurosurgical Research "Petros Kokkalis;" and
| | - Konstantinos Themistoklis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital;,Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece
| | - Damianos Sakas
- Department of Neurosurgery, University of Athens, Evangelismos Hospital;,Hellenic Center for Neurosurgical Research "Petros Kokkalis;" and
| | - George Stranjalis
- Department of Neurosurgery, University of Athens, Evangelismos Hospital;,Hellenic Center for Neurosurgical Research "Petros Kokkalis;" and.,Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece
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Koutsarnakis C, Liakos F, Kalyvas AV, Sakas DE, Stranjalis G. A Laboratory Manual for Stepwise Cerebral White Matter Fiber Dissection. World Neurosurg 2015; 84:483-93. [DOI: 10.1016/j.wneu.2015.04.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/06/2015] [Accepted: 04/08/2015] [Indexed: 11/29/2022]
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Goga C, Türe U. The anatomy of Meyer's loop revisited: changing the anatomical paradigm of the temporal loop based on evidence from fiber microdissection. J Neurosurg 2015; 122:1253-62. [DOI: 10.3171/2014.12.jns14281] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The goal in this study was to explore and further refine comprehension of the anatomical features of the temporal loop, known as Meyer's loop.
METHODS
The lateral and inferior aspects of 20 previously frozen, formalin-fixed human brains were dissected under the operating microscope by using fiber microdissection.
RESULTS
A loop of the fibers in the anterior temporal region was clearly demonstrated in all dissections. This temporal loop, or Meyer's loop, is commonly known as the anterior portion of the optic radiation. Fiber microdissection in this study, however, revealed that various projection fibers that emerge from the sublentiform portion of the internal capsule (IC-SL), which are the temporopontine fibers, occipitopontine fibers, and the posterior thalamic peduncle (which includes the optic radiation), participate in this temporal loop and become a part of the sagittal stratum. No individual optic radiation fibers could be differentiated in the temporal loop. The dissections also disclosed that the anterior extension and angulation of the temporal loop vary significantly.
CONCLUSIONS
The fiber microdissection technique provides clear evidence that a loop in the anterior temporal region exists, but that this temporal loop is not formed exclusively by the optic radiation. Various projection fibers of the IC-SL, of which the optic radiation is only one of the several components, display this common course. The inherent limitations of the fiber dissection technique preclude accurate differentiation among individual fibers of the temporal loop, such as the optic radiation fibers.
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Affiliation(s)
- Cristina Goga
- 1Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; and
- 2Department of Anatomy, University of Medicine and Pharmacy Targu Mures, Romania
| | - Uğur Türe
- 1Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; and
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Lilja Y, Ljungberg M, Starck G, Malmgren K, Rydenhag B, Nilsson DT. Tractography of Meyer's loop for temporal lobe resection—validation by prediction of postoperative visual field outcome. Acta Neurochir (Wien) 2015; 157:947-56; discussion 956. [PMID: 25845549 DOI: 10.1007/s00701-015-2403-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Postoperative visual field defects are common after temporal lobe resection because of injury to the most anterior part of the optic radiation, Meyer's loop. Diffusion tensor tractography is a promising technique for visualizing the optic radiation preoperatively. The aim of this study was to assess the anatomical accuracy of Meyer's loop, visualized by the two most common tractography methods—deterministic (DTG) and probabilistic tractography (PTG)—in patients who had undergone temporal lobe resection. METHODS Eight patients with temporal lobe resection for temporal lobe pathology were included. Perimetry and diffusion tensor imaging were performed pre- and postoperatively. Two independent operators analyzed the distance between the temporal pole and Meyer's loop (TP-ML) using DTG and PTG. Results were compared to each other, to data from previously published dissection studies and to postoperative perimetry results. For the latter, Spearman's rank correlation coefficient (r(s)) was used. RESULTS Median preoperative TP-ML distances for nonoperated sides were 42 and 35 mm, as determined by DTG and PTG, respectively. TP-ML assessed with PTG was a closer match to dissection studies. Intraclass correlation coefficients were 0.4 for DTG and 0.7 for PTG. Difference between preoperative TP-ML (by DTG and PTG, respectively) and resection length could predict the degree of postoperative visual field defects (DTG: r(s) = -0.86, p < 0.05; PTG: r(s) = -0.76, p < 0.05). CONCLUSION Both DTG and PTG could predict the degree of visual field defects. However, PTG was superior to DTG in terms of reproducibility and anatomical accuracy. PTG is thus a strong candidate for presurgical planning of temporal lobe resection that aims to minimize injury to Meyer's loop.
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How Klingler's dissection permits exploration of brain structural connectivity? An electron microscopy study of human white matter. Brain Struct Funct 2015; 221:2477-86. [PMID: 25905864 DOI: 10.1007/s00429-015-1050-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/20/2015] [Indexed: 12/21/2022]
Abstract
The objective of this study is to explore histological and ultrastructural changes induced by Klingler's method. Five human brains were prepared. First, the effects of freezing-defrosting on white matter were explored with optical microscopy on corpus callosum samples of two brains; one prepared in accordance with the description of Klingler (1956) and the other without freezing-defrosting. Then, the combined effect of formalin fixation and freezing-defrosting was explored with transmission electron microscopy (EM) on samples of cingulum from one brain: samples from one hemisphere were fixed in paraformaldehyde-glutaraldehyde (para/gluta), other samples from the other hemisphere were fixed in formalin; once fixed, half of the samples were frozen-defrosted. Finally, the effect of dissection was explored from three formalin-fixed brains: one hemisphere of each brain was frozen-defrosted; samples of the corpus callosum were dissected before preparation for scanning EM. Optical microscopy showed enlarged extracellular space on frozen samples. Transmission EM showed no significant alteration of white matter ultrastructure after formalin or para/gluta fixation. Freezing-defrosting created extra-axonal lacunas, larger on formalin-fixed than on para/gluta-fixed samples. In all cases, myelin sheaths were preserved, allowing maintenance of axonal integrity. Scanning EM showed the destruction of most of the extra-axonal structures after freezing-defrosting and the preservation of most of the axons after dissection. Our results are the first to highlight the effects of Klingler's preparation and dissection on white matter ultrastructure. Preservation of myelinated axons is a strong argument to support the reliability of Klingler's dissection to explore the structure of human white matter.
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Lilja Y, Nilsson DT. Strengths and limitations of tractography methods to identify the optic radiation for epilepsy surgery. Quant Imaging Med Surg 2015; 5:288-99. [PMID: 25853086 DOI: 10.3978/j.issn.2223-4292.2015.01.08] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/22/2015] [Indexed: 11/14/2022]
Abstract
Diffusion tensor imaging (DTI) tractography (TG) can visualize Meyer's loop (ML), providing important information for the epilepsy surgery team, both for preoperative counseling and to reduce the frequency of visual field defects after temporal lobe resection (TLR). This review highlights significant steps in the TG process, specifically the processing of raw data including choice of TG algorithm and the interpretation and validation of results. A lack of standardization of TG of the optic radiation makes study comparisons challenging. We discuss results showing differences between studies and uncertainties large enough to be of clinical relevance and present implications of this technique for temporal lobe epilepsy surgery. Recent studies in temporal lobe epilepsy patients, employing TG intraoperatively, show promising results in reduction of visual field defects, with maintained seizure reduction.
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Affiliation(s)
- Ylva Lilja
- 1 Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; 2 Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel T Nilsson
- 1 Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; 2 Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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38
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Lv X, Chen X, Xu B, Zhang J, Zheng G, Li J, Li F, Sun G. Magnetic resonance diffusion tensor imaging-based evaluation of optic-radiation shape and position in meningioma. Neural Regen Res 2015; 7:686-91. [PMID: 25745464 PMCID: PMC4347009 DOI: 10.3969/j.issn.1673-5374.2012.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 01/03/2012] [Indexed: 11/30/2022] Open
Abstract
Employing magnetic resonance diffusion tensor imaging, three-dimensional white-matter imaging and conventional magnetic resonance imaging can demonstrate the tumor parenchyma, peritumoral edema and compression on surrounding brain tissue. A color-coded tensor map and three-dimensional tracer diagram were applied to clearly display the optic-radiation location, course and damage. Results showed that the altered anisotropy values of meningioma patients corresponded with optic-radiation shape, size and position on both sides. Experimental findings indicate that the magnetic resonance diffusion tensor imaging technique is a means of tracing and clearly visualizing the optic radiation.
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Affiliation(s)
- Xueming Lv
- Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing 100853, China
| | - Xiaolei Chen
- Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing 100853, China
| | - Bainan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing 100853, China
| | - Jiashu Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing 100853, China
| | - Gang Zheng
- Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing 100853, China
| | - Jinjiang Li
- Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing 100853, China
| | - Fangye Li
- Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing 100853, China
| | - Guochen Sun
- Department of Neurosurgery, Chinese PLA General Hospital, Chinese PLA Postgraduate Medical School, Beijing 100853, China
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39
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Walterfang M, Luders E, Looi JCL, Rajagopalan P, Velakoulis D, Thompson PM, Lindberg O, Ostberg P, Nordin LE, Svensson L, Wahlund LO. Shape analysis of the corpus callosum in Alzheimer's disease and frontotemporal lobar degeneration subtypes. J Alzheimers Dis 2015; 40:897-906. [PMID: 24531157 DOI: 10.3233/jad-131853] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Morphology of the corpus callosum is a useful biomarker of neuronal loss, as different patterns of cortical atrophy help to distinguish between dementias such as Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD). We used a sophisticated morphometric analysis of the corpus callosum in FTLD subtypes including frontotemporal dementia (FTD), semantic dementia (SD), and progressive non-fluent aphasia (PNFA), and compared them to AD patients and 27 matched controls. FTLD patient subgroups diverged in their callosal morphology profiles, with FTD patients showing marked widespread differences, PNFA patients with differences largely in the anterior half of the callosum, and SD patients differences in a small segment of the genu. AD patients showed differences in predominantly posterior callosal regions. This study is consistent with our previous findings showing significant cortical and subcortical regional atrophy across FTLD subtypes, and suggests that callosal atrophy patterns differentiate AD from FTLD, and FTLD subtypes.
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Affiliation(s)
- Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital and Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Eileen Luders
- Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, Los Angeles, CA, USA
| | - Jeffrey C L Looi
- Research Centre for Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, Australia Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Priya Rajagopalan
- Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, Los Angeles, CA, USA
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital and Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Paul M Thompson
- Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, Los Angeles, CA, USA Department of Neurology, Psychiatry, Radiology, Pediatrics, Engineering & Ophthalmology, University of Southern California, Los Angeles, CA, USA USC Imaging Genetics Center, Marina del Rey, CA, USA
| | - Olof Lindberg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Per Ostberg
- Division of Speech-Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and Department of Speech-Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Love E Nordin
- Hospital Physics, Karolinska University Hospital, Hospital Physics and Radiology, Huddinge, Stockholm, Sweden
| | - Leif Svensson
- Hospital Physics, Karolinska University Hospital, Hospital Physics and Radiology, Huddinge, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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40
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Akakin A, Yılmaz B, Akakin D, Dagbasi N, Kilic T. Three dimensional anatomical microdissection of rat brain using fiber dissection technique. J ANAT SOC INDIA 2014. [DOI: 10.1016/j.jasi.2014.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Bucheli C, Mato D, Marco de Lucas E, García-Porrero JA, Vázquez-Barquero A, Martino J. Fascículos asociativos ínsulo-operculares: revisión de su anatomía y de las implicaciones para el abordaje transopercular a la ínsula. Neurocirugia (Astur) 2014; 25:268-74. [DOI: 10.1016/j.neucir.2014.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 12/27/2022]
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Caverzasi E, Papinutto N, Amirbekian B, Berger MS, Henry RG. Q-ball of inferior fronto-occipital fasciculus and beyond. PLoS One 2014; 9:e100274. [PMID: 24945305 PMCID: PMC4063757 DOI: 10.1371/journal.pone.0100274] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/24/2014] [Indexed: 11/19/2022] Open
Abstract
The inferior fronto-occipital fasciculus (IFOF) is historically described as the longest associative bundle in the human brain and it connects various parts of the occipital cortex, temporo-basal area and the superior parietal lobule to the frontal lobe through the external/extreme capsule complex. The exact functional role and the detailed anatomical definition of the IFOF are still under debate within the scientific community. In this study we present a fiber tracking dissection of the right and left IFOF by using a q-ball residual-bootstrap reconstruction of High-Angular Resolution Diffusion Imaging (HARDI) data sets in 20 healthy subjects. By defining a single seed region of interest on the coronal fractional anisotropy (FA) color map of each subject, we investigated all the pathways connecting the parietal, occipital and posterior temporal cortices to the frontal lobe through the external/extreme capsule. In line with recent post-mortem dissection studies we found more extended anterior-posterior association connections than the “classical” fronto-occipital representation of the IFOF. In particular the pathways we evidenced showed: a) diffuse projections in the frontal lobe, b) fronto-parietal lobes connections trough the external capsule in almost all the subjects and c) widespread connections in the posterior regions. Our study represents the first consistent in vivo demonstration across a large group of individuals of these novel anterior and posterior terminations of the IFOF detailed described only by post-mortem anatomical dissection. Furthermore our work establishes the feasibility of consistent in vivo mapping of this architecture with independent in vivo methodologies. In conclusion q-ball tractography dissection supports a more complex definition of IFOF, which includes several subcomponents likely underlying specific function.
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Affiliation(s)
- Eduardo Caverzasi
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Nico Papinutto
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Bagrat Amirbekian
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Joint Graduate Group in Bioengineering, University of California San Francisco and University of California Berkeley, San Francisco/Berkeley, California, United States of America
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States of America
| | - Roland G. Henry
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Joint Graduate Group in Bioengineering, University of California San Francisco and University of California Berkeley, San Francisco/Berkeley, California, United States of America
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Alvarez I, Schwarzkopf DS, Clark CA. Extrastriate projections in human optic radiation revealed by fMRI-informed tractography. Brain Struct Funct 2014; 220:2519-32. [PMID: 24903826 PMCID: PMC4549382 DOI: 10.1007/s00429-014-0799-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
Abstract
The human optic radiation (OR) is the main pathway for conveying visual input to occipital cortex, but it is unclear whether it projects beyond primary visual cortex (V1). In this study, we used functional MRI mapping to delineate early visual areas in 30 healthy volunteers and determined the termination area of the OR as reconstructed with diffusion tractography. Direct thalamo-cortical projections to areas V2 and V3 were found in all hemispheres tested, with a distinct anatomical arrangement of superior–inferior fiber placement for dorsal and ventral projections, respectively, and a medio-lateral nesting arrangement for projections to V1, V2 and V3. Finally, segment-specific microstructure was examined, revealing sub-fascicular information. This is to date the first in vivo demonstration of direct extrastriate projections of the OR in humans.
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Affiliation(s)
- Ivan Alvarez
- Institute of Child Health, University College London, London, WC1N 1EH, UK,
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Visualizing Meyer's loop: A comparison of deterministic and probabilistic tractography. Epilepsy Res 2014; 108:481-90. [PMID: 24559840 DOI: 10.1016/j.eplepsyres.2014.01.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/29/2013] [Accepted: 01/14/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Diffusion tensor tractography of the anterior extent of the optic radiation - Meyer's loop - prior to temporal lobe resection (TLR) may reduce the risk for postoperative visual field defect. Currently there is no standardized way to perform tractography. OBJECTIVE To visualize Meyer's loop using deterministic (DTG) and probabilistic tractography (PTG) at different probability levels, with the primary aim to explore possible differences between methods, and the secondary aim to explore anatomical accuracy. METHODS Twenty-three diffusion tensor imaging exams (11 controls and 7 TLR-patients, pre- and post-surgical) were analyzed using DTG and PTG thresholded at probability levels 0.2%, 0.5%, 1%, 5% and 10%. The distance from the tip of the temporal lobe to the anterior limit of Meyer's loop (TP-ML) was measured in 46 optic radiations. Differences in TP-ML between the methods were compared. Results of the control group were compared to dissection studies and to a histological atlas. RESULTS For controls and patients together, there were statistically significant differences (p<0.01) for TP-ML between all methods thresholded at PTG ≤1% compared to all methods thresholded at PTG ≥5% and DTG. There were no statistically significant differences between PTG 0.2%, 0.5% and 1% or between PTG 5%, 10% and DTG. For the control group, PTG ≤1% showed a closer match to dissection studies and PTG 1% showed the best match to histological tracings of Meyer's loop. CONCLUSIONS Choice of tractography method affected the visualized location of Meyer's loop significantly in a heterogeneous, clinically relevant study group. For the controls, PTG at probability levels ≤1% was a closer match to dissection studies. To determine the anterior extent of Meyer's loop, PTG is superior to DTG and the probability level of PTG matters.
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45
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Martino J, De Lucas EM. Subcortical anatomy of the lateral association fascicles of the brain: A review. Clin Anat 2014; 27:563-9. [PMID: 24453050 DOI: 10.1002/ca.22321] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 08/28/2013] [Indexed: 11/09/2022]
Abstract
Precise knowledge of the connectivities of the different white matter bundles is of great value for neuroscience research. Our knowledge of subcortical anatomy has improved exponentially during recent decades owing to the development of magnetic resonance diffusion tensor imaging tractography (DTI). Although DTI tractography has led to important progress in understanding white matter anatomy, the precise trajectory and cortical connections of the subcortical bundles remain poorly determined. The recent literature was extensively reviewed in order to analyze the trajectories and cortical terminations of the lateral association fibers of the brain.The anatomy of the following tracts is reviewed: superior longitudinal fasciculus, middle longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, frontal aslant tract, and vertical occipital fasciculus. The functional role of a tract can be inferred from its topography within the brain. Knowing the functional roles of the cortical areas connected by a certain bundle, it is possible to develop new insights into the putative functional properties of such connections.
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Affiliation(s)
- Juan Martino
- Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla and Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Avda, Valdecilla s/n, Santander, Cantabria, Spain
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Kucukyuruk B, Yagmurlu K, Tanriover N, Uzan M, Rhoton AL. Microsurgical Anatomy of the White Matter Tracts in Hemispherotomy. Oper Neurosurg (Hagerstown) 2014; 10 Suppl 2:305-24; discussion 324. [DOI: 10.1227/neu.0000000000000288] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Abstract
BACKGROUND:
Hemispherotomy is a surgical procedure performed for refractory epileptic seizures due to wide hemispheric damage.
OBJECTIVE:
To describe the microanatomy of the white matter tracts transected in a hemispherotomy and the relationship of the surgical landmarks used during the intraventricular callosotomy.
METHODS:
The cortical and subcortical structures were examined in 32 hemispheres.
RESULTS:
Incision of the temporal stem along the inferior limiting sulcus crosses the insulo-opercular fibers, uncinate, inferior occipitofrontal and middle longitudinal fasciculi, anterior commissure, and optic and auditory radiations. The incision along the superior limiting sulcus transects insulo-opercular fibers and the genu and posterior limb of internal capsule. The incision along the anterior limiting sulcus crosses the insulo-opercular fibers, anterior limb of the internal capsule, anterior commissure, and the anterior thalamic bundle. The disconnection of the posterior part of the corpus callosum may be incomplete if the point at which the last cortical branch of the anterior cerebral artery (ACA) turns upward and disappears from the view through the intraventricular exposure is used as the landmark for estimating the posterior extent of the callosotomy. This ACA branch turns upward before reaching the posterior edge of the splenium in 85% of hemispheres. The falx, followed to the posterior edge of the splenium, is a more reliable landmark for completing the posterior part of an intraventricular callosotomy.
CONCLUSION:
The fiber tracts disconnected in hemispherotomy were reviewed. The falx is a more reliable guide than the ACA in completing the posterior part of the intraventricular callosotomy.
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Affiliation(s)
- Baris Kucukyuruk
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Kaan Yagmurlu
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Necmettin Tanriover
- Department of Neurosurgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mustafa Uzan
- Department of Neurosurgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Albert L. Rhoton
- Department of Neurosurgery, University of Florida, Gainesville, Florida
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Arnts H, Kleinnijenhuis M, Kooloos JGM, Schepens-Franke AN, van Cappellen van Walsum AM. Combining fiber dissection, plastination, and tractography for neuroanatomical education: Revealing the cerebellar nuclei and their white matter connections. ANATOMICAL SCIENCES EDUCATION 2014; 7:47-55. [PMID: 23839938 DOI: 10.1002/ase.1385] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/23/2013] [Accepted: 06/10/2013] [Indexed: 06/02/2023]
Abstract
In recent years, there has been a growing interest in white matter anatomy of the human brain. With advances in brain imaging techniques, the significance of white matter integrity for brain function has been demonstrated in various neurological and psychiatric disorders. As the demand for interpretation of clinical and imaging data on white matter increases, the needs for white matter anatomy education are changing. Because cross-sectional images and formalin-fixed brain specimens are often insufficient in visualizing the complexity of three-dimensional (3D) white matter anatomy, obtaining a comprehensible conception of fiber tract morphology can be difficult. Fiber dissection is a technique that allows isolation of whole fiber pathways, revealing 3D structural and functional relationships of white matter in the human brain. In this study, we describe the use of fiber dissection in combination with plastination to obtain durable and easy to use 3D white matter specimens that do not require special care or conditions. The specimens can be used as a tool in teaching white matter anatomy and structural connectivity. We included four human brains and show a series of white matter specimens of both cerebrum and cerebellum focusing on the cerebellar nuclei and associated white matter tracts, as these are especially difficult to visualize in two-dimensional specimens and demonstrate preservation of detailed human anatomy. Finally, we describe how the integration of white matter specimens with radiological information of new brain imaging techniques such as diffusion tensor imaging tractography can be used in teaching modern neuroanatomy with emphasis on structural connectivity.
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Affiliation(s)
- Hisse Arnts
- Department of Anatomy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Alarcon C, de Notaris M, Palma K, Soria G, Weiss A, Kassam A, Prats-Galino A. Anatomic Study of the Central Core of the Cerebrum Correlating 7-T Magnetic Resonance Imaging and Fiber Dissection With the Aid of a Neuronavigation System. Oper Neurosurg (Hagerstown) 2013; 10 Suppl 2:294-304; discussion 304. [DOI: 10.1227/neu.0000000000000271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Different strategies have been used to study the fiber tract anatomy of the human brain in vivo and ex vivo. Nevertheless, the ideal method to study white matter anatomy has yet to be determined because it should integrate information obtained from multiple sources.
OBJECTIVE:
We developed an anatomic method in cadaveric specimens to study the central core of the cerebrum combining traditional white matter dissection with high-resolution 7-T magnetic resonance imaging (MRI) of the same specimen coregistered using a neuronavigation system.
METHODS:
Ten cerebral hemispheres were prepared using the traditional Klingler technique. Before dissection, a structural ultrahigh magnetic field 7-T MRI study was performed on each hemisphere specifically prepared with surface fiducials for neuronavigation. The dissection was then performed from the medial hemispheric surface using the classic white fiber dissection technique. During each step of the dissection, the correlation between the anatomic findings and the 7-T MRI was evaluated with the neuronavigation system.
RESULTS:
The anatomic study was divided in 2 stages: diencephalic and limbic. The diencephalic stage included epithalamic, thalamic, hypothalamic, and subthalamic components. The limbic stage consisted of extending the dissection to complete the Papez circuit. The detailed information given by the combination of both methods allowed us to identify and validate the position of fibers that may be difficult to appreciate and dissect (ie, the medial forebrain bundle).
CONCLUSION:
The correlation of high-definition 7-T MRI and the white matter dissection technique with neuronavigation significantly improves the understanding of the structural connections in complex areas of the human cerebrum.
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Affiliation(s)
- Carlos Alarcon
- Laboratory of Surgical Neuroanatomy (LSNA), Universitat de Barcelona, Barcelona, Spain
- Department of Neurosurgery, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Matteo de Notaris
- Laboratory of Surgical Neuroanatomy (LSNA), Universitat de Barcelona, Barcelona, Spain
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Kenneth Palma
- Experimental MRI 7T Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Guadalupe Soria
- Laboratory of Surgical Neuroanatomy (LSNA), Universitat de Barcelona, Barcelona, Spain
- Department of Neurosurgery, University of Pisa, Pisa, Italy
| | - Alessandro Weiss
- Department of Neurosurgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Amin Kassam
- Laboratory of Surgical Neuroanatomy (LSNA), Universitat de Barcelona, Barcelona, Spain
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Dayan M, Munoz M, Jentschke S, Chadwick MJ, Cooper JM, Riney K, Vargha-Khadem F, Clark CA. Optic radiation structure and anatomy in the normally developing brain determined using diffusion MRI and tractography. Brain Struct Funct 2013; 220:291-306. [PMID: 24170375 PMCID: PMC4286633 DOI: 10.1007/s00429-013-0655-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/26/2013] [Indexed: 11/28/2022]
Abstract
The optic radiation (OR) is a component of the visual system known to be myelin mature very early in life. Diffusion tensor imaging (DTI) and its unique ability to reconstruct the OR in vivo were used to study structural maturation through analysis of DTI metrics in a cohort of 90 children aged 5–18 years. As the OR is at risk of damage during epilepsy surgery, we measured its position relative to characteristic anatomical landmarks. Anatomical distances, DTI metrics and volume of the OR were investigated for age, gender and hemisphere effects. We observed changes in DTI metrics with age comparable to known trajectories in other white matter tracts. Left lateralization of DTI metrics was observed that showed a gender effect in lateralization. Sexual dimorphism of DTI metrics in the right hemisphere was also found. With respect to OR dimensions, volume was shown to be right lateralised and sexual dimorphism demonstrated for the extent of the left OR. The anatomical results presented for the OR have potentially important applications for neurosurgical planning.
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Affiliation(s)
- Michael Dayan
- Imaging and Biophysics Unit, UCL Institute of Child Health, London, UK,
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50
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Duffau H. Diffusion tensor imaging is a research and educational tool, but not yet a clinical tool. World Neurosurg 2013; 82:e43-5. [PMID: 24017954 DOI: 10.1016/j.wneu.2013.08.054] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/30/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center; and the National Institute for Health and Medical Research (INSERM), U1051 Laboratory, Team "Brain Plasticity, Stem Cells and Glial Tumors," Institute for Neurosciences of Montpellier, Montpellier University Medical Center, Montpellier, France.
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