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Maldonado IL, Descoteaux M, Rheault F, Zemmoura I, Benn A, Margulies D, Boré A, Duffau H, Mandonnet E. Multimodal study of multilevel pulvino-temporal connections: a new piece in the puzzle of lexical retrieval networks. Brain 2024; 147:2245-2257. [PMID: 38243610 PMCID: PMC11146422 DOI: 10.1093/brain/awae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/18/2023] [Accepted: 12/30/2023] [Indexed: 01/21/2024] Open
Abstract
Advanced methods of imaging and mapping the healthy and lesioned brain have allowed for the identification of the cortical nodes and white matter tracts supporting the dual neurofunctional organization of language networks in a dorsal phonological and a ventral semantic stream. Much less understood are the anatomical correlates of the interaction between the two streams; one hypothesis being that of a subcortically mediated interaction, through crossed cortico-striato-thalamo-cortical and cortico-thalamo-cortical loops. In this regard, the pulvinar is the thalamic subdivision that has most regularly appeared as implicated in the processing of lexical retrieval. However, descriptions of its connections with temporal (language) areas remain scarce. Here we assess this pulvino-temporal connectivity using a combination of state-of-the-art techniques: white matter stimulation in awake surgery and postoperative diffusion MRI (n = 4), virtual dissection from the Human Connectome Project 3 and 7 T datasets (n = 172) and operative microscope-assisted post-mortem fibre dissection (n = 12). We demonstrate the presence of four fundamental fibre contingents: (i) the anterior component (Arnold's bundle proper) initially described by Arnold in the 19th century and destined to the anterior temporal lobe; (ii) the optic radiations-like component, which leaves the pulvinar accompanying the optical radiations and reaches the posterior basal temporal cortices; (iii) the lateral component, which crosses the temporal stem orthogonally and reaches the middle temporal gyrus; and (iv) the auditory radiations-like component, which leaves the pulvinar accompanying the auditory radiations to the superomedial aspect of the temporal operculum, just posteriorly to Heschl's gyrus. Each of those components might correspond to a different level of information processing involved in the lexical retrieval process of picture naming.
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Affiliation(s)
- Igor Lima Maldonado
- UMR 1253, iBrain, Université de Tours, Inserm, 37000 Tours, France
- Department of Neurosurgery, CHRU de Tours, 37000 Tours, France
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Laboratory, Department of Computer Science, Faculty of Sciences, Université de Sherbrooke, J1K 2X9 Sherbrooke, Quebec, Canada
- Imeka Solutions, J1H 4A7 Sherbrooke, Quebec, Canada
| | | | - Ilyess Zemmoura
- UMR 1253, iBrain, Université de Tours, Inserm, 37000 Tours, France
- Department of Neurosurgery, CHRU de Tours, 37000 Tours, France
| | - Austin Benn
- CNRS, Integrative Neuroscience and Cognition Center (UMR 8002), Université de Paris Cité, 75006 Paris, France
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, OX1 3QD Oxford, UK
| | - Daniel Margulies
- CNRS, Integrative Neuroscience and Cognition Center (UMR 8002), Université de Paris Cité, 75006 Paris, France
| | - Arnaud Boré
- Sherbrooke Connectivity Imaging Laboratory, Department of Computer Science, Faculty of Sciences, Université de Sherbrooke, J1K 2X9 Sherbrooke, Quebec, Canada
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34090 Montpellier, France
- Team ‘Plasticity of Central Nervous System, Stem Cells and Glial Tumors’, U1191 Laboratory, Institute of Functional Genomics, National Institute for Health and Medical Research (INSERM), University of Montpellier, 34000, Montpellier, France
| | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, 75010 Paris, France
- Frontlab, CNRS UMR 7225, INSERM U1127, Paris Brain Institute (ICM), 75013 Paris, France
- UFR Médecine, Université de Paris Cité, 75006 Paris, France
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Gulsuna B, Güngör A, Börcek AO, Türe U. Revealing the confusion of the evolution of the term sagittal stratum. Historical overview and systematic literature review. Cortex 2024; 171:40-59. [PMID: 37979231 DOI: 10.1016/j.cortex.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/14/2023] [Accepted: 10/26/2023] [Indexed: 11/20/2023]
Abstract
The fiber dissection technique is one of the earliest methods used to demonstrate the internal structures of the brain, but until the development of fiber tractography, most neuroanatomy studies were related to the cerebral cortex and less attention was given to the white matter. During the historical evolution of white matter dissection, debates have arisen about tissue preservation methods, dissection methodology, nomenclature, and efforts to adopt findings from primates to the human brain. Since its first description, the sagittal stratum has been one of the white matter structures subject to controversy and has not been sufficiently considered in the literature. With recent functional studies suggesting potential functions of the sagittal stratum, the importance of attaining a precise understanding of this structure and its constituent fiber tracts is further highlighted. This study revisits the historical background of white matter dissection, unveils the early synonymous descriptions of the sagittal stratum, and provides a systematic review of the current literature. Through evaluation of the historical statements about the sagittal stratum, we provide an understanding of the divergence and explain the reasons for the ambiguity. We believe that acquiring such an understanding will lead to further investigations on this subject, which has the potential to benefit in addressing various neuropsychiatric conditions, maintaining functional connectivity, and optimizing surgical outcomes.
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Affiliation(s)
- Beste Gulsuna
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Abuzer Güngör
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey; Department of Neurosurgery, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Alp O Börcek
- Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey
| | - Uğur Türe
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey.
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Saygi T, Avyasov R, Barut O, Daglar Z, Baran O, Hasimoglu O, Altinkaya A, Tanriover N. Microsurgical anatomy of the isthmic cingulum: a new white matter crossroad and neurosurgical implications in the posteromedial interhemispheric approaches and the glioma invasion patterns. Neurosurg Rev 2023; 46:82. [PMID: 37002437 DOI: 10.1007/s10143-023-01982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023]
Abstract
The dichotomy of the cingulum bundle into the dorsal supracallosal and ventral parahippocampal parts is widely accepted; however, the retrosplenial component with its multiple alternative connections has not been revealed. The aim of this study was to delineate the microsurgical anatomy of a connectionally transition zone, the isthmic cingulum, in relation to the posteromedial interhemispheric access to the atrium and discuss the relevant patterns of glioma invasion on the basis of its fiber connections. White matter (WM) fibers were dissected layer by layer in a medial-to-lateral, lateral-to-medial, and posterior-to-anterior fashion. All related tracts and their connections were generated using deterministic tractography. The magnetic resonance imaging (MRI) tractography findings were correlated with those of fiber dissection. A medial parieto-occipital approach to reach the atrium was performed with special emphasis on the cingulate isthmus and underlying WM connections. The isthmic cingulum, introduced as a retrosplenial connectional crossroad for the first time, displayed multiple connections to the splenium and the superior thalamic radiations. Another new finding was the demonstration of lateral hemispheric extension of the isthmic cingulum fibers through the base of the posterior part of the precuneus at the base of the parieto-occipital sulcus. The laterally crossing cingulum fibers were interconnected with three distinct association tracts: the middle longitudinal (MdLF), the inferior frontooccipital fasciculi (IFOF), and the claustro-cortical fibers (CCF). In the process of entry to the atrium during posterior interhemispheric approaches, the splenial and thalamic connections, as well as the laterally crossing fibers of the isthmic cingulum, were all in jeopardy. The connectional anatomy of the retrosplenial area is much more complicated than previously known. The isthmic cingulum connections may explain the concept of interhemispheric and medial to lateral cerebral hemisphere invasion patterns in medial parieto-occipital and posteromesial temporal gliomas. The isthmic cingulum is of key importance in posteromedial interhemispheric approaches to both: the atrium and the posterior mesial temporal lobe.
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Affiliation(s)
- Tahsin Saygi
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
- Department of Neurosurgery, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Rashid Avyasov
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Ozan Barut
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
- Department of Neurosurgery, Basaksehir Cam Sakura Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Daglar
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Oguz Baran
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
| | - Ozan Hasimoglu
- Department of Neurosurgery, Basaksehir Cam Sakura Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ayca Altinkaya
- Department of Neurology, Basaksehir Cam Sakura Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Necmettin Tanriover
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey.
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Cerrahpasa Street, No: 53, Fatih, Istanbul, Turkey.
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Fava A, Gorgoglione N, De Angelis M, Esposito V, di Russo P. Key role of microsurgical dissections on cadaveric specimens in neurosurgical training: Setting up a new research anatomical laboratory and defining neuroanatomical milestones. Front Surg 2023; 10:1145881. [PMID: 36969758 PMCID: PMC10033783 DOI: 10.3389/fsurg.2023.1145881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionNeurosurgery is one of the most complex surgical disciplines where psychomotor skills and deep anatomical and neurological knowledge find their maximum expression. A long period of preparation is necessary to acquire a solid theoretical background and technical skills, improve manual dexterity and visuospatial ability, and try and refine surgical techniques. Moreover, both studying and surgical practice are necessary to deeply understand neuroanatomy, the relationships between structures, and the three-dimensional (3D) orientation that is the core of neurosurgeons' preparation. For all these reasons, a microsurgical neuroanatomy laboratory with human cadaveric specimens results in a unique and irreplaceable training tool that allows the reproduction of patients' positions, 3D anatomy, tissues' consistencies, and step-by-step surgical procedures almost identical to the real ones.MethodsWe describe our experience in setting up a new microsurgical neuroanatomy lab (IRCCS Neuromed, Pozzilli, Italy), focusing on the development of training activity programs and microsurgical milestones useful to train the next generation of surgeons. All the required materials and instruments were listed.ResultsSix competency levels were designed according to the year of residency, with training exercises and procedures defined for each competency level: (1) soft tissue dissections, bone drilling, and microsurgical suturing; (2) basic craniotomies and neurovascular anatomy; (3) white matter dissection; (4) skull base transcranial approaches; (5) endoscopic approaches; and (6) microanastomosis. A checklist with the milestones was provided.DiscussionMicrosurgical dissection of human cadaveric specimens is the optimal way to learn and train on neuroanatomy and neurosurgical procedures before performing them safely in the operating room. We provided a “neurosurgery booklet” with progressive milestones for neurosurgical residents. This step-by-step program may improve the quality of training and guarantee equal skill acquisition across countries. We believe that more efforts should be made to create new microsurgical laboratories, popularize the importance of body donation, and establish a network between universities and laboratories to introduce a compulsory operative training program.
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Affiliation(s)
- Arianna Fava
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Italy
- Department of Neuroscience, Sapienza University, Rome, Italy
- Correspondence: Arianna Fava
| | | | | | - Vincenzo Esposito
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Italy
- Department of Neuroscience, Sapienza University, Rome, Italy
| | - Paolo di Russo
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Italy
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Anterior transtemporal endoscopic selective amygdalohippocampectomy: a virtual and cadaveric feasibility study. Acta Neurochir (Wien) 2022; 164:2841-2849. [PMID: 35809147 DOI: 10.1007/s00701-022-05295-7] [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: 04/24/2022] [Accepted: 06/20/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Selective amygdalohippocampectomy (SelAH) is one of the most common surgical treatments for mesial temporal sclerosis. Microsurgical approaches are associated with the risk of cognitive and visual deficits due to damage to the cortex and white matter (WM) pathways. Our objective is to test the feasibility of an endoscopic approach through the anterior middle temporal gyrus (aMTG) to perform a SelAH. METHODS Virtual simulation with MRI scans of ten patients (20 hemispheres) was used to identify the endoscopic trajectory through the aMTG. A cadaveric study was performed on 22 specimens using a temporal craniotomy. The anterior part of the temporal horn was accessed using a tubular retractor through the aMTG after performing a 1.5 cm corticectomy at 1.5 cm posterior to the temporal pole. Then, an endoscope was introduced. SeIAH was performed in each specimen. The specimens underwent neuronavigation-assisted endoscopic SeIAH to confirm our surgical trajectory. WM dissection using Klingler's technique was performed on five specimens to assess WM integrity. RESULTS This approach allowed the identification of collateral eminence, lateral ventricular sulcus, choroid plexus, inferior choroidal point, amygdala, hippocampus, and fimbria. SelAH was successfully performed on all specimens, and CT neuronavigation confirmed the planned trajectory. WM dissection confirmed the integrity of language pathways and optic radiations. CONCLUSIONS Endoscopic SelAH through the aMTG can be successfully performed with a corticectomy of 15 mm, presenting a reduced risk of vascular injury and damage to WM pathways. This could potentially help to reduce cognitive and visual deficits associated with SelAH.
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Esen Aydin A, Aydin S, Bilgin B, Mirkhasilova M, Bayramli N, Tanriover N. Microsurgical anatomy of the auditory radiations: revealing the enigmatic acoustic pathway from a surgical viewpoint. J Neurosurg 2022; 138:1443-1456. [PMID: 36115054 DOI: 10.3171/2022.7.jns22247] [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: 01/29/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The thalamocortical projections of the auditory system have not been detailed via microanatomical fiber dissections from a surgical viewpoint. The aim of this study was to delineate the course of the auditory radiations (ARs) from the medial geniculate body to their final destination in the auditory cortex. The authors' additional purpose was to display the relevant neural structures in relation to their course en route to Heschl's gyrus. METHODS White matter fibers were dissected layer by layer in a lateral-to-medial, inferolateral-to-superomedial, and inferior-to-superior fashion. RESULTS The origin of ARs just distal to the medial geniculate body was revealed following the removal of the parahippocampal gyrus, cingulum bundle, and mesial temporal structures, in addition to the lateral geniculate body. Removing the fimbria, stria terminalis, and the tail of the caudate nucleus along the roof of the temporal horn in an inferior-to-superior direction exposed the lateral compartment of the sublenticular segment of the internal capsule as the predominant obstacle that prevents access to the ARs. The ARs were initially obscured by the inferolaterally located temporopulvinar tract of Arnold, and their initial course passed posterolateral to the temporopontine fascicle of Türck. The ARs subsequently traversed above the temporopulvinar fibers in a perpendicular manner and coursed in between the optic radiations at the sensory intersection region deep to the inferior limiting sulcus of insula. The distal part of the ARs intermingled with the fibers of the anterior commissure and inferior fronto-occipital fasciculus during its ascent toward Heschl's gyrus. The ARs finally projected to a large area over the superior temporal gyrus, extending well beyond the anteroposterior boundaries of the transverse temporal gyri. CONCLUSIONS The ARs can be appreciated as a distinct fiber bundle ascending between the fibers of the sublenticular segment of the internal capsule and traversing superiorly along the roof of the temporal horn by spanning between the optic radiations. Our novel findings suggest potential disruption of the ARs' integrity during transsylvian and transtemporal approaches along the roof of the temporal horn toward the mesial temporal lobe. The detailed 3D understanding of the ARs' relations and awareness of their course may prove helpful to secure surgical interventions to the region.
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Affiliation(s)
- Aysegul Esen Aydin
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,2Department of Neurosurgery, Arnavutkoy State Hospital, Istanbul
| | - Seckin Aydin
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,3Department of Neurosurgery, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul
| | - Berra Bilgin
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,4Department of Neurosurgery, Tokat State Hospital, Tokat
| | - Muyassar Mirkhasilova
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,5Department of Neurosurgery, İstanbul Demiroglu Bilim University, Gayrettepe Florence Nightingale Hospital, Istanbul; and
| | - Nicat Bayramli
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul
| | - Necmettin Tanriover
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,6Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ana K, Iris ŽI, Nina P, Marina R, Tomislav Ć, Snježana S, Andrea B, Milan R, Ivica K. Linking integrity of visual pathways trajectories to visual behavior deficit in very preterm infants. Infant Behav Dev 2022; 67:101697. [DOI: 10.1016/j.infbeh.2022.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 11/05/2022]
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Radwan AM, Sunaert S, Schilling K, Descoteaux M, Landman BA, Vandenbulcke M, Theys T, Dupont P, Emsell L. An atlas of white matter anatomy, its variability, and reproducibility based on constrained spherical deconvolution of diffusion MRI. Neuroimage 2022; 254:119029. [PMID: 35231632 DOI: 10.1016/j.neuroimage.2022.119029] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/19/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Virtual dissection of white matter (WM) using diffusion MRI tractography is confounded by its poor reproducibility. Despite the increased adoption of advanced reconstruction models, early region-of-interest driven protocols based on diffusion tensor imaging (DTI) remain the dominant reference for virtual dissection protocols. Here we bridge this gap by providing a comprehensive description of typical WM anatomy reconstructed using a reproducible automated subject-specific parcellation-based approach based on probabilistic constrained-spherical deconvolution (CSD) tractography. We complement this with a WM template in MNI space comprising 68 bundles, including all associated anatomical tract selection labels and associated automated workflows. Additionally, we demonstrate bundle inter- and intra-subject variability using 40 (20 test-retest) datasets from the human connectome project (HCP) and 5 sessions with varying b-values and number of b-shells from the single-subject Multiple Acquisitions for Standardization of Structural Imaging Validation and Evaluation (MASSIVE) dataset. The most reliably reconstructed bundles were the whole pyramidal tracts, primary corticospinal tracts, whole superior longitudinal fasciculi, frontal, parietal and occipital segments of the corpus callosum and middle cerebellar peduncles. More variability was found in less dense bundles, e.g., the fornix, dentato-rubro-thalamic tract (DRTT), and premotor pyramidal tract. Using the DRTT as an example, we show that this variability can be reduced by using a higher number of seeding attempts. Overall inter-session similarity was high for HCP test-retest data (median weighted-dice = 0.963, stdev = 0.201 and IQR = 0.099). Compared to the HCP-template bundles there was a high level of agreement for the HCP test-retest data (median weighted-dice = 0.747, stdev = 0.220 and IQR = 0.277) and for the MASSIVE data (median weighted-dice = 0.767, stdev = 0.255 and IQR = 0.338). In summary, this WM atlas provides an overview of the capabilities and limitations of automated subject-specific probabilistic CSD tractography for mapping white matter fasciculi in healthy adults. It will be most useful in applications requiring a reproducible parcellation-based dissection protocol, and as an educational resource for applied neuroimaging and clinical professionals.
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Affiliation(s)
- Ahmed M Radwan
- KU Leuven, Department of Imaging and pathology, Translational MRI, Leuven, Belgium; KU Leuven, Leuven Brain Institute (LBI), Department of Neurosciences, Leuven, Belgium.
| | - Stefan Sunaert
- KU Leuven, Department of Imaging and pathology, Translational MRI, Leuven, Belgium; KU Leuven, Leuven Brain Institute (LBI), Department of Neurosciences, Leuven, Belgium; UZ Leuven, Department of Radiology, Leuven, Belgium
| | - Kurt Schilling
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN, USA
| | | | - Bennett A Landman
- Vanderbilt University, Department of Electrical Engineering and Computer Engineering, Nashville, TN, USA
| | - Mathieu Vandenbulcke
- KU Leuven, Leuven Brain Institute (LBI), Department of Neurosciences, Leuven, Belgium; KU Leuven, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; KU Leuven, Department of Geriatric Psychiatry, University Psychiatric Center (UPC), Leuven, Belgium
| | - Tom Theys
- KU Leuven, Leuven Brain Institute (LBI), Department of Neurosciences, Leuven, Belgium; KU Leuven, Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, Leuven, Belgium; UZ Leuven, Department of Neurosurgery, Leuven, Belgium
| | - Patrick Dupont
- KU Leuven, Leuven Brain Institute (LBI), Department of Neurosciences, Leuven, Belgium; KU Leuven, Laboratory for Cognitive Neurology, Department of Neurosciences, Leuven, Belgium
| | - Louise Emsell
- KU Leuven, Department of Imaging and pathology, Translational MRI, Leuven, Belgium; KU Leuven, Leuven Brain Institute (LBI), Department of Neurosciences, Leuven, Belgium; KU Leuven, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; KU Leuven, Department of Geriatric Psychiatry, University Psychiatric Center (UPC), Leuven, Belgium
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The posterior interhemispheric transparieto-occipital fissure approach to the atrium of the lateral ventricle: a fiber microdissection study with case series. Neurosurg Rev 2021; 45:1663-1674. [PMID: 34822014 DOI: 10.1007/s10143-021-01693-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/21/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
The surgical approach to the atrium of the lateral ventricle remains a challenge because of its deep location and close relationship to important neurovascular structures. We present an alternative and safer approach to lesions of the atrium using a natural pathway through the parieto-occipital fissure. We demonstrate this approach through cadaveric anatomical microdissection and a case series. Five formalin-fixed brain specimens (10 hemispheres) were dissected with the Klingler technique. Transillumination was used to show the trajectory of the approach in cadaveric specimens. Clinical data from five patients who underwent this approach were reviewed. This data included intraoperative ultrasound images, operative images, pre- and postoperative magnetic resonance imaging, MR tractography, and visual field examination. The parieto-occipital fissure is a constant, uninterrupted fissure that can be easily identified in cadavers. Our anatomical dissection study revealed that the atrium of the lateral ventricle can be approached through the parieto-occipital fissure with minor damage to the short association fibers between the precuneus and cuneus, and a few fibers of the forceps major. In our series, five patients underwent total resection of their atrial lesions via the posterior interhemispheric transparieto-occipital fissure. No morbidity or mortality was observed, and the disruption of white matter was minimal, as indicated on postoperative tractography. The postoperative visual fields were normal. The posterior interhemispheric transparieto-occipital fissure approach is an alternative to remove lesions in the atrium of the lateral ventricle, causing the least damage to white matter tracts and preserving visual cortex and optic radiation.
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A Fiber Dissection Study of the Anterior Commissure: Correlations with Diffusion Spectrum Imaging Tractography and Clinical Relevance in Gliomas. Brain Topogr 2021; 35:232-240. [PMID: 34755238 DOI: 10.1007/s10548-021-00879-5] [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: 09/07/2020] [Accepted: 10/29/2021] [Indexed: 11/27/2022]
Abstract
The anterior commissure, which connects bilateral temporal lobes and olfactive areas, remains elusive in many aspects of its structure and functional role. To comparatively describe anatomical details of the anterior commissure using cadaveric fiber dissection (FD) and diffusion spectrum imaging (DSI) thus refining our knowledge of the tract and exploring its clinical relevance in glioma migration. Twelve normal postmortem hemispheres were treated with Klingler's method and subjected to FD with medial, inferior, and lateral approaches. The FD findings were correlated with DSI tractography results. To illustrate the clinical relevance, two patients with recurrent temporal high-grade glioma are described. Our FD and DSI tractography of the anterior commissure disclosed a new anatomical paradigm. The FD confirmed that the anterior limb (absent sometimes and variable) and the lateral/temporal extension include the rostral portion and caudal portion, respectively, of the anterior commissure fibers. The shape of the lateral/temporal extension predominantly resembles an 'H'. The DSI tractography findings corresponded to these FD results. According to the FD, the Virchow-Robin space is continuous with the subarachnoid space and very close to the anterior commissure. The two clinical cases presented severe disturbances of consciousness and behavior despite good local tumor control. Subsequent magnetic resonance images showed new lesions infiltrating the contralateral temporal lobes. FD combined with DSI provided anatomical details facilitating a better understanding of the anterior commissure. Glioma migration routes to the contralateral temporal lobe included the anterior commissure, Virchow-Robin space, and subarachnoid space and were clinically relevant.
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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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12
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Pruthi N, Kadri PAS, Türe U. Fiber Microdissection Technique for Demonstrating the Deep Cerebellar Nuclei and Cerebellar Peduncles. Oper Neurosurg (Hagerstown) 2021; 20:E118-E125. [PMID: 33047123 DOI: 10.1093/ons/opaa318] [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: 02/03/2020] [Accepted: 08/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The cerebellum is one of the most primitive and complex parts of the human brain. The fiber microdissection technique can be extremely useful for neurosurgeons to understand the topographical organization of the cerebellum's important contents, such as the deep cerebellar nuclei and the cerebellar peduncles, and their relationship with the brain stem. OBJECTIVE To dissect the deep cerebellar nuclei and the cerebellar peduncles using the fiber microdissection technique. METHODS Under the operating microscope, 5 previously frozen, formalin-fixed human cerebellums and brain stems were dissected from the superior surface, and 5 were dissected from the inferior surface. Each stage of the process is described. The primary dissection tools were handmade, thin, wooden spatulas with tips of various sizes, toothpicks, and a fine regulated suction. RESULTS In 15 simplified dissection steps (6 for the superior surface and 9 for the inferior surface), the deep cerebellar nuclei (dentate, interpositus, and fastigial) and the cerebellar peduncles (inferior, middle, and superior) are delineated. Their anatomical relationships with each other and other neighboring structures are demonstrated. CONCLUSION The anatomy of the deep cerebellar nuclei and the cerebellar peduncles are clearly defined and understood through the use of the fiber microdissection technique. These stepwise dissections will guide the neurosurgeon in acquiring a topographical understanding of these complex and deep structures of the cerebellum. This knowledge, along with radiological information, can help in planning the most appropriate surgical strategy for various lesions of the cerebellum.
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Affiliation(s)
- Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.,Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Paulo A S Kadri
- Division of Neurosurgery, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Uğur Türe
- Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey
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13
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Baran O, Balak N, Baydin S, Aydin I, Kayhan A, Evran S, Kemerdere R, Tanriover N. Assessing the connectional anatomy of superior and lateral surgical approaches for medial temporal lobe epilepsy. J Clin Neurosci 2020; 81:378-389. [PMID: 33222947 DOI: 10.1016/j.jocn.2020.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/15/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
The most common approaches in the treatment of epilepsy, the trans-sylvian selective amygdalohippocampectomy (SAH) and the anterior temporal lobe resection (ATLR) reach the medial temporal lobe through different surgical routes. Our aim was to delineate the white matter (WM) fiber tracts at risk in relation to trans-sylvian SAH and ATLR by defining each fascicle en route to medial temporal lobe during each approach. ATLR and trans-sylvian SAH were performedand related WM tracts en route to medial temporal region were presented in relation to the relevant approaches and surrounding neurovascular structures. The WM tracts most likely to be disrupted during trans-sylvian SAH along the roof of the temporal horn were the UF - and less commonly IFOF - at the layer of the external capsule, anterior commissure, anterior bend of optic radiations, and sublenticular internal capsule. Amygdaloid projections to the claustrum, putamen and globus pallidus, the tail of caudate and the peduncle of the lentiform nucleus were also in close proximity to the resection cavity. Fiber tracts most likely to be impaired during ATLR included the UF, ILF, IFOF, anterior commissure, optic radiations, and, less likely, the vertical ventral segment of the arcuate fascicle. Both ATLR and trans-sylvian SAH carry the risk of injury to WM pathways, which may result in unpredictable functional loss. A detailed 3-D knowledge of the related connectional anatomy will help subside neurocognitive, neuroophtalmologic, neurolinguistic complications of epilepsy surgery, providing an opportunity to tailor the surgery according to patient's unique connectional and functional anatomy.
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Affiliation(s)
- Oguz Baran
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey; Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey
| | - Naci Balak
- Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Serhat Baydin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Ondokuz Mayis University, Medical Faculty, Department of Neurosurgery, Samsun, Turkey
| | - Ilhan Aydin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Medical Park Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Ahmet Kayhan
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Haseki Research and Training Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Sevket Evran
- Haseki Research and Training Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Rahsan Kemerdere
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
| | - Necmettin Tanriover
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey.
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14
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Comparison of the keyhole trans-middle temporal gyrus approach and transsylvian approach for selective amygdalohippocampectomy: A single-center experience. J Clin Neurosci 2020; 81:390-396. [PMID: 33222948 DOI: 10.1016/j.jocn.2020.10.019] [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: 06/09/2020] [Revised: 09/19/2020] [Accepted: 10/03/2020] [Indexed: 01/19/2023]
Abstract
Several approach routes exist for selective amygdalohippocampectomy (SAH); however, previous reports regarding a comparison of these routes are limited. Here, we compared trans-middle temporal gyrus (T2) SAH and transsylvian (TS) SAH in terms of seizure outcome, visual-field defect, memory function, and operation time in our institution. This retrospective study examined the data of 16 patients with medically intractable mesial temporal lobe epilepsy. Six patients underwent trans-T2 SAH and 10 patients underwent TS SAH between July 2014 and February 2019 in Osaka City University Hospital. In trans-T2 SAH, we performed a keyhole temporal craniotomy and a small corticotomy on T2. In TS SAH, we performed a 1.5 cm corticotomy along the inferior periinsular sulcus after opening the sylvian fissure. Amygdalohippocampectomy after reaching the inferior horn of the lateral ventricle was performed in the same manner in both procedures. The seizure outcome, visual-field defect, memory function, and operation time were retrospectively compared between the procedures. Seizure-free outcomes were achieved for six patients in the trans-T2 SAH and eight patients in the TS SAH group. There were no significant differences in the seizure outcome, visual-field defect, and memory function. The operation time was significantly shorter for trans-T2 SAH than TS SAH. The postoperative scar was less conspicuous for trans-T2 SAH. Trans-T2 SAH and TS SAH were comparable in terms of the seizure outcome, visual-field defect, and memory function. The operation time and length of the skin incision were shorter for trans-T2 SAH, suggesting that it may be preferable for general epilepsy surgeons.
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15
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Kurzawski JW, Mikellidou K, Morrone MC, Pestilli F. The visual white matter connecting human area prostriata and the thalamus is retinotopically organized. Brain Struct Funct 2020; 225:1839-1853. [PMID: 32535840 PMCID: PMC7321903 DOI: 10.1007/s00429-020-02096-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
The human visual system is capable of processing visual information from fovea to the far peripheral visual field. Recent fMRI studies have shown a full and detailed retinotopic map in area prostriata, located ventro-dorsally and anterior to the calcarine sulcus along the parieto-occipital sulcus with strong preference for peripheral and wide-field stimulation. Here, we report the anatomical pattern of white matter connections between area prostriata and the thalamus encompassing the lateral geniculate nucleus (LGN). To this end, we developed and utilized an automated pipeline comprising a series of Apps that run openly on the cloud computing platform brainlife.io to analyse 139 subjects of the Human Connectome Project (HCP). We observe a continuous and extended bundle of white matter fibers from which two subcomponents can be extracted: one passing ventrally parallel to the optic radiations (OR) and another passing dorsally circumventing the lateral ventricle. Interestingly, the loop travelling dorsally connects the thalamus with the central visual field representation of prostriata located anteriorly, while the other loop travelling more ventrally connects the LGN with the more peripheral visual field representation located posteriorly. We then analyse an additional cohort of 10 HCP subjects using a manual plane extraction method outside brainlife.io to study the relationship between the two extracted white matter subcomponents and eccentricity, myelin and cortical thickness gradients within prostriata. Our results are consistent with a retinotopic segregation recently demonstrated in the OR, connecting the LGN and V1 in humans and reveal for the first time a retinotopic segregation regarding the trajectory of a fiber bundle between the thalamus and an associative visual area.
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Affiliation(s)
| | - Kyriaki Mikellidou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Maria Concetta Morrone
- IRCCS Stella Maris, Viale del Tirreno, 331, Pisa, Italy.,Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Franco Pestilli
- Department of Psychological and Brain Sciences, Program in Neuroscience and Program in Cognitive Science, Indiana University, 1101 E 10th Street, Bloomington, IN, 47401, USA.
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16
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Rushmore RJ, Bouix S, Kubicki M, Rathi Y, Yeterian EH, Makris N. How Human Is Human Connectional Neuroanatomy? Front Neuroanat 2020; 14:18. [PMID: 32351367 PMCID: PMC7176274 DOI: 10.3389/fnana.2020.00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/23/2020] [Indexed: 01/16/2023] Open
Abstract
The structure of the human brain has been studied extensively. Despite all the knowledge accrued, direct information about connections, from origin to termination, in the human brain is extremely limited. Yet there is a widespread misperception that human connectional neuroanatomy is well-established and validated. In this article, we consider what is known directly about human structural and connectional neuroanatomy. Information on neuroanatomical connections in the human brain is derived largely from studies in non-human experimental models in which the entire connectional pathway, including origins, course, and terminations, is directly visualized. Techniques to examine structural connectivity in the human brain are progressing rapidly; nevertheless, our present understanding of such connectivity is limited largely to data derived from homological comparisons, particularly with non-human primates. We take the position that an in-depth and more precise understanding of human connectional neuroanatomy will be obtained by a systematic application of this homological approach.
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Affiliation(s)
- R Jarrett Rushmore
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States.,Psychiatric Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.,Center for Morphometric Analysis, Department of Psychiatry and Neurology, A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sylvain Bouix
- Psychiatric Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Marek Kubicki
- Psychiatric Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.,Center for Morphometric Analysis, Department of Psychiatry and Neurology, A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yogesh Rathi
- Psychiatric Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.,Center for Morphometric Analysis, Department of Psychiatry and Neurology, A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Edward H Yeterian
- Psychiatric Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.,Center for Morphometric Analysis, Department of Psychiatry and Neurology, A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychology, Colby College, Waterville, ME, United States
| | - Nikos Makris
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, United States.,Psychiatric Neuroimaging Laboratory, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.,Center for Morphometric Analysis, Department of Psychiatry and Neurology, A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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17
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Park HH, Ronconi D, Hanakita S, Watanabe K, Labidi M, Bernat AL, Froelich S. Endoscopic endonasal approach to the mesial temporal lobe: anatomical study and clinical considerations for a selective amygdalohippocampectomy. Acta Neurochir (Wien) 2020; 162:881-891. [PMID: 31834499 DOI: 10.1007/s00701-019-04163-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Selective amygdalohippocampectomy (AH) is a surgical option for patients with medically intractable seizures from mesial temporal lobe pathology. The transcranial route is considered the best method to achieve this goal. However, the standard approach through the neocortex is still invasive. The risks can be minimized if the mesial temporal lobe is resected while preserving the lateral temporal lobe and the Meyer's loop. This study explores the feasibility of selective AH by endoscopic endonasal approach (EEA) in cadaveric specimens. METHODS The endoscopic anatomy of the mesial temporal lobe and the feasibility of a successful selective AH were studied in six hemispheres from three injected human cadavers. Quantitative analyses on the extent of resection and angles of exposure were performed based on CT and MRI studies of pre- and post-selective AH and measurements taken during dissections. RESULTS The EEA V1-V2 corridor provided a direct and logical line of access to the mesial temporal lobe, following its natural trajectory with no brain retraction and minimal exposure of the pterygopalatine fossa. The components of the mesial temporal lobe were resected just as selectively and easily as the transcranial route, but without compromising the structures of the lateral temporal lobe or the Meyer's loop. CONCLUSIONS The EEA V1-V2 corridor demonstrated its selective resectability and accessibility of the mesial temporal lobe in cadaveric specimens. The clinical value of this approach should be explored responsibly by a surgeon with both competent microsurgical skills and experiences in EEA.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Daniel Ronconi
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Shunya Hanakita
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Kentaro Watanabe
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Moujahed Labidi
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, 2 Rue Ambroise Pare, 75475, Paris, France.
- Paris VII-Diderot University, Paris, France.
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18
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Jennings JE, Kassam AB, Fukui MB, Monroy-Sosa A, Chakravarthi S, Kojis N, Rovin RA. The Surgical White Matter Chassis: A Practical 3-Dimensional Atlas for Planning Subcortical Surgical Trajectories. Oper Neurosurg (Hagerstown) 2019; 14:469-482. [PMID: 28961936 DOI: 10.1093/ons/opx177] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 07/13/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The imperative role of white matter preservation in improving surgical functional outcomes is now recognized. Understanding the fundamental white matter framework is essential for translating the anatomic and functional literature into practical strategies for surgical planning and neuronavigation. OBJECTIVE To present a 3-dimensional (3-D) atlas of the structural and functional scaffolding of human white matter-ie, a "Surgical White Matter Chassis (SWMC)"-that can be used as an organizational tool in designing precise and individualized trajectory-based neurosurgical corridors. METHODS Preoperative diffusion tensor imaging magnetic resonance images were obtained prior to each of our last 100 awake subcortical resections, using a clinically available 3.0 Tesla system. Tractography was generated using a semiautomated deterministic global seeding algorithm. Tract data were conceptualized as a 3-D modular chassis based on the 3 major fiber types, organized along median and paramedian planes, with special attention to limbic and neocortical association tracts and their interconnections. RESULTS We discuss practical implementation of the SWMC concept, and highlight its use in planning select illustrative cases. Emphasis has been given to developing practical understanding of the arcuate fasciculus, uncinate fasciculus, and vertical rami of the superior longitudinal fasciculus, which are often-neglected fibers in surgical planning. CONCLUSION A working knowledge of white matter anatomy, as embodied in the SWMC, is of paramount importance to the planning of parafascicular surgical trajectories, and can serve as a basis for developing reliable safe corridors, or modules, toward the goal of "zero-footprint" transsulcal access to the subcortical space.
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Affiliation(s)
- Jonathan E Jennings
- Aurora Neuroscience Innovation Insti-tute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Amin B Kassam
- Aurora Neuroscience Innovation Insti-tute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Melanie B Fukui
- Aurora Neuroscience Innovation Insti-tute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Alejandro Monroy-Sosa
- Aurora Neuroscience Innovation Insti-tute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Srikant Chakravarthi
- Aurora Neuroscience Innovation Insti-tute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Nathan Kojis
- Aurora Neuroscience Innovation Insti-tute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Richard A Rovin
- Aurora Neuroscience Innovation Insti-tute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
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19
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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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20
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Koutsarnakis C, Kalyvas AV, Komaitis S, Liakos F, Skandalakis GP, Anagnostopoulos C, Stranjalis G. Defining the relationship of the optic radiation to the roof and floor of the ventricular atrium: a focused microanatomical study. J Neurosurg 2019; 130:1728-1739. [PMID: 29726766 DOI: 10.3171/2017.10.jns171836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors investigated the specific topographic relationship of the optic radiation fibers to the roof and floor of the ventricular atrium because the current literature is ambiguous. METHODS Thirty-five normal, adult, formalin-fixed cerebral hemispheres and 30 focused MRI slices at the level of the atrium were included in the study. The correlative anatomy of the optic radiation with regard to the atrial roof and floor was investigated in 15 specimens, each through focused fiber microdissections. The remaining 5 hemispheres were explored with particular emphasis on the trajectory of the collateral sulcus in relation to the floor of the atrium. In addition, the trajectory of the collateral sulcus was evaluated in 30 MRI scans. RESULTS The atrial roof was observed to be devoid of optic radiations in all studied hemispheres, whereas the atrial floor was seen to harbor optic fibers on its lateral part. Moreover, the trajectory of the intraparietal sulcus, when followed, was always seen to correspond to the roof of the atrium, thus avoiding the optic pathway, whereas that of the collateral sulcus was found to lead to either the lateral atrial floor or outside the ventricle in 88% of the cases, therefore hitting the visual pathway. CONCLUSIONS Operative corridors accessing the ventricular atrium should be carefully tailored through detailed preoperative planning and effective use of intraoperative navigation to increase patient safety and enhance the surgeon's maneuverability. The authors strongly emphasize the significance of accurate anatomical knowledge.
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Affiliation(s)
- Christos Koutsarnakis
- 1Athens Microneurosurgery Laboratory, Evangelismos Hospital
- 2Department of Neurosurgery, Evangelismos Hospital, and
| | - Aristotelis V Kalyvas
- 1Athens Microneurosurgery Laboratory, Evangelismos Hospital
- 2Department of Neurosurgery, Evangelismos Hospital, and
| | - Spyridon Komaitis
- 1Athens Microneurosurgery Laboratory, Evangelismos Hospital
- 2Department of Neurosurgery, Evangelismos Hospital, and
| | - Faidon Liakos
- 1Athens Microneurosurgery Laboratory, Evangelismos Hospital
| | - Georgios P Skandalakis
- 1Athens Microneurosurgery Laboratory, Evangelismos Hospital
- 3Department of Anatomy
- 5Hellenic Center for Neurosurgical Research "Petros Kokkalis," Athens, Greece
| | | | - George Stranjalis
- 1Athens Microneurosurgery Laboratory, Evangelismos Hospital
- 2Department of Neurosurgery, Evangelismos Hospital, and
- 3Department of Anatomy
- 4Medical School, National and Kapodistrian University of Athens; and
- 5Hellenic Center for Neurosurgical Research "Petros Kokkalis," Athens, Greece
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21
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You Y, Joseph C, Wang C, Gupta V, Liu S, Yiannikas C, Chua BE, Chitranshi N, Shen T, Dheer Y, Invernizzi A, Borotkanics R, Barnett M, Graham SL, Klistorner A. Demyelination precedes axonal loss in the transneuronal spread of human neurodegenerative disease. Brain 2019; 142:426-442. [DOI: 10.1093/brain/awy338] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/20/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yuyi You
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Macquarie University, Sydney, Australia
| | - Chitra Joseph
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Macquarie University, Sydney, Australia
| | - Chenyu Wang
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia
- Sydney Neuroimaging Analysis Centre, Sydney, Australia
| | - Vivek Gupta
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Macquarie University, Sydney, Australia
| | - Sidong Liu
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Con Yiannikas
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | - Brian E Chua
- Glaucoma Unit, Sydney Eye Hospital, Sydney, Australia
| | - Nitin Chitranshi
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Macquarie University, Sydney, Australia
| | - Ting Shen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Macquarie University, Sydney, Australia
| | - Yogita Dheer
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Macquarie University, Sydney, Australia
| | - Alessandro Invernizzi
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
- Eye Clinic, Department of Biomedical and Clinical Science ‘L. Sacco’, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Robert Borotkanics
- Applied Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, USA
- Department of Biostatistics and Epidemiology, Faculty of Medicine and Environmental Sciences, Auckland University of Technology, New Zealand
| | - Michael Barnett
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia
- Sydney Neuroimaging Analysis Centre, Sydney, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Stuart L Graham
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Macquarie University, Sydney, Australia
| | - Alexander Klistorner
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Macquarie University, Sydney, Australia
- Sydney Neuroimaging Analysis Centre, Sydney, Australia
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22
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Rodríguez-Mena R, Piquer-Belloch J, Llácer-Ortega JL, Riesgo-Suárez P, Rovira-Lillo V. 3D microsurgical anatomy of the cortico-spinal tract and lemniscal pathway based on fiber microdissection and demonstration with tractography. Neurocirugia (Astur) 2018; 29:275-295. [PMID: 30153974 DOI: 10.1016/j.neucir.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/06/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To demonstrate tridimensionally the anatomy of the cortico-spinal tract and the medial lemniscus, based on fiber microdissection and diffusion tensor tractography (DTT). MATERIAL AND METHODS Ten brain hemispheres and brain-stem human specimens were dissected and studied under the operating microscope with microsurgical instruments by applying the fiber microdissection technique. Brain magnetic resonance imaging was obtained from 15 healthy subjects using diffusion-weighted images, in order to reproduce the cortico-spinal tract and the lemniscal pathway on DTT images. RESULTS The main bundles of the cortico-spinal tract and medial lemniscus were demonstrated and delineated throughout most of their trajectories, noticing their gross anatomical relation to one another and with other white matter tracts and gray matter nuclei the surround them, specially in the brain-stem; together with their corresponding representation on DTT images. CONCLUSIONS Using the fiber microdissection technique we were able to distinguish the disposition, architecture and general topography of the cortico-spinal tract and medial lemniscus. This knowledge has provided a unique and profound anatomical perspective, supporting the correct representation and interpretation of DTT images. This information should be incorporated in the clinical scenario in order to assist surgeons in the detailed and critic analysis of lesions located inside the brain-stem, and therefore, improve the surgical indications and planning, including the preoperative selection of optimal surgical strategies and possible corridors to enter the brainstem, to achieve safer and more precise microsurgical technique.
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Affiliation(s)
- Ruben Rodríguez-Mena
- Cátedra de Neurociencias - Fundación NISA, CEU Hospital Universitario de la Ribera, Alzira, Valencia, España.
| | - José Piquer-Belloch
- Cátedra de Neurociencias - Fundación NISA, CEU Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - José Luis Llácer-Ortega
- Cátedra de Neurociencias - Fundación NISA, CEU Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - Pedro Riesgo-Suárez
- Cátedra de Neurociencias - Fundación NISA, CEU Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - Vicente Rovira-Lillo
- Cátedra de Neurociencias - Fundación NISA, CEU Hospital Universitario de la Ribera, Alzira, Valencia, España
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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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24
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Rokem A, Takemura H, Bock AS, Scherf KS, Behrmann M, Wandell BA, Fine I, Bridge H, Pestilli F. The visual white matter: The application of diffusion MRI and fiber tractography to vision science. J Vis 2017; 17:4. [PMID: 28196374 PMCID: PMC5317208 DOI: 10.1167/17.2.4] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/12/2016] [Indexed: 12/19/2022] Open
Abstract
Visual neuroscience has traditionally focused much of its attention on understanding the response properties of single neurons or neuronal ensembles. The visual white matter and the long-range neuronal connections it supports are fundamental in establishing such neuronal response properties and visual function. This review article provides an introduction to measurements and methods to study the human visual white matter using diffusion MRI. These methods allow us to measure the microstructural and macrostructural properties of the white matter in living human individuals; they allow us to trace long-range connections between neurons in different parts of the visual system and to measure the biophysical properties of these connections. We also review a range of findings from recent studies on connections between different visual field maps, the effects of visual impairment on the white matter, and the properties underlying networks that process visual information supporting visual face recognition. Finally, we discuss a few promising directions for future studies. These include new methods for analysis of MRI data, open datasets that are becoming available to study brain connectivity and white matter properties, and open source software for the analysis of these data.
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Affiliation(s)
- Ariel Rokem
- The University of Washington eScience Institute, Seattle, WA, ://arokem.org
| | - Hiromasa Takemura
- Center for Information and Neural Networks (CiNet), National Institute of Information and Communications Technology, and Osaka University, Suita-shi, JapanGraduate School of Frontier Biosciences, Osaka University, Suita-shi,
| | | | | | | | | | - Ione Fine
- University of Washington, Seattle, WA,
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25
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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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Topographic Classification of the Thalamus Surfaces Related to Microneurosurgery: A White Matter Fiber Microdissection Study. World Neurosurg 2017; 97:438-452. [DOI: 10.1016/j.wneu.2016.09.101] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 12/23/2022]
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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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Güngör A, Baydin S, Middlebrooks EH, Tanriover N, Isler C, Rhoton AL. The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus. J Neurosurg 2016; 126:945-971. [PMID: 27257832 DOI: 10.3171/2016.1.jns152082] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The relationship of the white matter tracts to the lateral ventricles is important when planning surgical approaches to the ventricles and in understanding the symptoms of hydrocephalus. The authors' aim was to explore the relationship of the white matter tracts of the cerebrum to the lateral ventricles using fiber dissection technique and MR tractography and to discuss these findings in relation to approaches to ventricular lesions. METHODS Forty adult human formalin-fixed cadaveric hemispheres (20 brains) and 3 whole heads were examined using fiber dissection technique. The dissections were performed from lateral to medial, medial to lateral, superior to inferior, and inferior to superior. MR tractography showing the lateral ventricles aided in the understanding of the 3D relationships of the white matter tracts with the lateral ventricles. RESULTS The relationship between the lateral ventricles and the superior longitudinal I, II, and III, arcuate, vertical occipital, middle longitudinal, inferior longitudinal, inferior frontooccipital, uncinate, sledge runner, and lingular amygdaloidal fasciculi; and the anterior commissure fibers, optic radiations, internal capsule, corona radiata, thalamic radiations, cingulum, corpus callosum, fornix, caudate nucleus, thalamus, stria terminalis, and stria medullaris thalami were defined anatomically and radiologically. These fibers and structures have a consistent relationship to the lateral ventricles. CONCLUSIONS Knowledge of the relationship of the white matter tracts of the cerebrum to the lateral ventricles should aid in planning more accurate surgery for lesions within the lateral ventricles.
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Affiliation(s)
| | | | - Erik H Middlebrooks
- Radiology, and the.,K. Scott and E. R. Andrew Advanced Neuroimaging Lab, College of Medicine, University of Florida, Gainesville, Florida; and
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Martínez-Heras E, Varriano F, Prčkovska V, Laredo C, Andorrà M, Martínez-Lapiscina EH, Calvo A, Lampert E, Villoslada P, Saiz A, Prats-Galino A, Llufriu S. Improved Framework for Tractography Reconstruction of the Optic Radiation. PLoS One 2015; 10:e0137064. [PMID: 26376179 PMCID: PMC4573981 DOI: 10.1371/journal.pone.0137064] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/12/2015] [Indexed: 01/21/2023] Open
Abstract
The optic radiation (OR) is one of the major components of the visual system and a key structure at risk in white matter diseases such as multiple sclerosis (MS). However, it is challenging to perform track reconstruction of the OR using diffusion MRI due to a sharp change of direction in the Meyer's loop and the presence of kissing and crossing fibers along the pathway. As such, we aimed to provide a highly precise and reproducible framework for tracking the OR from thalamic and visual cortex masks. The framework combined the generation of probabilistic streamlines by high order fiber orientation distributions estimated with constrained spherical deconvolution and an automatic post-processing based on anatomical exclusion criteria (AEC) to compensate for the presence of anatomically implausible streamlines. Specifically, those ending in the contralateral hemisphere, cerebrospinal fluid or grey matter outside the visual cortex were automatically excluded. We applied the framework to two distinct high angular resolution diffusion-weighted imaging (HARDI) acquisition protocols on one cohort, comprised of ten healthy volunteers and five MS patients. The OR was successfully delineated in both HARDI acquisitions in the healthy volunteers and MS patients. Quantitative evaluation of the OR position was done by comparing the results with histological reference data. Compared with histological mask, the OR reconstruction into a template (OR-TCT) was highly precise (percentage of voxels within the OR-TCT correctly defined as OR), ranging from 0.71 to 0.83. The sensitivity (percentage of voxels in histological reference mask correctly defined as OR in OR-TCT) ranged from 0.65 to 0.81 and the accuracy (measured by F1 score) was 0.73 to 0.77 in healthy volunteers. When AEC was not applied the precision and accuracy decreased. The absolute agreement between both HARDI datasets measured by the intraclass correlation coefficient was 0.73. This improved framework allowed us to reconstruct the OR with high reliability and accuracy independently of the acquisition parameters. Moreover, the reconstruction was possible even in the presence of tissue damage due to MS. This framework could also be applied to other tracts with complex configuration.
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Affiliation(s)
- Eloy Martínez-Heras
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Federico Varriano
- Laboratory of Surgical NeuroAnatomy (LSNA). Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
| | - Vesna Prčkovska
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlos Laredo
- Comprehensive Stroke Center, Department of Neuroscience. Hospital Clinic and Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Magí Andorrà
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena H. Martínez-Lapiscina
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Calvo
- Medical Imaging Platform, Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Erika Lampert
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Villoslada
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Albert Saiz
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical NeuroAnatomy (LSNA). Facultat de Medicina. Universitat de Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d′Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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30
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Shah A, Jhawar SS, Goel A. Letter to the Editor: Optic radiations and anterior commissure. J Neurosurg 2015; 123:824-6. [DOI: 10.3171/2015.3.jns15539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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