Surgical Approaches to the Temporal Horn: An Anatomic Analysis of White Matter Tract Interruption

2016 ◽  
Vol 13 (2) ◽  
pp. 258-270 ◽  
Author(s):  
Paulo A. S. Kadri ◽  
Jean G. de Oliveira ◽  
Niklaus Krayenbühl ◽  
Uğur Türe ◽  
Evandro P. L. de Oliveira ◽  
...  
Keyword(s):  
White Matter ◽  
Anterior Commissure ◽  
Anterior Segment ◽  
Clinical Manifestations ◽  
Fiber Bundles ◽  
Surgical Approaches ◽  
Middle Temporal Gyrus ◽  
Uncinate Fasciculus ◽  
Middle Temporal ◽  
Temporal Horn

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.

Diffusion tensor tractography of the temporal stem on the inferior limiting sulcus

2008 ◽  
Vol 108 (4) ◽  
pp. 775-781 ◽  
Author(s):  
Feng Wang ◽  
Tao Sun ◽  
Xing-Gang Li ◽  
Na-Jia Liu
Keyword(s):  
White Matter ◽  
Diffusion Tensor ◽  
Anterior Commissure ◽  
Region Of Interest ◽  
Diffusion Tensor Tractography ◽  
Optic Radiation ◽  
Uncinate Fasciculus ◽  
White Matter Tracts ◽  
Temporal Horn ◽  
Temporal Stem

Object The aim of this study was to use diffusion tensor tractography (DTT) to define the 3D relationships of the uncinate fasciculus, anterior commissure, inferior occipitofrontal fasciculus, inferior thalamic peduncle, and optic radiation and to determine the positioning landmarks of these white matter tracts. Methods The anatomy was studied in 10 adult human brain specimens. Brain DTT was performed in 10 healthy volunteers. Diffusion tensor tractography images of the white matter tracts in the temporal stem were obtained using the simple single region of interest (ROI) and multi-ROIs based on the anatomical knowledge. Results The posteroinferior insular point is the anterior extremity of intersection of the Heschl gyrus and the inferior limiting sulcus. On the inferior limiting sulcus, this point is the posterior limit of the optic radiation, and the temporal stem begins at the limen insulae and ends at the posteroinferior insular point. The distance from the limen insulae to the tip of the temporal horn is just one third the length of the temporal stem. The uncinate fasciculus comprises the core of the anterior temporal stem, behind which the anterior commissure and the inferior thalamic peduncle are located, and they occupy the anterior third of the temporal stem. The inferior occipitofrontal fasciculus passes through the entire temporal stem. The most anterior extent of the Meyer loop is located between the anterior tip of the temporal horn and the limen insulae. Most of the optic radiation crosses the postmedian two thirds of the temporal stem. Conclusions On the inferior limiting sulcus, the posteroinferior insular point is a reliable landmark of the posterior limit of the optic radiations. The limen insulae, anterior tip of the temporal horn, and posteroinferior insular point may be used to localize the white matter fibers of the temporal stem in analyzing magnetic resonance imaging or during surgery.

Microsurgical and Tractographic Anatomical Study of Transtemporal-Transchoroidal Fissure Approaches to the Ambient Cistern

2020 ◽  
Author(s):  
Emrah Egemen ◽  
Pinar Celtikci ◽  
Yücel Dogruel ◽  
Fatih Yakar ◽  
Defne Sahinoglu ◽  
...  
Keyword(s):  
White Matter ◽  
Anterior Commissure ◽  
Temporal Cortex ◽  
Anatomical Study ◽  
Middle Temporal Gyrus ◽  
Detailed Knowledge ◽  
Fiber Tractography ◽  
Human Connectome Project ◽  
Fiber Dissection ◽  
Ambient Cistern

Abstract BACKGROUND Approaching ambient cistern lesions is still a challenge because of deep location and related white matter tracts (WMTs) and neural structures. OBJECTIVE To investigate the white matter anatomy in the course of 3 types of transtemporal-transchoroidal fissure approaches (TTcFA) to ambient cistern by using fiber dissection technique with translumination and magnetic resonance imaging fiber tractography. METHODS Eight formalin-fixed cerebral hemispheres were dissected on surgical corridor from the temporal cortex to the ambient cistern by using Klingler's method. The trans-middle temporal gyrus, trans-inferior temporal sulcus (TITS), and trans-inferior temporal gyrus (TITG) approaches were evaluated. WMTs that were identified during dissection were then reconstructed on the Human Connectome Project 1021 individual template for validation. RESULTS The trans-middle gyrus approach interrupted the U fibers, arcuate fasciculus (AF), the ventral segment of inferior frontoocipital fasciculus (IFOF), the temporal extensions of the anterior commissure (AC) posterior crura, the tapetum (Tp) fibers, and the anterior loop of the optic radiation (OR). The TITS approach interrupted U fibers, inferior longitudinal fasciculus (ILF), IFOF, and OR. The TITG approach interrupted the U fibers, ILF, and OR. The middle longitudinal fasciculus, ILF, and uncinate fasciculus (UF) were not interrupted in the trans-middle gyrus approach and the AF, UF, AC, and Tp fibers were not interrupted in the TITS/gyrus approaches. CONCLUSION Surgical planning of the ambient cistern lesions requires detailed knowledge about WMTs. Fiber dissection and tractography techniques improve the orientation during surgery and may help decrease surgical complications.

Anatomy of the Anterior Temporal Lobe and the Frontotemporal Region Demonstrated by Fiber Dissection

Neurosurgery ◽  
2004 ◽  
Vol 55 (5) ◽  
pp. 1174-1184 ◽  
Author(s):  
Diedrik Peuskens ◽  
Johannes van Loon ◽  
Frank Van Calenbergh ◽  
Raymond van den Bergh ◽  
Jan Goffin ◽  
...  
Keyword(s):  
White Matter ◽  
Temporal Lobe ◽  
Anterior Commissure ◽  
Three Dimensional ◽  
Dimensional Structure ◽  
Surgical Approaches ◽  
Anterior Temporal Lobe ◽  
White Matter Tracts ◽  
Fiber Dissection ◽  
Dissection Technique

Abstract OBJECTIVE: The white matter structure of the anterior temporal lobe and the frontotemporal region is complex and not well appreciated from the available neurosurgical literature. The fiber dissection method is an excellent means of attaining a thorough knowledge of the three-dimensional structure of the white matter tracts. This study was performed to demonstrate the usefulness of the dissection technique in understanding the white matter anatomy and the effects of current surgical approaches on the subcortical structure of the region. METHODS: Seventeen brain specimens obtained at routine autopsy were dissected by use of Klingler's fiber dissection technique after preparation by fixation and freezing. The dissections were performed with an operating microscope and followed a stepwise pattern of progressive white matter dissection. RESULTS: The dissection is described in an orderly fashion showing the white matter tracts of the anterior temporal lobe and the frontotemporal region. An insight is gained into the three-dimensional course of the anterior loop of the optic radiation, the temporal stem, the anterior commissure, and the ansa peduncularis. CONCLUSION: The anterior temporal lobe and the frontotemporal region contain several important white matter tracts that can be uniquely understood by performing a white matter dissection of the region. Surgical procedures on the anterior temporal lobe differ substantially as to their repercussions on the subcortical white matter tract anatomy, as shown by the findings in this study.

scholarly journals The Connectivity–Based Parcellation of The Angular Gyrus: Fiber Dissection And MR Tractography Study

2022 ◽  
Author(s):  
Fatih Yakar ◽  
Pınar Çeltikçi ◽  
Yücel Doğruel ◽  
Emrah Egemen ◽  
Abuzer Güngör
Keyword(s):  
Anterior Commissure ◽  
Angular Gyrus ◽  
Middle Temporal Gyrus ◽  
Supramarginal Gyrus ◽  
Middle Temporal ◽  
Fiber Tracts ◽  
Human Connectome Project ◽  
Cortical Parcellation ◽  
Fiber Dissection ◽  
First Time

Abstract The angular gyrus (AG) wraps the posterior end of the superior temporal sulcus (STS), so it is considered as a continuation of the superior/middle temporal gyrus and forms the inferior parietal lobule (IPL) with the supramarginal gyrus (SMG). The AG was functionally divided in the literature, but there is no fiber dissection study in this context. This study divided AG into superior (sAG) and inferior (iAG) parts by focusing on STS. Red blue silicone injected eight human cadaveric cerebrums were dissected via the Klingler method focusing on the AG. White matter (WM) tracts identified during dissection were then reconstructed on the Human Connectome Project 1065 individual template for validation. According to this study, superior longitudinal fasciculus (SLF) II and middle longitudinal fasciculus (MdLF) are associated with sAG; the anterior commissure (AC), optic radiation (OR) with iAG; the arcuate fasciculus (AF), inferior frontooccipital fasciculus (IFOF), and tapetum (Tp) with both parts. In cortical parcellation of AG based on STS, sAG and iAG were found to be associated with different fiber tracts. Although it has been shown in previous studies that there are functionally different subunits with AG parcellation, here, for the first time, different functions of the subunits have been revealed with cadaveric dissection and tractography images.

scholarly journals Cortical projection of the inferior choroidal point as a reliable landmark to place the corticectomy and reach the temporal horn through a middle temporal gyrus approach

2014 ◽  
Vol 72 (10) ◽  
pp. 777-781 ◽  
Author(s):  
Thomas Frigeri ◽  
Albert Rhoton ◽  
Eliseu Paglioli ◽  
Ney Azambuja
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Cerebral Hemispheres ◽  
Middle Temporal Gyrus ◽  
Cortical Projection ◽  
Anatomical Features ◽  
Middle Temporal ◽  
Temporal Horn ◽  
Mesial Temporal Lobe

Objective To establish preoperatively the localization of the cortical projection of the inferior choroidal point (ICP) and use it as a reliable landmark when approaching the temporal horn through a middle temporal gyrus access. To review relevant anatomical features regarding selective amigdalohippocampectomy (AH) for treatment of mesial temporal lobe epilepsy (MTLE). Method The cortical projection of the inferior choroidal point was used in more than 300 surgeries by one authors as a reliable landmark to reach the temporal horn. In the laboratory, forty cerebral hemispheres were examined. Conclusion The cortical projection of the ICP is a reliable landmark for reaching the temporal horn.

scholarly journals Indirect White Matter Pathways Are Associated With Treated Naming Improvement in Aphasia

2021 ◽  
pp. 154596832199905
Author(s):  
Janina Wilmskoetter ◽  
Julius Fridriksson ◽  
Alexandra Basilakos ◽  
Lorelei Phillip Johnson ◽  
Barbara Marebwa ◽  
...  
Keyword(s):  
White Matter ◽  
Treatment Outcomes ◽  
Inferior Frontal Gyrus ◽  
Brain Regions ◽  
Angular Gyrus ◽  
Middle Temporal Gyrus ◽  
Middle Temporal ◽  
Pars Opercularis ◽  
Left Hemisphere Stroke ◽  
Linear Regressions

Background White matter disconnection of language-specific brain regions associates with worse aphasia recovery. Despite a loss of direct connections, many stroke survivors may maintain indirect connections between brain regions. Objective To determine (1) whether preserved direct connections between language-specific brain regions relate to better poststroke naming treatment outcomes compared to no direct connections and (2) whether for individuals with a loss of direct connections, preserved indirect connections are associated with better treatment outcomes compared to individuals with no connections. Methods We computed structural whole-brain connectomes from 69 individuals with chronic left-hemisphere stroke and aphasia who completed a 3-week-long language treatment that was supplemented by either anodal transcranial direct current stimulation (A-tDCS) or sham stimulation (S-tDCS). We determined differences in naming improvement between individuals with direct, indirect, and no connections using 1-way analyses of covariance and multivariable linear regressions. Results Independently of tDCS modality, direct or indirect connections between the inferior frontal gyrus pars opercularis and angular gyrus were both associated with a greater increase in correct naming compared to no connections ( P = .027 and P = .039, respectively). Participants with direct connections between the inferior frontal gyrus pars opercularis and middle temporal gyrus who received S-tDCS and participants with indirect connections who received A-tDCS significantly improved in naming accuracy. Conclusions Poststroke preservation of indirect white matter connections is associated with better treated naming improvement in aphasia even when direct connections are damaged. This mechanistic information can be used to stratify and predict treated naming recovery in individuals with aphasia.

scholarly journals Microsurgical anatomy of the inferior limiting insular sulcus and the temporal stem

2015 ◽  
Vol 122 (6) ◽  
pp. 1263-1273 ◽  
Author(s):  
Eduardo Carvalhal Ribas ◽  
Kaan Yagmurlu ◽  
Hung Tzu Wen ◽  
Albert L. Rhoton
Keyword(s):  
White Matter ◽  
Medial Temporal Lobe ◽  
Anterior Commissure ◽  
Internal Capsule ◽  
Microsurgical Anatomy ◽  
Uncinate Fasciculus ◽  
Fiber Tracts ◽  
Transsylvian Approach ◽  
Temporal Stem ◽  
Optic Radiations

OBJECT The purpose of this study was to describe the location of each white matter pathway in the area between the inferior limiting insular sulcus (ILS) and temporal horn that may be crossed in approaches through the temporal stem to the medial temporal lobe. METHODS The fiber tracts in 14 adult cadaveric cerebral hemispheres were examined using the Klingler technique. The fiber dissections were completed in a stepwise manner, identifying each white matter pathway in different planes and describing its position in relation to the anterior end of the ILS. RESULTS The short-association fibers from the extreme capsule, which continue toward the operculae, are the most superficial subcortical layer deep to the ILS. The external capsule fibers are found deeper at an intermediate layer and are formed by the uncinate fasciculus, inferior frontooccipital fasciculus, and claustrocortical fibers in a sequential anteroposterior disposition. The anterior commissure forms the next deeper layer, and the optic radiations in the sublenticular part of the internal capsule represent the deepest layer. The uncinate fasciculus is found deep to the anterior third of the ILS, whereas the inferior frontooccipital fasciculus and optic radiations are found superficial and deep, respectively, at the posterior two-thirds of this length. CONCLUSIONS The authors' findings suggest that in the transsylvian approach, a 6-mm incision beginning just posterior to the limen insula through the ILS will cross the uncinate fasciculus but not the inferior frontooccipital fasciculus or optic radiations, but that longer incisions carry a risk to language and visual functions.

scholarly journals The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus

2017 ◽  
Vol 126 (3) ◽  
pp. 945-971 ◽  
Author(s):  
Abuzer Güngör ◽  
Serhat Baydin ◽  
Erik H. Middlebrooks ◽  
Necmettin Tanriover ◽  
Cihan Isler ◽  
...  
Keyword(s):  
White Matter ◽  
Anterior Commissure ◽  
Internal Capsule ◽  
Surgical Approaches ◽  
White Matter Tracts ◽  
Lateral Ventricles ◽  
Fiber Dissection ◽  
Dissection Technique ◽  
Relationship Of ◽  
The Relationship

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.

The Unique Fiber Anatomy of Middle Temporal Gyrus Default Mode Connectivity

2021 ◽  
Author(s):  
Robert G Briggs ◽  
Onur Tanglay ◽  
Nicholas B Dadario ◽  
Isabella M Young ◽  
R Dineth Fonseka ◽  
...  
Keyword(s):  
White Matter ◽  
Language Processing ◽  
Ex Vivo ◽  
Diffusion Imaging ◽  
Middle Temporal Gyrus ◽  
Middle Temporal ◽  
Default Mode ◽  
Linear Sequence ◽  
Human Connectome Project ◽  
Association Fibers

Abstract BACKGROUND The middle temporal gyrus (MTG) is understood to play a role in language-related tasks such as lexical comprehension and semantic cognition. However, a more specific understanding of its key white matter connections could promote the preservation of these functions during neurosurgery. OBJECTIVE To provide a detailed description of the underlying white matter tracts associated with the MTG to improve semantic preservation during neurosurgery. METHODS Tractography was performed using diffusion imaging obtained from 10 healthy adults from the Human Connectome Project. All tracts were mapped between cerebral hemispheres with a subsequent laterality index calculated based on resultant tract volumes. Ten postmortem dissections were performed for ex vivo validation of the tractography based on qualitative visual agreement. RESULTS We identified 2 major white matter bundles leaving the MTG: the inferior longitudinal fasciculus and superior longitudinal fasciculus. In addition to long association fibers, a unique linear sequence of U-shaped fibers was identified, possibly representing a form of visual semantic transfer down the temporal lobe. CONCLUSION We elucidate the underlying fiber-bundle anatomy of the MTG, an area highly involved in the brain's language network. Improved understanding of the unique, underlying white matter connections in and around this area may augment our overall understanding of language processing as well as the involvement of higher order cerebral networks like the default mode network in these functions.

Central core of the cerebrum

2011 ◽  
Vol 114 (2) ◽  
pp. 463-469 ◽  
Author(s):  
Chan-Young Choi ◽  
Seong-Rok Han ◽  
Gi-Taek Yee ◽  
Chae-Heuck Lee
Keyword(s):  
White Matter ◽  
Caudate Nucleus ◽  
Anterior Commissure ◽  
Central Core ◽  
Surgical Approaches ◽  
Fasciculus Retroflexus ◽  
Complex Anatomy ◽  
Fiber Dissection ◽  
Mammillothalamic Tract ◽  
Dissection Technique

Object The purpose of this study was to understand 3D relationships of white matter fibers and subcortical areas of gray matter in the central core. Methods The lateral and medial aspects of 4 cerebral hemispheres were dissected, applying the fiber dissection technique under the microscope. Results The central core between the insula and midline includes the extreme, external, and internal capsules; claustrum; putamen; globus pallidus; caudate nucleus; amygdala; diencephalon; substantia innominata; fornix; anterior commissure; mammillothalamic tract; fasciculus retroflexus; thalamic peduncles, including optic and auditory radiations; ansa peduncularis; thalamic fasciculus; and lenticular fasciculus. It is attached to the remainder of the cerebral hemisphere by the cerebral isthmus, which is composed of white matter fibers located between the dorsolateral margin of the caudate nucleus and the full circumference of the circular sulcus of insula. The rostral fibers of the corpus callosum are included in the frontal portion of the cerebral isthmus. Conclusions It is very useful for neurosurgeons to facilitate the understanding of spatial relationships and pertinent surgical approaches in and around the central core with a highly complex anatomy by using fiber dissection.

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