Anatomo-functional study of the temporo-parieto-occipital region: dissection, tractographic and brain mapping evidence from a neurosurgical perspective
Anatomo-functional study of the temporo-parieto-occipital region: dissection, tractographic and brain mapping evidence from a neurosurgical perspective
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DOI：
10.1111/joa.12204
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发表时间：
2014-08-01
影响因子：
2.4
通讯作者：
Sarubbo, Silvio
中科院分区：
文献类型：
--
作者：
De Benedictis, Alessandro;Duffau, Hugues;Sarubbo, Silvio
颞-顶-枕（TPO）连接部是一个复杂的脑区域，其严重涉及若干高级神经功能，例如语言、视觉-空间识别、书写、阅读、符号处理、计算、自我处理、工作记忆、音乐记忆以及面部和物体识别。最近的研究表明，这一地区是由一个厚厚的网络覆盖的白色物质（WM）的连接，提供有效的和多模态的信息整合之间的本地和远程皮质节点。重要的是神经外科医生有很好的三维皮质下组织的高度连接的区域，以尽量减少术后永久性赤字的知识。本解剖研究的目的是从局部手术角度突出皮质下功能解剖。根据Klingler的技术，从四具人类尸体获得八个人类半球（四个左，四个右）。从外侧内侧开始，作者描述了穿过TPO的主要通路的解剖过程和它们之间的关系。从解剖获得的结果首先与扩散张量成像重建，随后与从三个手术病例中获得的功能数据相结合，所有切除浸润性神经胶质瘤的患者在清醒状态下使用直接电标测。在TPO区域内进行安全病灶切除术的皮质下限制如下：在顶骨区域内，上级纵束的前水平部分和更深的弓状束;背侧，垂直投射的丘脑-皮质纤维。对于位于颞叶和枕叶内的病变，应根据水平联合通路（额枕下束、下纵束和视放射）的方向进行切除。并观察了WM束与脑室系统的关系。这些结果表明，当接近内在脑病变以优化手术结果并尽量减少术后发病率时，TPO区域内WM结构的详细解剖功能意识是强制性的。
The temporo-parieto-occipital (TPO) junction is a complex brain territory heavily involved in several high-level neurological functions, such as language, visuo-spatial recognition, writing, reading, symbol processing, calculation, self-processing, working memory, musical memory, and face and object recognition. Recent studies indicate that this area is covered by a thick network of white matter (WM) connections, which provide efficient and multimodal integration of information between both local and distant cortical nodes. It is important for neurosurgeons to have good knowledge of the three-dimensional subcortical organisation of this highly connected region to minimise post-operative permanent deficits. The aim of this dissection study was to highlight the subcortical functional anatomy from a topographical surgical perspective. Eight human hemispheres (four left, four right) obtained from four human cadavers were dissected according to Klingler's technique. Proceeding latero-medially, the authors describe the anatomical courses of and the relationships between the main pathways crossing the TPO. The results obtained from dissection were first integrated with diffusion tensor imaging reconstructions and subsequently with functional data obtained from three surgical cases, all resection of infiltrating glial tumours using direct electrical mapping in awake patients. The subcortical limits for performing safe lesionectomies within the TPO region are as follows: within the parietal region, the anterior horizontal part of the superior longitudinal fasciculus and, more deeply, the arcuate fasciculus; dorsally, the vertical projective thalamo-cortical fibres. For lesions located within the temporal and occipital lobes, the resection should be tailored according to the orientation of the horizontal associative pathways (the inferior fronto-occipital fascicle, inferior longitudinal fascicle and optic radiation). The relationships between the WM tracts and the ventricle system were also examined. These results indicate that a detailed anatomo-functional awareness of the WM architecture within the TPO area is mandatory when approaching intrinsic brain lesions to optimise surgical results and to minimise post-operative morbidity.