Brain white matter fibre tracts: a review of functional neuro-oncological relevance

Voets, Natalie L.; Bartsch, Andreas J.; Plaha, Puneet

doi:10.1136/jnnp-2017-316170

Cited by 31 publications

(20 citation statements)

References 60 publications

(72 reference statements)

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“…A description of a glioma’s anatomic location within the gyri and/or along white matter tracts is an important initial step in understanding what critical structures are nearby [ 4 , 16 ]. Completion of this cognitive task begins with the understanding of what disconnection is likely to be required and what tracts are likely to be encountered.…”

Section: Reviewmentioning

confidence: 99%

“…Diffusion tensor imaging (DTI) tractography does not tell us where the functional networks are located per se, but tractography does suggest where large bundle white matter tracts are likely to be located [ 15 ]. As gliomas commonly expand gyri and later spread along white matter tracts [ 16 ], they may be classified not only by their anatomic location but also by which white matter tract they have overrun [ 16 - 17 ]. By determining the pattern of spread and, therefore, the tracts likely to be involved, it is possible to develop a neuroanatomic understanding of the tumor.…”

Section: Introductionmentioning

confidence: 99%

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Common Disconnections in Glioma Surgery: An Anatomic Description

Glenn

Conner

Rahimi

et al. 2017

Cureus

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Within the surgical treatment of glioma, extended survival is predicated upon extent of resection which is limited by proximity and/or invasion of eloquent structures. Diffusion tensor imaging (DTI) tractography is a very useful tool for guiding supramaximal surgical resection while preserving eloquence. Although gliomas can vary significantly in size, shape, and invasion of functionally significant brain tissue, typical surgical disconnection patterns emerge. In this study, our typical surgical paradigm is outlined. We describe our surgical philosophy for resecting gliomas supramaximally summarized as define, divide, and destroy with the adjuvant utilization of neuronavigation and DTI. We describe the most common disconnections involved in glioma surgery at our institution; specifically, delineating tumor disconnections involving the medial posterior frontal, lateral posterior frontal, posterior temporal, anterior occipital, medial parietal, and insular regions. Although gliomas are highly variable, common patterns emerge in relation to the necessary disconnections required to preserve eloquent brain while maximizing the extent of resection.

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Section: Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Common Disconnections in Glioma Surgery: An Anatomic Description

Glenn

Conner

Rahimi

et al. 2017

Cureus

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“…The critical role of the AF is demonstrated by the interruption of speech production typically observed when the tract is electrically stimulated intraoperatively. When injured, it has been found to disrupt phonological processing and reduce speech fluency (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

From Neurosurgical Planning to Histopathological Brain Tumor Characterization: Potentialities of Arcuate Fasciculus Along-Tract Diffusion Tensor Imaging Tractography Measures

et al. 2021

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Background: Tractography has been widely adopted to improve brain gliomas' surgical planning and guide their resection. This study aimed to evaluate state-of-the-art of arcuate fasciculus (AF) tractography for surgical planning and explore the role of along-tract analyses in vivo for characterizing tumor histopathology.Methods: High angular resolution diffusion imaging (HARDI) images were acquired for nine patients with tumors located in or near language areas (age: 41 ± 14 years, mean ± standard deviation; five males) and 32 healthy volunteers (age: 39 ± 16 years; 16 males). Phonemic fluency task fMRI was acquired preoperatively for patients. AF tractography was performed using constrained spherical deconvolution diffusivity modeling and probabilistic fiber tracking. Along-tract analyses were performed, dividing the AF into 15 segments along the length of the tract defined using the Laplacian operator. For each AF segment, diffusion tensor imaging (DTI) measures were compared with those obtained in healthy controls (HCs). The hemispheric laterality index (LI) was calculated from language task fMRI activations in the frontal, parietal, and temporal lobe parcellations. Tumors were grouped into low/high grade (LG/HG).Results: Four tumors were LG gliomas (one dysembryoplastic neuroepithelial tumor and three glioma grade II) and five HG gliomas (two grade III and three grade IV). For LG tumors, gross total removal was achieved in all but one case, for HG in two patients. Tractography identified the AF trajectory in all cases. Four along-tract DTI measures potentially discriminated LG and HG tumor patients (false discovery rate < 0.1): the number of abnormal MD and RD segments, median AD, and MD measures. Both a higher number of abnormal AF segments and a higher AD and MD measures were associated with HG tumor patients. Moreover, correlations (unadjusted p < 0.05) were found between the parietal lobe LI and the DTI measures, which discriminated between LG and HG tumor patients. In particular, a more rightward parietal lobe activation (LI < 0) correlated with a higher number of abnormal MD segments (R = −0.732) and RD segments (R = −0.724).Conclusions: AF tractography allows to detect the course of the tract, favoring the safer-as-possible tumor resection. Our preliminary study shows that along-tract DTI metrics can provide useful information for differentiating LG and HG tumors during pre-surgical tumor characterization.

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“…Intraoperative stimulation of the dominant AF/SLF complex results in expressive aphasia, phonemic paraphasias and repetition disorders (AF) or speech articulation dysfunction (SLF III), which are assessed during the picture naming task. On the non-dominant hemisphere, stimulation of the AF/SLF complex may result in contralateral hemineglect syndrome, which is related to the stimulation of the second compartment of the SLF (SLF II) ( 23 ), which is assessed with an intraoperative line bisection task ( 2 , 24 ). The sagittal stratum is the most superficial fiber system, under the u-fibers posterior to the sulcus of Jensen or posterior half of the IPL.…”

Section: Discussionmentioning

confidence: 99%

Cortical and Subcortical Anatomy of the Parietal Lobe From the Neurosurgical Perspective

2021

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Introduction: The anatomical structures of the parietal lobe at the cortical and subcortical levels are related mainly to sensory, visuospatial, visual and language function. The aim of this study was to present an intraoperative perspective of these critical structures in terms of the surgical treatment of intra-axial lesions. The study also discusses the results of the technique and the results of direct brain stimulation under awake conditions.Materials and Methods: Five adult brains were prepared according to the Klingler technique. Cortical assessments and all measurements were performed with the naked eye, while white matter dissection was performed with microscopic magnification.Results: Intra-axial lesions within the parietal lobe can be approached through a lateral or superior trajectory. This decision is based on the location of the lesions in relation to the arcuate fascicle/superior longitudinal fascicle (AF/SLF) complex and ventricular system. Regardless of the approach, the functional borders of the resection are defined by the postcentral gyrus anteriorly and Wernicke's speech area inferiorly. On the subcortical level, active identification of the AF/SLF complex and of the optic radiation within the sagittal stratum should be performed. The intraparietal sulcus (IPS) is a reliable landmark for the AF/SLF complex in ~60% of cases.Conclusion: Knowledge of the cortical and subcortical anatomical and functional borders of the resection is crucial in preoperative planning, prediction of the risk of postoperative deficits, and intraoperative decision making.

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Brain white matter fibre tracts: a review of functional neuro-oncological relevance

Cited by 31 publications

References 60 publications

Common Disconnections in Glioma Surgery: An Anatomic Description

Common Disconnections in Glioma Surgery: An Anatomic Description

From Neurosurgical Planning to Histopathological Brain Tumor Characterization: Potentialities of Arcuate Fasciculus Along-Tract Diffusion Tensor Imaging Tractography Measures

Cortical and Subcortical Anatomy of the Parietal Lobe From the Neurosurgical Perspective

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