Functional Anatomy of the Brain: A View from the Surgeon’s Eye

Foreword
Preface
Contents
About the Editors
Anatomy Guided Microneurosurgery of Cerebral Lesions
	1	 Introduction
	2	 General Features of the Brain Sulci and Gyri Architecture
	3	 The Superolateral Brain Surface and its Sulcal Key-Points
	References
An Overview of Cortical and Subcortical Anatomy Relevant for Intra-Axial Brain Surgery
	1	 Introduction
	2	 Frontal Lobe
		2.1	 Superolateral Surface of the Frontal Lobe
			2.1.1	 Cortical Anatomy
			2.1.2	 Subcortical Anatomy
		2.2	 Medial Surface of Frontal Lobe
			2.2.1	 Cortical Anatomy
			2.2.2	 Subcortical Anatomy
		2.3	 Basal/Orbital Surface of the Frontal Brain
			2.3.1	 Cortical Anatomy
			2.3.2	 Subcortical Anatomy
	3	 Central Lobe
		3.1	 Cortical Anatomy
		3.2	 Subcortical Anatomy
	4	 Parietal Lobe
		4.1	 Supero-Lateral Surface
			4.1.1	 Cortical Anatomy
			4.1.2	 Subcortical Anatomy
		4.2	 Medial Surface
			4.2.1	 Cortical Anatomy
			4.2.2	 Subcortical Anatomy
	5	 Occipital Lobe
		5.1	 Superolateral Surface
			5.1.1	 Cortical Anatomy
			5.1.2	 Subcortical Anatomy
		5.2	 Medial Surface
			5.2.1	 Cortical Anatomy
			5.2.2	 Subcortical Anatomy
		5.3	 Basal Surface
			5.3.1	 Cortical Anatomy
			5.3.2	 Subcortical Anatomy
	6	 Temporal Lobe
		6.1	 Superolateral Surface
			6.1.1	 Cortical Anatomy
			6.1.2	 Subcortical Anatomy
		6.2	 Basal Surface
			6.2.1	 Cortical Anatomy
			6.2.2	 Subcortical Anatomy
		6.3	 Opercular Surface
	7	 Insular Lobe
		7.1	 Cortical Anatomy
		7.2	 Subcortical Anatomy:
	8	 Limbic Lobe
	9	 White Fibers
	10	 Classification of White Fibers of the Brain
		10.1	 The First Layer/Superficial Group
			10.1.1	 Short Association or U Fibers
		10.2	 The Second Layer/the Middle Group
			10.2.1	 Superior Longitudinal Fasciculus (SLF)
				Course and Connections
				Function
			10.2.2	 Arcuate Fasciculus (AF)
				Course and Connections
				Function
			10.2.3	 Ventral Occipital Fasciculus
				Course and Connections
				Function
			10.2.4	 Middle Longitudinal Fasciculus
				Course and Connections
				Function
			10.2.5	 Inferior Longitudinal Fasciculus (ILF)
				Course and Connections
				Function
			10.2.6	 Inferior Fronto-occipital fasciculus (IFOF)
				Course and Connections
				Function
			10.2.7	 Uncinate Fasciculus (UF)
				Course and Connections
				Function
			10.2.8	 Sagittal Stratum and the Optic Radiations
				Course and Connections
				Function
			10.2.9	 Cingulum
				Course and Connections
				Function
			10.2.10	 Medial and Lateral Olfactory Striae
				Course and Connections
				Function
		10.3	 The Central Group
			10.3.1	 Corpus Callosum
				Course and Connections
				Function
			10.3.2	 Anterior Commissure
				Course and Connections
				Function
			10.3.3	 Hippocampal Commissure/Psalterium
				Course and Connections
				Function
		10.4	 The Vertical group
			10.4.1	 Internal Capsule
				Course and Connections
				Function
			10.4.2	 External Capsule
				Course and Connections
				Function
			10.4.3	 Corona Radiata
				Course and Connections
				Function
		10.5	 The Third Layer/Deep Group
			10.5.1	 Fornix
				Course and Connections
				Function
			10.5.2	 Mammillothalamic and Mammillotegmental Tracts
			10.5.3	 Stria Terminalis
			10.5.4	 Stria Medullaris Thalami
	References
Impact of White Matter Dissection in Microneurosurgical Procedures
	1	 History of White Matter Fiber Dissection
	2	 White Matter Dissection Technique
	3	 Main Fiber Systems of White Matter
		3.1	 Association Fibers
		3.2	 Commissural Fibers
		3.3	 Projection Fibers
		3.4	 Brain Stem
	4	 Fiber-Dissection Technique and DTI-Based Tractography
	5	 Impact of White Matter Dissection on Microneurosurgical Procedures
		5.1	 Case Presentations
	6	 Integration of White Matter Dissection, Photogrammetry, 3D Modeling, and Augmented/Virtual Reality Simulations in Neurosurgery and Neuroanatomy Education
	7	 Conclusion
	References
An Overview of Connectomics and Glioma Surgery
	1	 Introduction
	2	 What Is the Brain Connectome?
		2.1	 Functional Connectome
		2.2	 Structural Connectome
	3	 Who and What Are the Major Networks We Should Care About?
		3.1	 The Cognitive Control Networks
			3.1.1	 Default Mode Network
			3.1.2	 Central Executive Network
			3.1.3	 Salience Network
		3.2	 Expansion of More Traditional Networks
			3.2.1	 Sensorimotor Network
			3.2.2	 Limbic Network
			3.2.3	 Dorsal Attention Network
	4	 Brain Network Maps to Navigate the Brain
	5	 Moving Forward
	6	 Conclusion
	References
Intraoperative Mapping and Monitoring Techniques for Intra-Axial Brain Tumors
	1	 Introduction
	2	 Historical Overview
	3	 Intraoperative Neurophysiological Techniques for Brain Tumors Operated under Anesthesia
		3.1	 General Considerations
		3.2	 Various IONM Modalities Used: Neuro-Physiological Basis and Technical Aspects
			3.2.1	 Motor System
				Motor Evoked Potentials (MEPs) (transcranial, cortical, and subcortical)
				Free-Run electromyography and Triggered electromyography
			3.2.2	 Sensory System
				Sensory System and Somatosensory Evoked Potentials
				Visual Pathways and VEPs
				Brainstem Auditory Evoked Potentials (BAEPs)
			3.2.3	 Spontaneous and triggered brain activity recording:
			3.2.4	 Monitoring of Brainstem Reflexes
			3.2.5	 Newer IONM Modalities
		3.3	 Application of IONM Mapping and Monitoring Modalities for Intra-Axial Brain/ Brainstem Tumor Resection
			3.3.1	 Anesthesia Considerations for IONM
			3.3.2	 IONM for Supratentorial Tumors
			3.3.3	 IONM for Intra-Axial Brainstem Surgeries
			3.3.4	 Interpretation of IONM Changes and Warning Criteria
			3.3.5	 Challenges During IONM and Complication Avoidance
	4	 Awake Mapping and Monitoring
		4.1	 Background: Relevant Neuroanatomical Concepts and Basis of Use of Direct Electrical Stimulation (DES)
		4.2	 Technical Aspects of DES during Awake Mapping
		4.3	 Technique of Awake Brain Mapping – Setting up and Awake Surgery
			4.3.1	 Preoperative Planning
			4.3.2	 Perioperative Management
			4.3.3	 Anesthesia Techniques and Management
			4.3.4	 Selection of Tasks
			4.3.5	 Performance of Tasks and Assessment: Practical Tips and Tricks
			4.3.6	 Monitoring
			4.3.7	 Intraoperative Decision Making
		4.4	 Complication Avoidance
	5	 Clinical Benefits and Relevance of Functional Mapping and Monitoring
	References
Neural Basis of Language, a Comprehensive Update for Neurosurgeons
	1	 The Mental Lexicon (Semantics)
	2	 The Language-Relevant Cortical Regions
		2.1	 Language-relevant frontal regions
		2.2	The Insula
		2.3	 Language-relevant temporal regions
		2.4	 Language-Relevant Parietal Regions
		2.5	 Language-relevant right hemispheric (RH) regions
	3	 The Language-Relevant White Fiber Tracts
	4	 Neural Primary Network of Language Processing (a Simplified Model)
	References
Optic Radiations Monitoring in Awake Glioma Surgery: Intraoperative Campimetry
	1	 Introduction
	2	 Anatomy of the Visual Pathway
	3	 First Contact. Visual Tests & Imaging
		3.1	 Clinical Records and Neurological Exam
		3.2	 Visual Field Testing
		3.3	 Imaging Studies
			3.3.1	 Anatomical MRI Sequences
			3.3.2	 Functional MRI (fMRI)
			3.3.3	 DTI: Based Tractography
	4	 Second Contact. Functional Preoperative Tests
		4.1	 Preoperative Mapping: Visual Evoked Potentials (VEP)
	5	 Third Contact. Functional Intraoperative Tests
		5.1	 Intraoperative Mapping
			5.1.1	 Visual Evoked Potentials (VEP)
			5.1.2	 Direct Stimulation: Towards the Maximal Oncological Resection
	6	 Conclusions
	References
Visualization and Characterization of Glioma and Brain Activity to Maximize Safe Tumor Resection in Awake Surgery
	1	 Introduction
		1.1	 White Matter Fiber Visualization
		1.2	 Functional Magnetic Resonance Imaging (Task-Based and Resting-State)
		1.3	 Magnetoencephalography
		1.4	 Transcranial Magnetic Stimulation
		1.5	 Three-Dimensional Imaging
		1.6	 Electrophysiological Monitoring
		1.7	 Neuronavigation
		1.8	 Ultrasonography
		1.9	 Illuminating Probes and Fluorescence-Guided Surgery
			1.9.1	 5-Aminolevulinic Acid
			1.9.2	 Fluorescein Sodium
			1.9.3	 Indocyanine Green
			1.9.4	 New Fluorescence
		1.10	 Intraoperative Magnetic Resonance Imaging
		1.11	 Intraoperative Diagnosis (Stimulated Raman Scattering Microscopy and Confocal Microscopy)
		1.12	 Exoscope
	2	 Conclusion
	References
Insular Gliomas: A Review of Surgical Anatomy and Operative Considerations
	1	 Introduction
	2	 Anatomy of the Insula
		2.1	 Gryi of the Insula and Relevant Sulcal Boundaries
		2.2	 Subcortical Tracts Adjacent to the Insula
		2.3	 Connectivity of the Insula
	3	 Management of Insular Gliomas
		3.1	 Berger-Sanai Zone Classification of Insular Gliomas
		3.2	 Surgical Approaches to Insular Gliomas
		3.3	 Insular Glioma Surgical Outcomes
	4	 Conclusions
	References
Interpreting Imaging for Pre-Operative Planning and Execution of Glioma Surgery
	1	 Introduction
	2	 Case Presentation
		2.1	 Case 1
		2.2	 Case 2
		2.3	 Case 3
	3	 White Matter Fibers
		3.1	 SLF I
		3.2	 SLF II
		3.3	 SLF III
		3.4	 AF
		3.5	 IFOF
		3.6	 ILF
		3.7	 UF
		3.8	 CC
		3.9	 Cingulum
	References
Origin and Spread of Gliomas and Surgical Strategy of Gliomas Based on a Novel Surgical Classification
	1	 Introduction
	2	 Origin of Gliomas
	3	 Morphological Classification of Gliomas
	4	 Tumors of the Short Arcuate Fibers
		4.1	 Frontal Lobe
		4.2	 Central Lobe
		4.3	 Parietal Lobe
		4.4	 Temporal Lobe
		4.5	 Insular Lobe
		4.6	 Occipital Lobe
	5	 Tumors of the Long Association Fibers
		5.1	 Cingulum
		5.2	 Uncinate Fasciculus
		5.3	 Inferior Fronto-Occipital Fasciculus
		5.4	 Superior Longitudinal Fasciculus, Middle Longitudinal Fasciculus, Inferior Longitudinal Fasciculus
		5.5	 Arcuate Fasciculus
	6	 Tumors of the Commissural fibers
		6.1	 Corpus Callosum
		6.2	 Anterior Commissure
		6.3	 Hippocampal Commissure
		6.4	 Posterior Commissure
	7	 Surgical Implications
	8	 Conclusions
	References
Surgical Strategy for Low-Grade Gliomas Arising from Short Arcuate Fibers
	1	 Introduction
	2	 Pre-operative Planning
	3	 Clinical Evaluation
	4	 Imaging
	5	 Adjuncts During Surgery
	6	 Surgical Strategy
	7	 Post-operative Imaging
	8	 Surgical Results
	9	 Surgical Pearls
	10	 Conclusion
	References
Anatomy of the Limbic System and Surgery for Medial Temporal Lesions
	1	 Introduction
	2	 Delineation of the Limbic Connections - Medial to Lateral Dissection of the White Matter
	3	 Anatomical Correlates and Limbic Connections
	4	 Limbic Circuits
		4.1	 Papez Circuit
		4.2	 Supracallosal Circuit
		4.3	 Dorsal Amygdalo-Fugal Pathway
		4.4	 Ventral Amygdalo – Fugal Pathway
	5	 White Fiber Correlates of Amygdalo-Hippocampectomy Through the Middle Temporal Gyrus Approach
		5.1	 Anatomical Correlates Safe Zone to Enter the Temporal Horn
		5.2	 En Bloc Amygdalo-Hippocampectomy and Anterior Temporal Lobectomy Through the Middle Temporal Gyrus: Surgical Technique [31, 32]
	References
Medial Temporal Lobe Tumors: Surgical Anatomy and Technique
	1	 Introduction
	2	 Neural Features of the MTL
		2.1	 Anterior Segment
		2.2	 Middle Segment
		2.3	 Posterior Segment
	3	 Arterial Distribution of the MTL
		3.1	 Anterior Choroidal Artery (AChA)
		3.2	 Middle Cerebral Artery (MCA)
		3.3	 Internal Carotid Artery (ICA)
		3.4	 Posterior Cerebral Artery (PCA)
	4	 Venous Drainage
		4.1	 Anterior Segment of the MTL
		4.2	 Middle Segment of the MTL
		4.3	 Posterior Segment of MTL
	5	 Surgical Approach
		5.1	 Transsylvian Translimen Insula Approach
		5.2	 Lateral Transtemporal Approach
		5.3	 Subtemporal Approach
		5.4	 Supracerebellar Transtentorial Approach
	6	 Illustrative Cases
	7	 Conclusion
	References
Anatomy of Basal Forebrain and Orbital Cortical Approach to Caudate Head Tumors
	1	 Introduction
	2	 Anatomical Correlates
		2.1	 Cortical Anatomy
		2.2	 Subcortical Anatomy
			2.2.1	 Deep Gray Matter
				Basal Forebrain
			2.2.2	 Caudate Nucleus
		2.3	 White Fibers
			2.3.1	 Inferior Occipitofrontal Fasciculus (IFOF)
			2.3.2	 Uncinate Fasciculus
			2.3.3	 Anterior Commissure
			2.3.4	 Forceps Minor
		2.4	 Surgical Correlates
			2.4.1	 Medial Orbital Cortical Approach
			2.4.2	 Lateral Orbital Cortical Approach
	3	 Conclusions
	References
Pineal Region Anatomy with Clinical Correlates
	1	 Introduction
	2	 Embryology
	3	 Vascular Anatomy
		3.1	 Arteries
		3.2	 Veins
	4	 Neural Anatomy
	5	 Anaesthetic Considerations for the Sitting Position
	6	 Surgical Techniques
	References
Anatomy of Corpus Callosum and Its Connections and Surgery for Corpus Callosal Tumors
	1	 Introduction
	2	 Gross Anatomy
		2.1	 The Callosal Radiations
		2.2	 Dorsal Callosal Radiations
		2.3	 Ventral Callosal Radiations
		2.4	 Anterior Callosal Radiations
		2.5	 Posterior Callosal Radiations/Forceps Major
	3	 Surgical Implications
		3.1	 Callosotomy
		3.2	 Corpus Callosal Gliomas
	4	 Conclusions
	References
The Central Core of the Brain
	1	 Introduction
	2	 Defining the Central Core
	3	 Deep Structures
	4	 White Matter Fibers
	5	 Vascularization
	6	 Central Core Segmentation
		6.1	 Anteroinferior Quadrant
		6.2	 Anterosuperior Quadrant
		6.3	 Posterosuperior Quadrant
		6.4	 Posteroinferior Quadrant
	7	 Surgical Approaches at the Central Core
	References
Fiber Anatomy of the Brainstem and Implications for Surgery of Brainstem Tumors
	1	 Introduction
	2	 Mid Brain
		2.1	 Extent
		2.2	 Parts/Divisions
		2.3	 External Features
			2.3.1	 Anterior Corridor: Cerebral Peduncles
			2.3.2	 Lateral Corridor
			2.3.3	 Posterior Corridor: Corpora Quadrigemina
		2.4	 Internal Features
			2.4.1	 Ventral Midbrain
				White Fibers
				Gray Matter
			2.4.2	 Dorsal Midbrain
				White Fibers
				Decussations
				Gray Matter
	3	 Pons
		3.1	 Extent
		3.2	 Parts/Divisions
		3.3	 External Features
			3.3.1	 Anterior Corridor
			3.3.2	 Lateral Corridor
			3.3.3	 Posterior Corridor
		3.4	 Internal Features
			3.4.1	 Ventral Pons
				White Fibers
				Gray Matter
			3.4.2	 Dorsal Pons
				White Fibers
				Gray Matter
	4	 Medulla
		4.1	 Extent
		4.2	 Parts/Divisions
		4.3	 External Features
			4.3.1	 Anterior Corridor
			4.3.2	 Lateral Corridor
			4.3.3	 Posterior Corridor
		4.4	 Internal Features
			4.4.1	 White Fibers
			4.4.2	 Gray Matter
				Motor Nuclei
				Sensory Nuclei
	5	 Floor of Fourth Ventricle
		5.1	 External
		5.2	 Internal
	6	 Organization of White Fibers of Brainstem (Figs. 11, 12, and 13)
	7	 Zone 1
		7.1	 Cerebellar Peduncles
			7.1.1	 Superior Cerebellar Peduncle
			7.1.2	 Middle Cerebellar Peduncle
			7.1.3	 Inferior Cerebellar Peduncle
			7.1.4	 Lateral Lemniscus
			7.1.5	 Superior Brachium
			7.1.6	 Inferior Brachium
	8	 Zone 2
		8.1	 Corticospinal Tract (CST)
		8.2	 Medial Lemniscus
		8.3	 Trigeminal Tract
		8.4	 Dorsal and Ventral Spinocerebellar Tracts
		8.5	 Spinal Lemniscus
	9	 Zone 3
		9.1	 Medial Longitudinal Fasciculus (MLF)
		9.2	 Central Tegmental Tract (CTT)
		9.3	 Tectobulbar and Tectospinal Tract
		9.4	 Brainstem Safe Entry Zones
	10	 Midbrain
	11	 Pons
	12	 Medulla
	References
Virtual Reality Surgical Simulation and Planning
	1	 Image Processing
		1.1	 Images Used for Surgical Assessment
		1.2	 Image Analysis Software
			1.2.1	 Major Software Programs that Generate Medical Fusion 3DCG Images
			1.2.2	 Main Software Programs for Virtual Reality Surgical Simulation
		1.3	 Image Processing Methods
			1.3.1	 Registration
			1.3.2	 Segmentation
			1.3.3	 Rendering
			1.3.4	 Simulation Operations
			1.3.5	 Application of Device
	2	 Clinical Evaluation
		2.1	 Tool Accuracy Evaluation
		2.2	 Subjective Evaluation of Users
		2.3	 Improved Visibility of Tissues and Diagnostic Accuracy
		2.4	 Surgical Plans, Surgical Results, and Outcomes
	3	 Cost
	References
Artificial Intelligence in the Management of Glial Tumors
	1	 What Is Artificial Intelligence?
	2	 The Basics of Artificial Intelligence in Brief
	3	 Artificial Intelligence in Neurosurgery
	4	 Non-invasive Glioma Subtyping
	5	 Non-invasive Molecular Glioma Diagnostics
	6	 Segmentation of Brain Tumors
	7	 Predicting Complications and Treatment Outcomes in Neurooncology
	8	 Data in Neurosurgery Are Rarely Big, But Typically Complex
	9	 Non-trivial Application of Artificial Intelligence in Neurooncology
	10	 What Is the Rationale for Using Artificial Intelligence in Neurosurgery?
	11	 Is it Possible to Develop Artificial Intelligence at the Bedside?
	12	 Conclusion
	References