White matter fibres dissection in the human brain

Abstract

Introduction: lesion to white matter fibres can induce permanent neurological deficits due to the induction of disconnection syndromes. Knowledge of white matter fibre anatomy is therefore relevant to the neurosurgeon in order to minimise the risk of causing neurological damage when approaching lesions in eloquent areas of the brain. Aim: to investigate the 3D anatomy of white matter fibres with particular attention to the associative tracts, including short arcuate fibres and intralobar fibres. The results obtained will be used to provide insights in brain connectivity, delineating networks important for specific brain functions. Methods: The Klingler technique for white matter dissection was followed. Brain specimens were collected and prepared at the Newcastle Brain Tissue Resource, Newcastle University. Brains were initially fixed in 10% formalin for at least 4 weeks. After removing the pia-mater and arachnoid, the brains were frozen at -15C° for 2 weeks. The water crystallisation induced by the freezing process separates the white matter fibres, facilitating the dissection of the tracts. Dissection was performed with wooden spatulas and blunt metallic dissectors, removing the cortex and exposing the white matter. The short associative (U-shaped) fibres were initially exposed. Long associative, commissural and projection fibres were demonstrated as the dissection proceeded. Results: five papers form the main body of the present work: 1) “Raymond de Vieussens and his contribution to the study of white matter anatomy”. This historical paper reviewed the history of white matter dissection, focusing on the work of Raymond de Vieussens, who gave the first account of the centrum ovale and of the continuity of the corticospinal tract from the centrum ovale to the brainstem. 2) “The white matter of the human cerebrum: part I The occipital lobe by Heinrich Sachs “ ; 3) “Intralobar fibres of the occipital lobe: A post mortem dissection study”. These joint papers were dedicated to the white matter anatomy of the occipital lobe. A rich network of association fibres, arranged around the ventricular wall, was demonstrated. A new white matter tract, connecting the cuneus to the lingula, was also described. Our original data I II were compared to the atlas of occipital fibres produced by the German anatomist Heinrich Sachs. 4) “White matter connections of the Supplementary Motor Area (SMA) in humans”. This study demonstrated that the SMA shows a wide range of connections with motor, language and limbic areas. Features of the SMA syndrome (akinesia and mutism) can be better understood on the basis of these findings. 5) “Anatomical connections of the Subgenual Cingulate Region” (SCG). This study showed that the SCG is at the centre of a large network, connecting prefrontal, limbic and mesotemporal regions. The connectivity of this region can help explain the clinical effect of neuromodulaton of the SCG in Deep Brain Stimulation for neuropsychiatric disorders. Conclusions: Klingler dissection provided original data about the connections of different brain regions that are relevant to neurosurgical practice, along with the description of a new white matter tract, connecting the cuneus to the lingula.