Sincoff Eric H, Tan Yunxi, Abdulrauf Saleem I
Cerebrovascular and Skull Base Surgery Program, Division of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri 63110, USA.
J Neurosurg. 2004 Nov;101(5):739-46. doi: 10.3171/jns.2004.101.5.0739.
The aim of this anatomical study was to define more fully the three-dimensional (3D) relationships between the optic radiations and the temporal horn and superficial anatomy of the temporal lobe by using the Klingler white matter fiber dissection technique. These findings were correlated with established surgical trajectories to the temporal horn. Such surgical trajectories have implications for amygdalohippocampectomy and other procedures that involve entering the temporal horn for the resection of tumors or vascular lesions.
Ten human cadaveric hemispheres were prepared with several cycles of freezing and thawing by using a modification of the method described by Klingler. Wooden spatulas were used to strip away the deeper layers of white matter progressively in a lateromedial direction, and various association, projection, and commissural fibers were demonstrated. As the dissection progressed, photographs of each progressive layer were obtained. Special attention was given to the optic radiation and to the sagittal stratum of which the optic radiation is a part. The trajectories of fibers in the optic radiation were specifically studied in relation to the lateral, medial, superior, and inferior walls of the temporal horn as well as to the superficial anatomy of the temporal lobe. In three of the hemispheres coronal sections were made so that the relationship between the optic radiation and the temporal horn could be studied more fully. In all 10 hemispheres that were dissected the following observations were made. 1) The optic radiation covered the entire lateral aspect of the temporal horn as it extends to the occipital horn. 2) The anterior tip of the temporal horn was covered by the anterior optic radiation along its lateral half. 3) The entire medial wall of the temporal horn was free from optic radiation fibers, except at the level at which these fibers arise from the lateral geniculate body to ascend over the roof of the temporal horn. 4) The superior wall of the temporal horn was covered by optic radiation fibers. 5) The entire inferior wall of the temporal horn was free from optic radiation fibers anterior to the level of the lateral geniculate body.
Fiber dissections of the temporal lobe and horn demonstrated the complex 3D relationships between the optic radiations and the temporal horn and superficial anatomy of the temporal lobe. Based on the results of this study, the authors define two anatomical surgical trajectories to the temporal horn that would avoid the optic radiations. The first of these involves a transsylvian anterior medial approach and the second a pure inferior trajectory through a fusiform gyrus. Lateral approaches to the temporal horn through the superior and middle gyri, based on the authors' findings, would traverse the optic radiations.
本解剖学研究的目的是通过使用克林格勒白质纤维解剖技术，更全面地定义视辐射与颞叶角及颞叶表面解剖结构之间的三维（3D）关系。这些发现与已确立的进入颞叶角的手术路径相关。此类手术路径对杏仁核海马切除术及其他涉及进入颞叶角切除肿瘤或血管病变的手术具有重要意义。
采用对克林格勒所描述方法的改良，对10个人类尸体半球进行多次冻融循环处理。使用木质刮匙从外侧向内侧逐步剥离白质的深层，展示各种联合纤维、投射纤维和连合纤维。随着解剖的进行，获取每个进展层的照片。特别关注视辐射以及视辐射所属的矢状层。具体研究了视辐射中纤维相对于颞叶角的外侧壁、内侧壁、上壁和下壁以及颞叶表面解剖结构的走行。在其中3个半球制作了冠状切片，以便更全面地研究视辐射与颞叶角之间的关系。在所有10个解剖的半球中进行了以下观察：1）视辐射在延伸至枕叶角时覆盖了颞叶角的整个外侧。2）颞叶角的前端在其外侧一半被前视辐射覆盖。3）颞叶角的整个内侧壁没有视辐射纤维，除了这些纤维从外侧膝状体发出并越过颞叶角顶部上升的水平。4）颞叶角的上壁被视辐射纤维覆盖。5）在外侧膝状体水平之前，颞叶角的整个下壁没有视辐射纤维。
颞叶和颞叶角的纤维解剖显示了视辐射与颞叶角及颞叶表面解剖结构之间复杂的三维关系。基于本研究结果，作者定义了两条可避开视辐射的进入颞叶角的解剖学手术路径。第一条路径涉及经外侧裂前内侧入路，第二条路径是通过梭状回的纯粹下向路径。根据作者的发现，通过上回和中回的颞叶角外侧入路会穿过视辐射。
