Sarubbo Silvio, De Benedictis Alessandro, Milani Paola, Paradiso Beatrice, Barbareschi Mattia, Rozzanigo Umbero, Colarusso Enzo, Tugnoli Valeria, Farneti Marco, Granieri Enrico, Duffau Hugues, Chioffi Franco
Department of Neurosciences, Division of Neurosurgery, 'S. Chiara' Hospital, Trento, Italy; Biomedical and Surgical Sciences, Section of Neurological Psychiatric and Psychological Sciences, 'S. Anna' University-Hospital, Ferrara, Italy.
J Anat. 2015 Jan;226(1):47-59. doi: 10.1111/joa.12254. Epub 2014 Nov 17.
Even if different dissection, tractographic and connectivity studies provided pure anatomical evidences about the optic radiations (ORs), descriptions of both the anatomical structure and the anatomo-functional relationships of the ORs with the adjacent bundles were not reported. We propose a detailed anatomical and functional study with 'post mortem' dissections and 'in vivo' direct electrical stimulation (DES) of the OR, demonstrating also the relationships with the adjacent eloquent bundles in a neurosurgical 'connectomic' perspective. Six human hemispheres (three left, three right) were dissected after a modified Klingler's preparation. The anatomy of the white matter was analysed according to systematic and topographical surgical perspectives. The anatomical results were correlated to the functional responses collected during three resections of tumours guided by cortico-subcortical DES during awake procedures. We identified two groups of fibres forming the OR. The superior component runs along the lateral wall of the occipital horn, the trigone and the supero-medial wall of the temporal horn. The inferior component covers inferiorly the occipital horn and the trigone, the lateral wall of the temporal horn and arches antero-medially to form the Meyer's Loop. The inferior fronto-occipital fascicle (IFOF) covers completely the superior OR along its entire course, as confirmed by the subcortical DES. The inferior longitudinal fascicle runs in a postero-anterior and inferior direction, covering the superior OR posteriorly and the inferior OR anteriorly. The IFOF identification allows the preservation of the superior OR in the anterior temporal resection, avoiding post-operative complete hemianopia. The identification of the superior OR during the posterior temporal, inferior parietal and occipital resections leads to the preservation of the IFOF and of the eloquent functions it subserves. The accurate knowledge of the OR course and the relationships with the adjacent bundles is crucial to optimize quality of resection and functional outcome.
即使不同的解剖、纤维束成像和连通性研究提供了关于视辐射（ORs）的纯解剖学证据，但关于ORs的解剖结构及其与相邻束的解剖-功能关系的描述尚未见报道。我们提出通过对视辐射进行“尸检”解剖和“活体”直接电刺激（DES）进行详细的解剖学和功能研究，同时从神经外科“连接组学”角度展示其与相邻明确束的关系。在改良的克林格勒（Klingler）制备方法后，对六个人类大脑半球（三个左侧，三个右侧）进行了解剖。根据系统和局部解剖手术视角分析白质的解剖结构。将解剖学结果与清醒手术期间在皮质-皮质下DES引导下进行的三次肿瘤切除过程中收集的功能反应相关联。我们确定了构成视辐射的两组纤维。上部分沿着枕角的外侧壁、三角区和颞角的上内侧壁走行。下部分在下方覆盖枕角和三角区、颞角的外侧壁，并向前内侧呈弓形形成迈耶袢（Meyer's Loop）。经皮质下DES证实，额枕下束（IFOF）在其全程完全覆盖视辐射上部。下纵束向后上和下方走行，在后方覆盖视辐射上部，在前方覆盖视辐射下部。识别额枕下束可在颞前叶切除术中保留视辐射上部，避免术后完全性偏盲。在颞后叶、顶下叶和枕叶切除术中识别视辐射上部可保留额枕下束及其所支持的明确功能。对视辐射走行及其与相邻束关系的准确了解对于优化切除质量和功能结果至关重要。
