Bertolini Giacomo, La Corte Emanuele, Aquino Domenico, Greco Elena, Rossini Zefferino, Cardia Andrea, Nicolosi Federico, Bauer Dario, Bruzzone Maria Grazia, Ferroli Paolo, Serrao Graziano
Department of Health Sciences, University of Milan, Milan, Italy; Department of Neurosurgery, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy.
Department of Health Sciences, University of Milan, Milan, Italy; Department of Neurosurgery, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy.
World Neurosurg. 2019 May;125:198-206. doi: 10.1016/j.wneu.2019.01.196. Epub 2019 Feb 10.
Modern neuroanatomic education should be based on interdisciplinary methods that allow an understanding of the cerebral circuitry, which is at the base of the structural connectivity. Ex-vivo MRI-guided dissection is an essential method for developing and refining the knowledge of complex 3-dimensional brain anatomy and the mutual relationships between structures and architecture of the white matter bundles. The aim of this technical note is to present a new and innovative method of studying human brain white matter.
Four adult human cerebral hemispheres were prepared according to the Klinger's method. T1-weighted and T2-weighted and fluid attenuated inversion recovery images were obtained with a 3T magnetic resonance machine. The dissection was performed in a dedicated neurosurgical laboratory equipped with a microscope and an electromagnetic neuronavigation system that guided the whole white matter dissection.
Gyri and sulci morphology were studied in detail. The relations between superficial and inner structures were observed before and after the dissection. Gray matter was carefully removed with blunt dissectors, and the U-fibers were exposed. Afterwards, deeper association and projection fibers, such as the arcuate fasciculus, superior and inferior longitudinal fasciculus, corona radiata, extreme and external capsule, claustrum, anterior commissure, and internal capsule were visualized under high magnification. The neuronavigation system was crucial for continuously checking the whole dissection procedure to avoid any accidental excision of fibers.
Image-guided neuronavigated dissection can significantly improve the quality of white matter dissection and represents a valid tool for learning the 3-dimensional anatomy of the human brain tracts.
现代神经解剖学教育应以跨学科方法为基础，这种方法有助于理解大脑回路，而大脑回路是结构连接性的基础。体外磁共振成像引导下的解剖是一种重要方法，可用于拓展和完善对复杂三维脑解剖结构以及白质束结构与构筑之间相互关系的认识。本技术说明的目的是介绍一种全新且创新的研究人类脑白质的方法。
按照克林格氏方法制备4个成人脑半球。使用3T磁共振成像仪获取T1加权、T2加权和液体衰减反转恢复图像。解剖在配备显微镜和电磁神经导航系统的专用神经外科实验室进行，该系统引导整个白质解剖过程。
详细研究了脑回和脑沟的形态。观察了解剖前后浅表结构与内部结构之间的关系。用钝性解剖器小心去除灰质，暴露U形纤维。之后，在高倍放大下可看到更深层的联合纤维和投射纤维，如弓状束、上纵束和下纵束、放射冠、外囊和极外囊、屏状核、前连合和内囊。神经导航系统对于持续检查整个解剖过程至关重要，可避免意外切断纤维。
图像引导下的神经导航解剖可显著提高白质解剖的质量，是学习人类脑区三维解剖结构的有效工具。
