Saygi Tahsin, Avyasov Rashid, Barut Ozan, Daglar Zeynep, Baran Oguz, Hasimoglu Ozan, Altinkaya Ayca, Tanriover Necmettin
Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey.
Department of Neurosurgery, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Neurosurg Rev. 2023 Mar 31;46(1):82. doi: 10.1007/s10143-023-01982-w.
The dichotomy of the cingulum bundle into the dorsal supracallosal and ventral parahippocampal parts is widely accepted; however, the retrosplenial component with its multiple alternative connections has not been revealed. The aim of this study was to delineate the microsurgical anatomy of a connectionally transition zone, the isthmic cingulum, in relation to the posteromedial interhemispheric access to the atrium and discuss the relevant patterns of glioma invasion on the basis of its fiber connections. White matter (WM) fibers were dissected layer by layer in a medial-to-lateral, lateral-to-medial, and posterior-to-anterior fashion. All related tracts and their connections were generated using deterministic tractography. The magnetic resonance imaging (MRI) tractography findings were correlated with those of fiber dissection. A medial parieto-occipital approach to reach the atrium was performed with special emphasis on the cingulate isthmus and underlying WM connections. The isthmic cingulum, introduced as a retrosplenial connectional crossroad for the first time, displayed multiple connections to the splenium and the superior thalamic radiations. Another new finding was the demonstration of lateral hemispheric extension of the isthmic cingulum fibers through the base of the posterior part of the precuneus at the base of the parieto-occipital sulcus. The laterally crossing cingulum fibers were interconnected with three distinct association tracts: the middle longitudinal (MdLF), the inferior frontooccipital fasciculi (IFOF), and the claustro-cortical fibers (CCF). In the process of entry to the atrium during posterior interhemispheric approaches, the splenial and thalamic connections, as well as the laterally crossing fibers of the isthmic cingulum, were all in jeopardy. The connectional anatomy of the retrosplenial area is much more complicated than previously known. The isthmic cingulum connections may explain the concept of interhemispheric and medial to lateral cerebral hemisphere invasion patterns in medial parieto-occipital and posteromesial temporal gliomas. The isthmic cingulum is of key importance in posteromedial interhemispheric approaches to both: the atrium and the posterior mesial temporal lobe.
扣带束分为背侧胼胝体上部分和腹侧海马旁部分这一观点已被广泛接受；然而，具有多种替代连接的压后成分尚未被揭示。本研究的目的是描绘连接过渡区——峡部扣带——与经半球间后内侧入路到达侧脑室 atrium 的显微外科解剖结构，并基于其纤维连接讨论胶质瘤侵袭的相关模式。白质（WM）纤维以从内侧到外侧、从外侧到内侧以及从后到前的方式逐层解剖。所有相关束及其连接均使用确定性纤维束成像生成。磁共振成像（MRI）纤维束成像结果与纤维解剖结果相关联。采用内侧顶枕入路到达侧脑室 atrium，特别强调扣带回峡部和其下方的白质连接。峡部扣带首次被引入作为压后连接交叉点，显示出与胼胝体压部和丘脑上辐射有多种连接。另一个新发现是峡部扣带纤维通过顶枕沟底部楔前叶后部底部向外侧半球延伸。横向交叉的扣带纤维与三条不同的联合束相互连接：中间纵束（MdLF）、额枕下束（IFOF）和屏状核 - 皮质纤维（CCF）。在后半球间入路进入侧脑室 atrium 的过程中，胼胝体压部和丘脑连接以及峡部扣带的横向交叉纤维均处于危险之中。压后区域的连接解剖结构比以前所知的要复杂得多。峡部扣带连接可能解释内侧顶枕和颞叶内侧胶质瘤的半球间及从内侧到外侧脑半球侵袭模式的概念。峡部扣带在经半球间后内侧入路到达侧脑室 atrium 和颞叶内侧后份中起着关键作用。
