Al-Juboori Ahmed Adnan, Badran Saif Anmar, Sulaiman Injam Ibrahim, Shahadha Ali Akram, Alsamok Ali Sabah, Al-Badri Sajjad G, Al-Taie Rania H, Ismail Mustafa
Department of Surgery, Dr. Sa'ad AL-Witri Hospital for Neurosciences, Baghdad, Iraq.
Department of Surgery, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq.
Surg Neurol Int. 2025 Jan 3;16:4. doi: 10.25259/SNI_955_2024. eCollection 2025.
The sagittal stratum (SS) is an important white matter (WM) structure that provides the anatomic substrate for cortico-cortical and cortico-subcortical axial interconnections necessary to overcome sensory, cognitive and motor processes. SS damage due to diseases or surgical lesions often results in significant functional losses, mainly involving serious language, visual processing, and cognitive deficits. These risks are maximized in older adults because of age-related WM degeneration.
In this comprehensive review, the research aims to synthesize research conducted on anatomy-functional roles that concern the SS, damage, and surgical outcomes. This would then separate studies that employed high neuroimaging advanced techniques, such as diffusion tensor imaging, combined with intraoperative mapping performed during awake surgery. Key attention areas will, therefore, be trajectories pointing toward lateralization of the SS tracts, age-related vulnerabilities, and the effectiveness of surgical strategies in preserving SS integrity.
The review indicates that the pattern of SS damage is associated with lateralized deficits stemming from left-sided lesions, while language and vision are affected by right-sided. Older adults, already bearing significant WM degeneration, therefore, stand at a significantly greater risk of overall cognitive decline from compounding losses due to SS damage. However, advanced neuroimaging tools and refined surgical techniques have made the preservation of SS pathways much more effective, reducing long-term deficits.
Intraoperative preservation of SS integrity is crucial for the reduction of functional deficits and enhancement of the outcomes. Customized surgical techniques that consider tract lateralization and age-related changes are required. Further research in this area is needed.
矢状层（SS）是一种重要的白质（WM）结构，为克服感觉、认知和运动过程所需的皮质-皮质及皮质-皮质下轴向互连提供了解剖学基础。由于疾病或手术损伤导致的SS损伤通常会导致显著的功能丧失，主要包括严重的语言、视觉处理和认知缺陷。由于与年龄相关的白质退化，这些风险在老年人中会最大化。
在这篇综述中，研究旨在综合关于SS的解剖学-功能作用、损伤和手术结果的研究。然后将采用高神经成像先进技术（如扩散张量成像）并结合清醒手术期间进行的术中图谱的研究区分开来。因此，关键关注领域将是指向SS束侧化的轨迹、与年龄相关的易损性以及保留SS完整性的手术策略的有效性。
综述表明，SS损伤模式与左侧病变引起的侧化缺陷相关，而语言和视觉受右侧病变影响。因此，已经存在显著白质退化的老年人，因SS损伤导致的复合性损失而面临整体认知能力下降的风险显著更高。然而，先进的神经成像工具和精细的手术技术使保留SS通路更加有效，减少了长期缺陷。
术中保留SS完整性对于减少功能缺陷和改善手术结果至关重要。需要考虑束侧化和与年龄相关变化的定制手术技术。该领域需要进一步研究。
