A Connectomic Atlas of the Human Cerebrum-Chapter 10: Tractographic Description of the Superior Longitudinal Fasciculus.

The superior longitudinal fasciculus/arcuate white matter complex (SLF/AC) is the largest and most complex white matter tract of the human cerebrum with multiple inter-linked connections encompassing multiple cognitive functions such as language, attention, memory, emotion, and visuospatial function. However, little is known regarding the overall connectivity of this complex. Recently, the Human Connectome Project parcellated the human cortex into 180 distinct regions. Utilizing diffusion spectrum magnetic resonance imaging tractography coupled with the human cortex parcellation data presented earlier in this supplement, we aim to describe the macro-connectome of the SLF/AC in relation to the linked parcellations present within the human cortex. The purpose of this study is to present this information in an indexed, illustrated, and tractographically aided series of figures and tables for anatomic and clinical reference.

A Connectomic Atlas of the Human Cerebrum-Chapter 16: Tractographic Description of the Vertical Occipital Fasciculus.

In this supplement, we show a comprehensive anatomic atlas of the human cerebrum demonstrating all 180 distinct regions comprising the cerebral cortex. The location, functional connectivity, and structural connectivity of these regions are outlined, and where possible a discussion is included of the functional significance of these areas. In this chapter, we specifically address regions integrating to form the vertical occipital fasciculus.

A Connectomic Atlas of the Human Cerebrum-Chapter 17: Tractographic Description of the Cingulum.

In this supplement, we show a comprehensive anatomic atlas of the human cerebrum demonstrating all 180 distinct regions comprising the cerebral cortex. The location, functional connectivity, and structural connectivity of these regions are outlined, and where possible a discussion is included of the functional significance of these areas. In this chapter, we specifically address regions integrating to form the cingulum.

A Connectomic Atlas of the Human Cerebrum-Chapter 11: Tractographic Description of the Inferior Longitudinal Fasciculus.

In this supplement, we seek to show a comprehensive anatomic atlas of the human cerebrum demonstrating all 180 distinct regions comprising the cerebral cortex. The location, functional connectivity, and structural connectivity of these regions are outlined, and where possible a discussion is included of the functional significance of these areas. In this chapter, we specifically address regions integrating to form the inferior longitudinal fasciculus.

A Connectomic Atlas of the Human Cerebrum-Chapter 13: Tractographic Description of the Inferior Fronto-Occipital Fasciculus.

The inferior fronto-occipital fasciculus (IFOF) is a large white matter tract of the human cerebrum with functional connectivity associated with semantic language processing and goal-oriented behavior. However, little is known regarding the overall connectivity of this tract. Recently, the Human Connectome Project parcellated the human cortex into 180 distinct regions. In our other work, we have shown these various regions in relation to clinically applicable anatomy and function. Utilizing Diffusion Spectrum Magnetic Resonance Imaging tractography coupled with the human cortex parcellation data presented earlier in this supplement, we aim to describe the macro-connectome of the IFOF in relation to the linked parcellations present within the human cortex. The purpose of this study is to present this information in an indexed, illustrated, and tractographically aided series of figures and tables for anatomic and clinical reference.

A Connectomic Atlas of the Human Cerebrum-Chapter 15: Tractographic Description of the Uncinate Fasciculus.

In this supplement, we show a comprehensive anatomic atlas of the human cerebrum demonstrating all 180 distinct regions comprising the cerebral cortex. The location, functional connectivity, and structural connectivity of these regions are outlined, and where possible a discussion is included of the functional significance of these areas. In this chapter, we specifically address the regions integrating to form the uncinate fasciculus.

A Connectomic Atlas of the Human Cerebrum-Chapter 14: Tractographic Description of the Frontal Aslant Tract.

In this supplement, we show a comprehensive anatomic atlas of the human cerebrum demonstrating all 180 distinct regions comprising the cerebral cortex. The location, functional connectivity, and structural connectivity of these regions are outlined, and where possible a discussion is included of the functional significance of these areas. In this chapter, we specifically address the regions integrating to form the frontal aslant tract.

A Connectomic Atlas of the Human Cerebrum-Chapter 12: Tractographic Description of the Middle Longitudinal Fasciculus.

The middle longitudinal fasciculus (MdLF) is a small and somewhat controversial white matter tract of the human cerebrum, confined to the posterior superior temporal region from which it courses posteriorly to connect at the occipital-parietal interface. The tract appears to be involved in language processing as well as auditory organization and localization, while sub-serving other higher level cognitive functions that have yet to be fully elucidated. Little is known about the specific, interparcellation connections that integrate to form the MdLF. Utilizing diffusion spectrum magnetic resonance imaging tractography coupled with the human cortex parcellation data presented earlier in this supplement, we aim to describe the macro-connectome of the MdLF in relation to the linked parcellations present within the human cortex. The purpose of this study is to present this information in an indexed, illustrated, and tractographically aided series of figures and tables for anatomic and clinical reference.

Mini-Pterional Craniotomy for Resection of Parasellar Meningiomas.

BACKGROUND: Surgical resection of parasellar meningiomas is a challenging operation that traditionally has been performed with a large pterional or orbitozygomatic craniotomy. In this study, we report patient outcomes and detail our surgical approach when resecting these tumors with a smaller, less invasive "mini-pterional" craniotomy. METHODS: We performed a retrospective review on all patients undergoing a mini-pterional craniotomy for resection of parasellar meningiomas from 2012 to 2016. We describe the technical aspects of the mini-pterional craniotomy and provide the outcomes of patients who received an operation with this approach. RESULTS: Twenty-four patients were treated with a mini-pterional craniotomy for resection of parasellar meningiomas. Median tumor volume was 6.2 cm3. Twenty-two of 24 (92%) patients had a World Health Organization grade I meningioma, and 2 of 24 (8%) patients had a World Health Organization grade II meningioma. Tumors were located at the medial sphenoid wing (60%), anterior clinoid (24%) and spheno-cavernous junction (12%). Nineteen of 24 (79%) patients had a Simpson Grade I resection and 5 of 24 (21%) a Simpson Grade IV resection. Median length of the operations was 242 minutes. Neurosurgical complications occurred in 2 patients who had a surgical-site infection and cerebrospinal fluid leak; one of these patients also developed postoperative hydrocephalus. In this series, no deaths, parenchymal contusions, or repeat operations occurred. CONCLUSIONS: The mini-pterional craniotomy can be used to resect parasellar meningiomas with good results and a low complication profile. This approach provides an efficacious method of resecting these tumors without sacrificing Simpson grade or patient safety.

Common Disconnections in Glioma Surgery: An Anatomic Description.

Within the surgical treatment of glioma, extended survival is predicated upon extent of resection which is limited by proximity and/or invasion of eloquent structures. Diffusion tensor imaging (DTI) tractography is a very useful tool for guiding supramaximal surgical resection while preserving eloquence. Although gliomas can vary significantly in size, shape, and invasion of functionally significant brain tissue, typical surgical disconnection patterns emerge. In this study, our typical surgical paradigm is outlined. We describe our surgical philosophy for resecting gliomas supramaximally summarized as define, divide, and destroy with the adjuvant utilization of neuronavigation and DTI. We describe the most common disconnections involved in glioma surgery at our institution; specifically, delineating tumor disconnections involving the medial posterior frontal, lateral posterior frontal, posterior temporal, anterior occipital, medial parietal, and insular regions. Although gliomas are highly variable, common patterns emerge in relation to the necessary disconnections required to preserve eloquent brain while maximizing the extent of resection.