Original ArticleThe Safe Area in the Parieto-Occipital Lobe in the Human Brain: Diffusion Tensor Tractography
Introduction
Invasive neurological interventions could often result in neural injury of the brain 4, 8, 14, 21, 25. These interventions comprise the operation, procedures of the shunt operation, radiotherapy, or radiosurgery 4, 8, 14, 21, 25. These interventions have been performed based on known neuroanatomy or experience (5). Anatomic identification of the safe area for performance of invasive neurological interventions could provide useful information for clinicians in the neuroscience field. However, due to limitations of previous neuroimaging techniques, such as conventional brain computerized tomography or magnetic resonance imaging, in identification and evaluation of neural tracts in the live human brain, research on this topic has been neglected.
In contrast, diffusion tensor tractography (DTT), which is derived from diffusion tensor imaging (DTI), enables identification and localization of neural tracts in 3 dimensions in the live human brain (18). A recent study (11) reported on the relatively safe area in the frontal lobe for performance of invasive neurological interventions. However, few DTT studies on the posterior safe area have been reported 2, 17. We hypothesized that the safe area in the parieto-occipital lobe could be identified using the reconstructed neural tracts for the cingulum, superior longitudinal fasciculus (SLF), middle longitudinal fasciculus (MLF), inferior longitudinal fasciculus (ILF), inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus (AF), and optic radiation (OR) 1, 3, 6, 9, 7, 10, 15, 16, 19, 24.
In the present study, using DTT, we attempted to identify the safe area in the parieto-occipital lobe in healthy subjects.
Section snippets
Subjects
We recruited 47 healthy subjects (men, 27; women, 20; mean age, 34.3 ± 11 years; range, 20–54 years) with no previous history of neurological, physical, or psychiatric illness. All subjects understood the purpose of the study and provided written, informed consent before participation. The study protocol was approved by the Institutional Review Board of a university hospital.
Diffusion Tensor Tractography
DTI data were acquired using a 6-channel head coil on a 1.5-T Philips Gyroscan Intera (Philips, Ltd., Best, the
Results
A summary of the anterior and medial boundaries of the safe area in 5 axial levels is shown in Table 1. In the upper cerebral cortex level, the anterior boundary of the safe area was located at 31.0 mm (24.7%) anteriorly from the line of the most posterior margin of the brain and the medial boundary was located at an average of 34.7 mm (60.6%) medially from the line of the most lateral margin of the brain. The anterior boundaries of the safe area in the lower cerebral cortex, CS, upper CR, and
Discussion
In the current study, we attempted to find the safe area in the parieto-occipital lobe for performance of invasive neurological interventions. We reconstructed all important neural tracts in the parieto-occipital area of the brain, the cingulum, SLF, MLF, ILF, IFOF, and OR, as well as other important neural tracts located in the middle portion of the brain, the CST, SST, CRP, and fornix. Our findings showed that the safe area was located in the posterolateral portion of the parieto-occipital
Conclusion
We investigated the safe area in the parieto-occipital lobe for performance of invasive neurological procedures and found that the safe area was located in the posterolateral portion of the parieto-occipital lobe in the shape of a triangle. However, we found no safe area in the deep white matter around the lateral ventricle. Therefore, research on the severity of neurological deficit and prognosis after injury of each neural tract would be helpful in selection of any neural tract when
References (25)
- et al.
A diffusion tensor imaging tractography atlas for virtual in vivo dissections
Cortex
(2008) - et al.
DtiStudio: resource program for diffusion tensor computation and fiber bundle tracking
Comput Methods Programs Biomed
(2006) - et al.
Diffusion spectrum magnetic resonance imaging (DSI) tractography of crossing fibers
Neuroimage
(2008) - et al.
Corticoreticular pathway in the human brain: diffusion tensor tractography study
Neurosci Lett
(2012) - et al.
Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations
J Neurosurg
(2014) - et al.
Diffusion tensor tractography of the limbic system
AJNR Am J Neuroradiol
(2005) - et al.
Brain injury due to ventricular shunt placement delineated by diffusion tensor imaging (DTI) tractography
Neurologist
(2008) Handbook of neurosurgery
(2010)- et al.
Reconstruction and dissection of the entire human visual pathway using diffusion tensor MRI
Front Neuroanat
(2010) - et al.
Limb apraxia in a patient with cerebral infarct: diffusion tensor tractography study
NeuroRehabilitation
(2012)
Serial diffusion tensor imaging for early detection of radiation-induced injuries to normal-appearing white matter in high-grade glioma patients
J Magn Reson Imaging
Somatotopic arrangement and location of the corticospinal tract in the brainstem of the human brain
Yonsei Med J
Cited by (5)
A taxonomy of the brain’s white matter: twenty-one major tracts for the 21st century
2022, Cerebral CortexStandard Parafascicular Approaches to Subcortical Regions
2022, Subcortical Neurosurgery: Open and Parafascicular Channel-Based Approaches for Subcortical and Intraventricular LesionsTrans-sulcal parafascicular surgical corridor for resection of brain tumors: The last frontier
2020, Principles of Neuro-Oncology: Brain & Skull BaseInjury of the superior longitudinal fasciculus by ventriculoperitoneal shunt: A diffusion tensor tractography study
2018, Neural Regeneration Research
Conflict of interest statement: This work was supported by the DGIST R&D Program of the Ministry of Science, ICT and Future Planning (15-BD-0401).