Abstract
Introduction: The anatomical structures of the parietal lobe at the cortical and subcortical levels are related mainly to sensory, visuospatial, visual and language function. The aim of this study was to present an intraoperative perspective of these critical structures in terms of the surgical treatment of intra-axial lesions. The study also discusses the results of the technique and the results of direct brain stimulation under awake conditions.Materials and Methods: Five adult brains were prepared according to the Klingler technique. Cortical assessments and all measurements were performed with the naked eye, while white matter dissection was performed with microscopic magnification.Results: Intra-axial lesions within the parietal lobe can be approached through a lateral or superior trajectory. This decision is based on the location of the lesions in relation to the arcuate fascicle/superior longitudinal fascicle (AF/SLF) complex and ventricular system. Regardless of the approach, the functional borders of the resection are defined by the postcentral gyrus anteriorly and Wernicke's speech area inferiorly. On the subcortical level, active identification of the AF/SLF complex and of the optic radiation within the sagittal stratum should be performed. The intraparietal sulcus (IPS) is a reliable landmark for the AF/SLF complex in ~60% of cases.Conclusion: Knowledge of the cortical and subcortical anatomical and functional borders of the resection is crucial in preoperative planning, prediction of the risk of postoperative deficits, and intraoperative decision making.
Highlights
The anatomical structures of the parietal lobe at the cortical and subcortical levels are related mainly to sensory, visuospatial, visual and language function
In addition to containing cortical regions related to sensory and language function at the subcortical level, the parietal lobe is a crossroads of white matter tracts related to motor, sensory, language, visuospatial, and visual function [2]
The parietal lobe has four main components: the postcentral gyrus, the inferior parietal lobule (IPL), the superior parietal lobule (SPL), and, on the medial surface, the precuneus, which merges with the SPL on the superior margin of the hemisphere [5] (Figures 1, 2)
Summary
The anatomical structures of the parietal lobe at the cortical and subcortical levels are related mainly to sensory, visuospatial, visual and language function. In addition to containing cortical regions related to sensory and language function at the subcortical level, the parietal lobe is a crossroads of white matter tracts related to motor, sensory, language, visuospatial, and visual function [2]. Surgical approaches to the parietal lobe are mainly based on the lesion’s localization in relation to the ventricular system and the main white matter tracts of the sagittal stratum (SS) and arcuate fasciculus/superior longitudinal fasciculus complex (AF/SLF complex) (Figure 1). We studied in detail the cortical anatomy of the parietal lobe as well as of white matter tracts and its relationship to the brain surface, which must be taken into consideration during surgical procedures
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