Sectional Neuroanatomy Research Articles

Enhancing the effectiveness of teaching neuroanatomy: A comparative study using stained and unstained brain sections to interpret cross sectional neuroanatomy

BackgroundNeuroanatomy is considered one of the most challenging parts of anatomy curriculum and the complexity in understanding neuroanatomy generates from the lack of a 3-dimensional view of the structures. Since everything appears grey and white and is difficult to differentiate the various structures in a cross section of brain, staining aids in the visual interpretation and retention. There are various staining methods employed such as Mulligan's method, Alston's method, Prussian blue reaction method, however the results obtained by Alston's method was the best as gathered from previous literature. Material and methodsThe study was conducted in the department of Anatomy, formalin fixed brain slices measuring 10 mm thickness were stained using Alston's method. 250 medical students of the first professional year were demonstrated features such as the internal capsule, caudate nucleus, lentiform and thalamus in the stained and unstained transverse sections of cerebrum during their neuroanatomy practical sessions. Following which a feedback was collected regarding both the specimens using Microsoft Forms. ResultsThere was a positive feedback from the students with 83 % of them preferring the stained over the unstained section. Excerpts from the open ended question where all in favour of the stained sections -“much easier to see and identify the parts in the stained section because of the clear distinction between white and grey matter”. ConclusionsMacroscopic staining of sections of the brain using Alston's method could be implemented as a valuable method for effective teaching of neuroanatomy since students appreciated the structures better in the stained sections which enhanced their retention of neuroanatomy. Since Alston stain produces the least shrinkage, these stained sections could be utilized for research studies and such specimens could also be plastinated.

Suggestions on the Proper Improvement of the Neuroanatomy Lab: Based in the Survey Analysis on the Online Sectional Neuroanatomy Lab Lecture to the Neuroanatomy Class

Suggestions on the Proper Improvement of the Neuroanatomy Lab: Based in the Survey Analysis on the Online Sectional Neuroanatomy Lab Lecture to the Neuroanatomy Class

Atlas of Anatomy

What factors should we consider when we are thinking of acquiring an atlas of anatomy? Those looking for an atlas that includes surface anatomy, sectional anatomy, and essential radiographic anatomy (including simple Rx, computed tomography, and magnetic resonance images, but also coronary angiographies), accompanied by brief “clinical boxes” in each chapter (some with endoscopic images), along with the possibility of online tests (www.winkingskull.com), will find all of these resources in this third edition of Thieme’s Atlas of Anatomy.1 A detailed subsection of neurovasculature, which may be of special interest for anesthetists, is included for each topographical anatomical chapter. This edition of Thieme’s Anatomy is a single volume of 760 pages, based on the illustrations of the Prometheus Atlas of Anatomy (3 volumes).2 A few authors have prepared a full-body photographic atlas (560 pages).3 Those interested in peripheral nerve blocks also might consult a specific photographic atlas of the locomotor system (422 pages).4 Only one of the other classical atlases based on illustrations5 is now presented in a smaller volume of 640 pages, because clinical “bonus plates” and anatomical variations are available online through the “student consult” tool, whereas “clinical anatomy” and “radiologic anatomy” are presented in separate volumes. The “clinical boxes” in the revised version of Thieme’s Anatomy are a pleasant surprise when exploring the different chapters. Indexation, however, in future editions would make them easier to locate. A few very common pathologies that require good anatomical knowledge (eg, tendinitis of the rotator cuff of the shoulder) could be added, the basic information on others (eg, carpal tunnel syndrome) could be slightly extended, and the identification of some structures in sectional anatomy could be improved (eg, the esophagus versus azygos vein in thoracic magnetic resonance imaging planes). Readers seeking more details about clinical anatomy can consult the larger single-volume editions of 818,6 888,7 or 11928 pages (which include basic embryology)8 with the online student consult tool for illustrations and quizzes6,8 or books like Clinically Oriented Anatomy,9 with specific references to regional anesthesia, including vascular approaches. As for the comprehension of the Thieme’s Atlas of Anatomy, the extreme simplicity of the neuroanatomy chapter is somewhat disappointing. The choice of illustrations with confusing anatomical variations in the cortical gyri (interrupted gyrus cinguli or duplications of the middle temporal gyrus), the absence of Brodmann’s areas, the use of a single nonrepresentative basal axial plane in the sectional neuroanatomy, or the use of a single T2-weighted axial plane (although T1 is better for appreciating anatomical details) in radiographic neuroanatomy could all be improved in future editions for medical students. It is likely that future correlation of anatomical photos or illustrations of sections with adjacent magnetic resonance images10 would enhance understanding. Nonetheless, anesthetists will find sufficient information on the most complex structures of interest to them, such as the infratemporal or pterygopalatine fossa, or the innervation of the orbit (including ethmoidal nerves, long and short ciliary nerves, and so on). Thieme’s Anatomy, 3rd edition, is available in English for the moment, but previous editions are available in other languages, as in the case of the referred atlases2,4,7–10 (some of them in more than 15 languages).3,5,6 Altogether, this single-volume Thieme’s Atlas of Anatomy may be a good choice for those who are interested in a pragmatic, simplified atlas of anatomy. Those looking for more detailed approaches to clinical anatomy will need to consult other resources. Anna Puigdellívol-Sánchez, MD, PhDHuman Anatomy and Embryology UnitDepartment of Surgery and Medico-surgicalSpecializationsUniversity of BarcelonaBarcelona, Spain[email protected] Miguel A. Reina, MD, PhDDepartment of AnesthesiologyMadrid-Montepríncipe University Hospitaland School of MedicineCEU San Pablo UniversityMadrid, Spain Alberto Prats-Galino, MD, PhDHuman Anatomy and Embryology UnitDepartment of Surgery and Medico-SurgicalSpecializationsUniversity of BarcelonaBarcelona, Spain

Computer-Based Learning: Graphical Integration of Whole and Sectional Neuroanatomy Improves Long-Term Retention

A study was conducted to test the hypothesis that instruction with graphically integrated representations of whole and sectional neuroanatomy is especially effective for learning to recognize neural structures in sectional imagery (such as magnetic resonance imaging [MRI]). Neuroanatomy was taught to two groups of participants using computer graphical models of the human brain. Both groups learned whole anatomy first with a three-dimensional model of the brain. One group then learned sectional anatomy using two-dimensional sectional representations, with the expectation that there would be transfer of learning from whole to sectional anatomy. The second group learned sectional anatomy by moving a virtual cutting plane through the three-dimensional model. In tests of long-term retention of sectional neuroanatomy, the group with graphically integrated representation recognized more neural structures that were known to be challenging to learn. This study demonstrates the use of graphical representation to facilitate a more elaborated (deeper) understanding of complex spatial relations.

Three-Dimensional Interactive Atlas of Cranial Nerve-Related Disorders

Anatomical knowledge of the cranial nerves (CN) is fundamental in education, research and clinical practice. Moreover, understanding CN-related pathology with underlying neuroanatomy and the resulting neurological deficits is of vital importance. To facilitate CN knowledge anatomy and pathology understanding, we created an atlas of CN-related disorders, which is a three-dimensional (3D) interactive tool correlating CN pathology with the underlying surface and sectional neuroanatomy as well as the resulting neurological deficits. A computer platform was developed with: 1) anatomy browser along with the normal brain atlas (built earlier); 2) simulator of CN lesions; 3) tools to label CN-related pathology; and 4) CN pathology database with lesions and disorders, and the resulting signs, symptoms and/or syndromes. The normal neuroanatomy comprises about 2,300 3D components subdivided into modules. Cranial nerves contain more than 600 components: all 12 pairs of cranial nerves (CN I - CN XII) and the brainstem CN nuclei. The CN pathology database was populated with 36 lesions compiled from clinical textbooks. The initial view of each disorder was preset in terms of lesion location and size, surrounding surface and sectional neuroanatomy, and disorder and neuroanatomy labeling. Moreover, path selection from a CN nucleus to a targeted organ further enhances pathology-anatomy relationships. This atlas of CN-related disorders is potentially useful to a wide variety of users ranging from medical students and residents to general practitioners, neuroradiologists and neurologists, as it contains both normal brain anatomy and CN-related pathology correlated with neurological disorders presented in a visual and interactive way.

Bridging Neuroanatomy, Neuroradiology and Neurology: Three-Dimensional Interactive Atlas of Neurological Disorders

Understanding brain pathology along with the underlying neuroanatomy and the resulting neurological deficits is of vital importance in medical education and clinical practice. To facilitate and expedite this understanding, we created a three-dimensional (3D) interactive atlas of neurological disorders providing the correspondence between a brain lesion and the resulting disorder(s). The atlas contains a 3D highly parcellated atlas of normal neuroanatomy along with a brain pathology database. Normal neuroanatomy is divided into about 2,300 components, including the cerebrum, cerebellum, brainstem, spinal cord, arteries, veins, dural sinuses, tracts, cranial nerves (CN), white matter, deep gray nuclei, ventricles, visual system, muscles, glands and cervical vertebrae (C1-C5). The brain pathology database contains 144 focal and distributed synthesized lesions (70 vascular, 36 CN-related, and 38 regional anatomy-related), each lesion labeled with the resulting disorder and associated signs, symptoms, and/or syndromes compiled from materials reported in the literature. The initial view of each lesion was preset in terms of its location and size, surrounding surface and sectional (magnetic resonance) neuroanatomy, and labeling of lesion and neuroanatomy. In addition, a glossary of neurological disorders was compiled and for each disorder materials from textbooks were included to provide neurological description. This atlas of neurological disorders is potentially useful to a wide variety of users ranging from medical students, residents and nurses to general practitioners, neuroanatomists, neuroradiologists and neurologists, as it contains both normal (surface and sectional) brain anatomy and pathology correlated with neurological disorders presented in a visual and interactive way.

Comparing the Traditional and Combined Methods of Teaching Neuroantomy

Introduction: The sectional neuroanatomy due to its great importance in identifying the internal structure of the brain seems to be a necessary course of study to the residents of the neurosurgery, neurology and neuroradiology. The aim of this study was to determine the effectiveness of the traditional and the combined methods of teaching the neuroanatomy to two separate groups of neurosurgery residents. Methods: At the Imam Reza hospital of the Tabriz University of the medical sciences, the efficacy of the traditional and the combined methods of teaching the neuroanatomy to two separate groups of neurosurgery residents was compared and assessed by final exams and using questionnaires. Results: The scores of the group B in a quite similar exam were higher than the group A. The questionnaire investigation also indicated that the combined method of teaching was more effective than the traditional method. Conclusion: This study also concluded that plus the traditional method of teaching the neuroanatomy, the direct observation of the serially sectioned slices of the human embalmed brain and comparing them concurrently with the similar slices of the MRI images, can raise the ability of the trainees to identify the internal structures of the brain more precisely in their medical experiences.

Three-dimensional interactive and stereotactic atlas of head muscles and glands correlated with cranial nerves and surface and sectional neuroanatomy

Three-dimensional (3D) relationships between head muscles and cranial nerves innervating them are complicated. Existing sources present these relationships in illustrations, radiologic scans, or autopsy photographs, which are limited for learning and use. Developed electronic atlases are limited in content, quality, functionality, and/or presentation. We create a truly 3D interactive, stereotactic and high quality atlas, which provides spatial relationships among head muscles, glands and cranial nerves, and correlates them to surface and sectional neuroanatomy.The head muscles and glands were created from a 3T scan by contouring them and generating 3D models. They were named and structured according to Terminologia anatomica. The muscles were divided into: extra-ocular, facial, masticatory and other muscles, and glands into mouth and other glands. The muscles, glands (and also head) were placed in a stereotactic coordinate system. This content was integrated with cranial nerves and neuroanatomy created earlier.To explore this complex content, a scalable user interface was designed with 12 modules including central nervous system (cerebrum, cerebellum, brainstem, spinal cord), cranial nerves, muscles, glands, arterial system, venous system, tracts, deep gray nuclei, ventricles, white matter, visual system, head. Anatomy exploration operations include compositing/decompositing, individual/group selection, 3D view-index mapping, 3D labeling, highlighting, distance measuring, 3D brain cutting, and axial/coronal/sagittal triplanar display.To our best knowledge, this is the first truly 3D, stereotactic, interactive, fairly complete atlas of head muscles, and the first attempt to create a 3D stereotactic atlas of glands. Its use ranges from education of students and patients to research to potential clinical applications.

Stroke Atlas: A 3D Interactive Tool Correlating Cerebrovascular Pathology with Underlying Neuroanatomy and Resulting Neurological Deficits

Understanding stroke-related pathology with underlying neuroanatomy and resulting neurological deficits is critical in education and clinical practice. Moreover, communicating a stroke situation to a patient/family is difficult because of complicated neuroanatomy and pathology. For this purpose, we created a stroke atlas. The atlas correlates localized cerebrovascular pathology with both the resulting disorder and surrounding neuroanatomy. It also provides 3D display both of labeled pathology and freely composed neuroanatomy. Disorders are described in terms of resulting signs, symptoms and syndromes, and they have been compiled for ischemic stroke, hemorrhagic stroke, and cerebral aneurysms. Neuroanatomy, subdivided into 2,000 components including 1,300 vessels, contains cerebrum, cerebellum, brainstem, spinal cord, white matter, deep grey nuclei, arteries, veins, dural sinuses, cranial nerves and tracts. A computer application was developed comprising: 1) anatomy browser with the normal brain atlas (created earlier); 2) simulator of infarcts/hematomas/aneurysms/stenoses; 3) tools to label pathology; 4) cerebrovascular pathology database with lesions and disorders, and resulting signs, symptoms and/or syndromes. The pathology database is populated with 70 lesions compiled from textbooks. The initial view of each pathological site is preset in terms of lesion location, size, surrounding surface and sectional neuroanatomy, and lesion and neuroanatomy labeling. The atlas is useful for medical students, residents, nurses, general practitioners, and stroke clinicians, neuroradiologists and neurologists. It may serve as an aid in patient-doctor communication helping a stroke clinician explain the situation to a patient/family. It also enables a layman to become familiarized with normal brain anatomy and understand what happens in stroke.

Computer‐based learning: Interleaving whole and sectional representation of neuroanatomy

The large volume of material to be learned in biomedical disciplines requires optimizing the efficiency of instruction. In prior work with computer-based instruction of neuroanatomy, it was relatively efficient for learners to master whole anatomy and then transfer to learning sectional anatomy. It may, however, be more efficient to continuously integrate learning of whole and sectional anatomy. A study of computer-based learning of neuroanatomy was conducted to compare a basic transfer paradigm for learning whole and sectional neuroanatomy with a method in which the two forms of representation were interleaved (alternated). For all experimental groups, interactive computer programs supported an approach to instruction called adaptive exploration. Each learning trial consisted of time-limited exploration of neuroanatomy, self-timed testing, and graphical feedback. The primary result of this study was that interleaved learning of whole and sectional neuroanatomy was more efficient than the basic transfer method, without cost to long-term retention or generalization of knowledge to recognizing new images (Visible Human and MRI).

Sectional Neuroanatomy of the Pelvic Floor

This is the sixth in a series of articles on the spine. The first 5 reviewed the sectional anatomy of the cervical, thoracic, and lumbosacral spines. This paper will review both the male and female pelves. Procedures performed in the pelvis include electromyography of the anal sphincter, pudendal and sacral nerve stimulator implants, and botulinum toxin type A injections into the prostate, the bladder, the urethra, and the anus. Complications from these procedures are rare. Electromyography in this region is particularly uncomfortable. Botulinum toxin type A denervation may result in local effects such as incontinence or urinary retention or rarely remote effects such as limb weakness. Neurostimulators may get infected or may fail. This article provides anatomically accurate schematics of innervations of the pelvis that can be used to interpret magnetic resonance images of muscles and nerves in the pelvic floor region. Cross-sectional schematics of the male and female pelves were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and the skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of both the male and female pelves allows the physician to increase the accuracy and efficacy of interventional procedures. This anatomic map could also assist the electromyographer in correlating the clinical and electrophysiologic findings on magnetic resonance images.

A new presentation and exploration of human cerebral vasculature correlated with surface and sectional neuroanatomy

The increasing complexity of human body models enabled by advances in diagnostic imaging, computing, and growing knowledge calls for the development of a new generation of systems for intelligent exploration of these models. Here, we introduce a novel paradigm for the exploration of digital body models illustrating cerebral vasculature. It enables dynamic scene compositing, real-time interaction combined with animation, correlation of 3D models with sectional images, quantification as well as 3D manipulation-independent labeling and knowledge-related meta labeling (with name, diameter, description, variants, and references). This novel exploration is incorporated into a 3D atlas of cerebral vasculature with arteries and veins along with the surrounding surface and sectional neuroanatomy derived from 3.0 Tesla scans. This exploration paradigm is useful in medical education, training, research, and clinical applications. It enables development of new generation systems for rapid and intelligent exploration of complicated digital body models in real time with dynamic scene compositing from highly parcellated 3D models, continuous navigation, and manipulation-independent labeling with multiple features.

Sectional Neuroanatomy of the Lumbosacral Spine (L1-S5)

This paper will review the lumbosacral spine (L1-S5). Procedures performed in the lumbosacral spine include electromyography, spinal stimulator implants, spinal infusion implants for spasticity or pain medications, sacroiliac spine injections, facet blocks, and steroid injections. Complications from these procedures include iatrogenic paraplegia or paraplegia due to transverse myelitis, intravascular penetration, dural puncture, increased pain at the injection site, increased radicular pain, increased spine pain, lightheadedness, nausea, nonspecific headache, and vomiting. Long-term complications include implant infection, implant or catheter dislodgment/kinking, and device failure. This paper provides anatomically accurate schematics of innervations of the lumbosacral spine (L1-S5) that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the lumbosacral spine were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the lumbosacral spine allows the physician to increase the accuracy and efficacy of interventional procedures. This anatomical map could also assist the electromyographer in correlating the clinical and electrophysiological findings on magnetic resonance images.

Sectional Neuroanatomy of the Middle Thoracic Spine (T5-T8) and Chest

This is the third in a series of articles on the spine. The first reviewed the anatomy of the neck. The second reviewed the upper thoracic spine and chest (T1-T4). A fourth article is planned for the lower thoracic spine. Procedures in the midthoracic spine include chest tube placement, trigger point injections, chemodenervation with botulinum toxin, video-assisted thoroscopic surgery, and spinal injections. Complications include pneumothorax, hemothorax, diaphragmatic irritation, sympathetic trunk irritation, postthoracotomy pain, and intradural abscesses. This article provides anatomically accurate schematics of innervations of the middle thoracic chest and spine (T5-T8) that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the middle thoracic chest and spine were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the middle thoracic chest and spine allows the physician to increase the accuracy and efficacy of interventional procedures. This could also assist the electromyographer in correlating the clinical and electrophysiologic findings with magnetic resonance images.

Sectional Neuroanatomy of the Upper Thoracic Spine and Chest

This is the second in a series of articles on the spine. The first reviewed the anatomy of the neck. Subsequent articles are planned to cover the anatomy of the middle and lower thoracic spine. Procedures and trauma of the upper thoracic spine and chest are fraught with potentially serious complications. Hemothorax, pneumothorax, nerve damage, pulmonary collapse, and thoracic aortic aneurysm are included in the list. This article provides anatomically accurate schematics of innervation of the upper thoracic chest and spine that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the upper chest and spine were drawn as they appear in imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the upper chest and spine allows the physician to increase the accuracy and efficacy of interventional procedures. This could also assist the electromyographer in correlating the clinical and electrophysiologic findings with magnetic resonance images.

Sectional Neuroanatomy of the Face

Needle electromyography and the injection procedures of the face are difficult because of the small size and close anatomic relations of the facial structures. Local injections of the face have increased in frequency since the introduction of botulinum toxin. This article intends to provide anatomically accurate schematics of innervation of the muscles of facial expression that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the face were drawn as they appear in imaging projections. The relevant cranial and spinal nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the face allows the physician to increase the accuracy and efficacy of interventional procedures. This could also assist the electromyographer in correlating the clinical and electrophysiologic findings with magnetic resonance images.

Sectional neuroanatomy of the lower limb II: leg and foot.

The authors have produced a pair of articles that can be used to rapidly identify back, hip, and lower limb muscles and their innervation(s). This article presents the motor and sensory innervation of the lower limb by color-coding structures to match their peripheral nerves. It provides a companion summary table that allows prediction of unique patterns of denervation from 12 lesions sites.

Sectional neuroanatomy of the lower limb I: lower back and hip.

This series of two articles is structured to provide anatomically accurate functional schematics of the motor and sensory innervation of the lower back, hip, and lower limb. This first paper provides radiographically oriented schematic axial sections of the lower back and hip in which the muscles are appropriately color-coded to match the peripheral nerves. A companion color-coded summary table allows prediction of unique patterns of denervation from 25 lesion sites. These are divided into three categories (roots T12 to S4, four plexal quadrants, and 11 sectional levels). Correlation between an imaging abnormality at one of these lesion sites and the predicted denervation pattern ensures the lesion is, in fact, clinically significant. The next article will continue this color-coded approach into the lower limb.

Sectional neuroanatomy of the upper limb III: forearm and hand.

This paper is the last of three articles that describe the functional anatomy of the upper limb. It extends the series by presenting the axial anatomy of the forearm and hand. In addition, it provides a table that defines the patterns of muscle denervation specific to six representative sites. This set of articles is clinically useful because it can be used to rapidly identify and describe the innervation of the muscles and skin of the upper limb.

Sectional Neuroanatomy of the Upper Limb II: Shoulder and Upper Arm

This article is the second in a series of three that presents an anatomic functional guide to the peripheral innervation of the shoulder and upper limb. It illustrates the axial anatomy of the shoulder and upper arm. The next article continues this format for the lower arm and hand. Together, all three papers can be used to rapidly identify each upper limb muscle and its innervation(s). They can also be used to locate the peripheral nerve trunks, and correlate lesions with the classic pattern(s) of muscle denervation and altered sensation.