Anterior peri-insular quadrantotomy: a cadaveric white matter dissection study

Area of Science:

• Neurosurgery
• Neuroanatomy
• Pediatric Oncology

Background:

• Large frontal lobe lesions in children anterior to the motor cortex pose surgical challenges.
• Safe and effective surgical options are crucial for pediatric patients with these lesions.

Purpose of the Study:

• To explore and illustrate the white matter tracts sectioned during anterior quadrant disconnection surgery.
• To provide a detailed anatomical basis for this surgical technique in pediatric patients.

Main Methods:

• Fiber dissection techniques were used on five human cadaveric hemispheres.
• Dissections were performed in multiple planes (lateral to medial, medial to lateral, ventral to dorsal).
• The study described tracts sectioned during four surgical steps: anterior suprainsular window, intrafrontal disconnection, anterior callosotomy, and frontobasal disconnection.

Main Results:

• The study detailed the sequential sectioning of white matter tracts, including U fibers, superior longitudinal fasciculus (SLF), uncinate fasciculus, inferior fronto-occipital fasciculus (IFOF), anterior limb of the internal capsule, corona radiata, cingulum, anterior callosum, and anterior commissure.
• Specific tracts visualized and sectioned at each surgical step were identified.

Conclusions:

• Anterior peri-insular quadrantotomy is an effective treatment for pediatric frontal lobe lesions anterior to the motor cortex.
• A thorough understanding of frontal lobe gyral anatomy and white matter connections is essential for surgical success and avoiding motor deficits.