Cadaveric White Matter Dissection Study of the Telencephalic Flexure: Surgical Implications

Area of Science:

• Neurosurgery and neuroscience research.

Background:

• Neurosurgery traditionally focused on cortical areas, but recent advances highlight white matter tracts (WMT) and brain networks.
• The human brain connectome is reshaping neurosurgical approaches.
• The telencephalic flexure significantly impacts CNS anatomy, particularly around the sylvian fissure.

Purpose of the Study:

• To describe the intricate anatomy of white matter tracts (WMT) influenced by the telencephalic flexure.
• To correlate cadaveric dissection data with neuro-embryogenesis and cross-species comparisons of the flexure.
• To emphasize the importance of understanding the telencephalic flexure's connectome for specific neurosurgical procedures.

Main Methods:

• Dissection of five adult human brains (medial to lateral and lateral to medial).
• Correlation of dissected WMT anatomy with literature on human neuro-embryogenesis and the telencephalic flexure.
• Cross-species comparison of the telencephalic flexure's anatomy.

Main Results:

• The telencephalic flexure dictates the ultimate shape and location of WMT in the human brain.
• Specific WMT, including projection, association, and commissural fibers, are intricately arranged due to the flexure.
• The flexure's influence is evident in the semicircular path of associative fibers and the intermingling of fiber types.

Conclusions:

• Precise definition of the telencephalic flexure's connectome is crucial for neurosurgery.
• This knowledge is particularly vital for glioma surgery and disconnective epilepsy surgery in the sylvian fissure region.
• Understanding the embryological development of the flexure enhances the interpretation of adult WMT anatomy.