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Anatomy of the supraventricular portion of the pyramidal tract

  • Experimental research
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Abstract

Background

The anatomy and somatotopy of the pyramidal tract during its course in the internal capsule has recently been discussed by many publications. However, the reports on the anatomy of the clinically more important supraventricular portion of the tract are scarce. The objective of this study is to investigate the anatomy and somatotopy of the supraventricular portion of the pyramidal tract.

Methods

In 13 patients undergoing surgery with subcortical electric stimulation for tumors located in the supraventricular white matter close to the pyramidal tract (as depicted by diffusion tensor tracking [DTT]), the relationship between the position of the stimulation point and the motor response in the arm or leg was analyzed. Additionally, the somatotopic organization of the tract was studied using separate tracking of arm and leg fibers in 20 healthy hemispheres. Finally, the course of the tract was studied by dissecting 15 previously frozen human hemispheres.

Results

In most cases, subcortical stimulation during the resection of tumors located behind and in front of the pyramidal tract elicited leg and arm movement, respectively. This association of stimulation point position with motor response type was significant. A DTT study of the somatotopy demonstrated a varying degree of rotation of the leg and arm fibers from mediolateral to posteroanterior configuration. Anatomic dissections demonstrated a folding-fan like structure of the pyramidal tract with a similar rotation pattern.

Conclusion

The pyramidal tract undergoes a large part of its rotation from mediolateral to posteroanterior configuration during its course in the supraventricular white matter, although interindividual differences exist.

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Acknowledgment

This work was supported by a grant from the Ministry of Health of the Czech Republic, NS 10478-3/2009.

Conflicts of interest

Amir Zolal was paid by Medtronic for lecturing on the use of the StealthViz software which was used for DTI in this work.

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Authors and Affiliations

  1. Department of Neurosurgery, J.E. Purkinje University and Masaryk Hospital, Socialni pece 12A, 401 00, Usti nad Labem, Czech Republic

    Amir Zolal, Petr Vachata, Aleš Hejčl, Robert Bartoš, Alberto Malucelli & Martin Sameš

  2. Department of Radiology, Masaryk Hospital, Usti nad Labem, Czech Republic

    Martina Nováková & Milouš Derner

Authors
  1. Amir Zolal
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  2. Petr Vachata
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  3. Aleš Hejčl
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  4. Robert Bartoš
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  5. Alberto Malucelli
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  6. Martina Nováková
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  7. Milouš Derner
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  8. Martin Sameš
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Corresponding author

Correspondence to Amir Zolal.

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Comment

Surgery of intrinsic brain lesions requires a precise anatomical knowledge and three-dimensional understanding of the spatial relationship of the different bundles of the white-matter, in particular of the pyramidal tract. As well demonstrated in this article, combining intraoperative electrophysiological cortical mapping techniques with diffusion tensor fiber tracking, it is possible to precisely and vividly understand the subcortical fiber tracts, so as to identify the patients' interindividual variation and ensure the accurate preoperative planning and prognosis assessment. Consistency of subcortical representation relies on the quality of DTI tractography, and certainly it will be improved when implemented DTI algorithm become available. The combination of high-resolution DTI fiber tracking with detailed information of functional anatomy of the cortical surface, as that provided by navigated transcranial magnetic stimulation will rise our awareness of the functional anatomy of the brain during surgical procedures.

Alfredo Conti

Messina, ITALY

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Zolal, A., Vachata, P., Hejčl, A. et al. Anatomy of the supraventricular portion of the pyramidal tract. Acta Neurochir 154, 1097–1104 (2012). https://doi.org/10.1007/s00701-012-1326-0

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  • DOI: https://doi.org/10.1007/s00701-012-1326-0

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