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Surgical Anatomy of Supratentorial Midline Lesions

Surgical Anatomy of Supratentorial Midline Lesions

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adjacent territories. This occurs via association, commissural, and projection pathways and helps to explain the increasing phenomena <strong>of</strong><br />

gliomatosis cerebri and mutlicentricity. For example, most insular-based gliomas have components in the temporal and frontal lobes. The<br />

detailed demonstration <strong>of</strong> the uncinate fasciculus clearly documents how this takes place. This fasciculus must be identified and entered,<br />

underlying the middle cerebral artery bifurcation, during removal <strong>of</strong> insular gliomas.<br />

Our knowledge <strong>of</strong> subcortical functional pathways continues to be deficient, and, unfortunately, an anatomic study such as this cannot<br />

provide the missing pieces to the puzzle. Notwithstanding, this is a valuable anatomic study using the fiber dissection technique, which will<br />

serve as an excellent substrate to aid in our understanding <strong>of</strong> these critical pathways during surgery and to explain the pathophysiology <strong>of</strong> certain<br />

disease states that we encounter on a daily basis.<br />

Mitchel S. Berger<br />

San Francisco, California<br />

This is an unusual and interesting article, describing an older anatomic technique that is perhaps underappreciated today. Türe et al. present<br />

a description <strong>of</strong> the fiber dissection technique, a “tour" <strong>of</strong> hemispheric fiber tract anatomy using the technique, and a fascinating historical<br />

account.<br />

This is not a quantitative description <strong>of</strong> fiber tracts based on their investigation; however, it does provide a better appreciation for the<br />

three-dimensional, nonlinear organization <strong>of</strong> the brain and its importance to neurosurgery. This is sufficient reward for the reader; however, if<br />

one also is left with the temptation to visit the anatomy or pathology department and try the technique, à la Willis, Bell, Reil, Gall, Rolando, and<br />

Meynert, that is icing on the cake.<br />

David W. Roberts<br />

Lebanon, New Hampshire<br />

Key words: Fiber dissection technique; Microsurgical anatomy; White matter<br />

Accession Number: 00006123-200008000-00028<br />

Copyright (c) 2000-2005 Ovid Technologies, Inc.<br />

Version: rel10.2.0, SourceID 1.11354.1.65

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