title: Anatomo-functional study of the temporo-parieto-occipital region: dissection, tractographic and brain mapping evidence from a neurosurgical perspective.
abstract: The temporo-parieto-occipital (TPO) junction is a complex brain territory heavily involved in several high-level neurological functions, such as language, visuo-spatial recognition, writing, reading, symbol processing, calculation, self-processing, working memory, musical memory, and face and object recognition. Recent studies indicate that this area is covered by a thick network of white matter (WM) connections, which provide efficient and multimodal integration of information between both local and distant cortical nodes. It is important for neurosurgeons to have good knowledge of the three-dimensional subcortical organisation of this highly connected region to minimise post-operative permanent deficits. The aim of this dissection study was to highlight the subcortical functional anatomy from a topographical surgical perspective. Eight human hemispheres (four left, four right) obtained from four human cadavers were dissected according to Klingler's technique. Proceeding latero-medially, the authors describe the anatomical courses of and the relationships between the main pathways crossing the TPO. The results obtained from dissection were first integrated with diffusion tensor imaging reconstructions and subsequently with functional data obtained from three surgical cases, all resection of infiltrating glial tumours using direct electrical mapping in awake patients. The subcortical limits for performing safe lesionectomies within the TPO region are as follows: within the parietal region, the anterior horizontal part of the superior longitudinal fasciculus and, more deeply, the arcuate fasciculus; dorsally, the vertical projective thalamo-cortical fibres. For lesions located within the temporal and occipital lobes, the resection should be tailored according to the orientation of the horizontal associative pathways (the inferior fronto-occipital fascicle, inferior longitudinal fascicle and optic radiation). The relationships between the WM tracts and the ventricle system were also examined. These results indicate that a detailed anatomo-functional awareness of the WM architecture within the TPO area is mandatory when approaching intrinsic brain lesions to optimise surgical results and to minimise post-operative morbidity.
authors: Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.
authors: Alessandro
authors: A
authors: De Benedictis
authors: Hugues
authors: H
authors: Duffau
authors: Beatrice
authors: B
authors: Paradiso
authors: Enrico
authors: E
authors: Grandi
authors: Sergio
authors: S
authors: Balbi
authors: Enrico
authors: E
authors: Granieri
authors: Enzo
authors: E
authors: Colarusso
authors: Franco
authors: F
authors: Chioffi
authors: Carlo Efisio
authors: CE
authors: Marras
authors: Silvio
authors: S
authors: Sarubbo
mesh_terms: D000328:Adult; D001931:Brain Mapping; D002102:Cadaver; D004210:Dissection; D006801:Humans; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000033:anatomy & histology*; D010296:Parietal Lobe / Q000033:anatomy & histology*; D013702:Temporal Lobe / Q000033:anatomy & histology*; D066127:White Matter / Q000033:anatomy & histology
keywords: Klingler's technique; anatomic dissection; awake mapping; eloquent areas; hodotopy; temporo-parieto-occipital junction; white matter