6/15/2023 0 Comments Definition of eloquent cortexShort association fibers, also known as U-fibers, lie immediately beneath the gray matter, and connect adjacent gyri, whereas long association fibers connect the more widely separated gyri in the same hemisphere. White matter tracts in the brain are categorized into association, commissural, and projection fibers. AF, arcuate fasciculus cs, central sulcus EC, extreme capsule pcg, precentral gyrus pog, postcentral gyrus SLF, superior longitudinal fasciculus SS, sagittal stratum th, temporal horn TL-OR, temporal loop of the optic radiation UF, uncinate fasciculus. 3.1 The spatial relationship between some eloquent fiber tracts and cortical areas. And for the same reason, detailed knowledge of the white matter tracts is of paramount importance while dealing with intrinsic lesions in the brain 3( Fig. Hence the idea of “eloquent areas” should be expanded to include deep structures rather than a purely cortical concept. 1 , 2If the fiber bundles do not function properly, neurological deficits will present regardless if eloquent cortical areas remain intact. Eloquent brain regions are defined as being essential for carrying out readily identifiable neurological functions, including the sensorimotor, verbal, acoustic, and visual cortex the thalamus and hypothalamus the internal capsule and the brainstem. Any damage to the white matter tracts may result in impairments of certain brain function.Īs axons of neurons, fiber tracts are generally not regarded as “eloquent areas” of the brain. White matter tracts carry nerve impulses between neurons that resided in gray matter, acting as relays and coordinating communications between different brain areas. The white matter is made up of bundles of myelinated axons, known as fiber tracts. The detailed knowledge of the three-dimensional brain anatomy is the key to avoid impairing brain functions during surgery. In this chapter, we will introduce the most relevant eloquent white matter tracts and their relationship with surgical approaches. Hence, the stereoscopic structures of the brain, better than a pure cortical conception, should be taken into account when considering the “eloquence” of the brain. Ignorance of the functioning fiber bundles and accidental injury may result in postoperative neurological deficits. At the same time, neurosurgical procedures ordinarily require passage through one or multiple fiber tracts to reach the target in intrinsic brain lesions. While the “eloquent area” is a concept that is more frequently linked to cortical regions alone, the role of deep fiber tracts in the proper functioning of the brain is often underestimated. Lesions in eloquent areas represent a great challenge for neurosurgeons due to its surgical complexity. 3 Anatomy of Eloquent White Matter Tracts Vicent Quilis-Quesada and Shao-Ching Chen
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