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Microsurgical anatomy of the sagittal stratum

  • Original Article - Neurosurgery general
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Abstract

Background

The sagittal stratum (SS) is a critical neural crossroad traversed by several white matter tracts that connect multiple areas of the ipsilateral hemisphere. Scant information about the anatomical organization of this structure is available in literature. The goal of this study was to provide a detailed anatomical description of the SS and to discuss the functional implications of the findings when a surgical approach through this structure is planned.

Methods

Five formalin-fixed human brains were dissected under the operating microscope by using the fiber dissection technique originally described by Ludwig and Klingler.

Results

The SS is a polygonal crossroad of associational fibers situated deep on the lateral surface of the hemisphere, medial to the arcuate/superior longitudinal fascicle complex, and laterally to the tapetal fibers of the atrium. It is organized in three layers: a superficial layer formed by the middle and inferior longitudinal fascicles, a middle layer corresponding to the inferior fronto-occipital fascicle, and a deep layer formed by the optic radiation, intermingled with fibers of the anterior commissure. It originates posteroinferiorly to the inferior limiting sulcus of the insula, contiguous with the fibers of the temporal stem, and ends into the posterior temporo-occipito-parietal cortex.

Conclusion

The white matter fiber dissection reveals the tridimensional architecture of the SS and the relationship between its fibers. A detailed understanding of the anatomy of the SS is essential to decrease the operative risks when a surgical approach within this area is undertaken.

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Acknowledgements

We thank Professor Beth De Felici for the English revision.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy

    Davide Tiziano Di Carlo, Nicola Benedetto, Federico Cagnazzo, Alessandro Weiss & Paolo Perrini

  2. Department of Neurosurgery, Gui de Chauliac Hospital, CHU Montpellier, Montpellier University Medical Center, 80, Avenue Augustin Fliche, 34295, Montpellier, France

    Hugues Duffau

  3. Institute for of Montpellier, INSERM U1051, Team “Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors,” Saint Eloi Hospital, Montpellier University Medical Neuroscience Center, Montpellier, France

    Hugues Duffau

  4. Department of Human Pathology, University of Pisa, Pisa, Italy

    Maura Castagna

  5. Department of Neuroradiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Paradisa 2, 56100, Pisa, Italy

    Mirco Cosottini

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  1. Davide Tiziano Di Carlo
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  2. Nicola Benedetto
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Correspondence to Davide Tiziano Di Carlo.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University of Pisa) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The specimens were obtained in the first 12-h postmortem from donors.

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Di Carlo, D.T., Benedetto, N., Duffau, H. et al. Microsurgical anatomy of the sagittal stratum. Acta Neurochir 161, 2319–2327 (2019). https://doi.org/10.1007/s00701-019-04019-8

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