Enhancing Surgical Skills and Outcomes Through White Fiber Dissection—Part 1: Lateral Cerebral Hemisphere Approach

Abstract In previous studies, it has been proposed that white fiber connections result in disconnection syndromes in animals and humans, leading to higher-level neurological deficits even when cortical areas remain intact. These conclusions were applied to delineate a surgical approach for neurosurgeons. Ten previously frozen and formalin-fixed cadaveric human brains were included in the study. The Klingler's method of fiber dissection was adopted where the cerebral hemispheres were prepared by numerous cycles of freezing and thawing. The chief tools used to carry white fiber dissection were wooden spatula and fiber bundles were studied by the naked eye as well as using the operating microscope. Using gyrus-based approach, the fiber tracts that came across during dissection were acknowledged. In this study, we have defined a lateral approach to dissecting white fiber tracts of the brain with the help of modified Klingler's technique. The dissection of white fiber bundles was done through gyrus. The fiber bundle course as well as its functional corelationship were observed. The knowledge of the anatomy of white fiber bundles is crucial during planning surgical trajectory, which further help to reduce the risk of postoperative complications. The three-dimensional anatomy of white fiber tracts relevant to lateral approach presented will aid in planning neurosurgery. The course of white fiber bundles and the relationships with adjacent bundles is decisive to optimize the quality of resection and functional outcome.