White matter fibres dissection in the human brain: the Klingler method

 

Dr Francesco Vergani, MD, FRCS. Department of Neurosurgery, King’s College Hospital, London

 

Knowledge of white matter anatomy is important to delineate the subcortical connectivity of the human brain. Recent studies have focused on the role of white matter connectivity in language, visuospatial attention, complex motor functions and memory. Involvement of white matter structures is also of emerging interest in elucidating the mechanisms of cognitive decline in ageing and neurodegenerative disorders.

To the neurosurgeon, knowledge of white matter anatomy is crucial to refine surgical approaches to brain lesions (such as tumours) close to eloquent areas. Damage to fibre tracts can result in severe and permanent neurological deficits, affecting the outcome of patients receiving brain surgery. A detailed understanding of the 3-D anatomy of white matter fibres is therefore of paramount importance to prevent neurological damage and improve surgical outcome.  

The post-mortem dissection technique originally developed by Klingler in the 30s of the last century, is a well-established method to investigate the anatomy of the white matter tracts. This relatively “old” technique has been recently revitalised in neurosurgery, with several anatomical studies published in recent years.

The present talk will offer an historical overview on the different techniques used to dissect the white matter, until the contribution of Klingler. We will then present the original results of anatomical studies where we used the Klingler technique to investigate the connectivity of the Supplementary Motor Area, the intralobar fibres of the occipital lobe, and the connections of the subgenual cingulate area. The clinical relevance of these connections is discussed, with a focus on their neurosurgical importance. A comparison with the results obtained with advanced MRI tractography is also presented.