Amaç: İnsan beyni frontal lob ak madde assosiyasyon yollarının, mikrocerrahi anatomilerinin (uzanımları, başlangıç ve bitiş bölgeleri), birbirleri ile olan ilişkilerinin, literatürde klinik çalışmalar ışığında bilinen özellikle dil fonksiyonları ile birlikte değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışma, Haziran 2013-Ağustos 2014 tarihleri arasında İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Nöroşirurji Ana Bilim Dalı Mikrocerrahi-Nöroanatomi Laboratuvarı'nda yapıldı. On adet postmortem insan beyin spesmeni, Klingler metoduna uygun şekilde muamele edildi. Beyin hemisferlerinin lateralden mediale ve doğru ak madde lif diseksiyonları, mikrocerrahi seti ile operasyon mikroskobu altında yapıldı ve her aşama fotoğraflandı. Bulgular: Kademeli olarak yapılan ak madde lif diseksiyonu çalışması sonucu, frontal lob ile bağlantılı ak madde assosiyasyon yolları veya frontal lobdaki kısa ak madde yolları literatürde bilinen klinik çalışmalarla korele şekilde gösterildi. Sonuç: Ak madde lif diseksiyon çalışması, beynin 3 boyutlu anatomisinin kavranmasında nöroşirurjiyenler için oldukça önemlidir. Anatomofonksiyonel ak madde liflerinin anatomik olarak bilinmesi, pre-intra ve postoperatif klinik 'diskonneksiyon sendromları', beyin fonksiyonları ve ak madde tümöral invazyon paternlerinin anlaşılmasında yardımcı olur; cerrahi strateji, preoperatif planlama buna göre yapılır, böylelikle cerrahi morbidite azalır.
Anahtar Kelimeler: Frontal lob; kadavra; mikrodiseksiyon; ak madde; afazi
Objective: The aim of this study is to evaluate the microsurgical anatomy of human brain frontal lobe association white matter pathways (course, start and target zones), relationships with each other and its potential functional role with reference to clinical trials in the literature. Material and Methods: This study was performed between June 2013-August 2014 at Istanbul University Cerrahpaşa Faculty of Medicine, Microsurgery- Neuroanatomy Laboratory of Department of Neurosurgery. Ten postmortem human brain specimens were prepared in accordance with Klingler's method. Brain hemispheres were dissected step by step from lateral to medial and medial to lateral under operating microscope and images were captured at every stage. Results: As a results of the white matter fiber dissection step by step, white matter association pathways associated with frontal lobe or short white matter tracts in frontal lobe were shown to correlate clinical studies known in the literature. Conclusion: Knowledge of the anatomofunctional role of fiber tracts helps to understand pre-, intra- and postoperative clinical 'disconnection syndromes' and white matter tumoral invasion patterns, and may improve presurgical planning and surgical strategy, thereby potentially decreasing surgical morbidity.
Keywords: Frontal lobe; cadaver; microdissection; white matter; aphasia
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