BACKGROUND: Lesion studies and recent surgical series report important sequelae when the inferior parietal lobe and posterior temporal lobe are damaged. Millions of axons cross through the white matter underlying these cortical areas; however, little is known about the complex organization of these connections.
OBJECTIVE: To analyze the subcortical anatomy of a specific region within the parietal and temporal lobes where 7 long-distances tracts intersect, ie, the temporoparietal fiber intersection area (TPFIA).
METHODS: Four postmortem human hemispheres were dissected, and 4 healthy hemispheres were analyzed through the use of diffusion tensor imaging--based tractography software. The different tracts that intersect at the posterior temporal and parietal lobes were isolated, and the relations with the surrounding structures were analyzed.
RESULTS: Seven tracts pass through the TPFIA: horizontal portion of the superior longitudinal fasciculus, arcuate fasciculus, middle longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, optic radiations, and tapetum. The TPFIA was located deep to the angular gyrus, posterior portion of the supramarginal gyrus, and posterior portion of the superior, middle, and inferior temporal gyri.
CONCLUSION: The TPFIA is a critical neural crossroad; it is traversed by 7 white matter tracts that connect multiple areas of the ipsilateral and contralateral hemisphere. It is also a vulnerable part of the network in that a lesion within this area will produce multiple disconnections. This is valuable information when a surgical approach through the parieto-temporo-occipital junction is planned. To decrease surgical risks, a detailed diffusion tensor imaging tractography reconstruction of the TPFIA should be performed, and intraoperative electric stimulation should be strongly considered.
ABBREVIATIONS: DTI, diffusion tensor imaging
IFOF, inferior fronto-occipital fasciculus
ILF, inferior longitudinal fasciculus
MLF, middle longitudinal fasciculus
ROI, region of interest
SLF, superior longitudinal fasciculus
TPFIA, temporoparietal fiber intersection area
WHO, World Health Organization
*Department of Neurological Surgery and
‡Department of Radiology, Hospital Universitario Marqués de Valdecilla and Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Cantabria, Spain
§Department of Anatomy and Cellular Biology, Cantabria University, Santander, Cantabria, Spain
Correspondence: Juan Martino, MD, PhD, Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla and Instituto de Formación e Investigación Marqués de Valdecilla, Av de Valdecilla s/n, 39008, Santander, Cantabria, Spain. E-mail: email@example.com
Received May 18, 2012
Accepted August 23, 2012