Studio anatomo-funzionale integrato della sostanza bianca cerebrale e computazione di un atlante funzionale sottocorticale

Abstract

Over the last 20 years the study of brain functions experienced a huge impulse due to the technical improvements in the imaging and neurosurgical cortico-subcortical direct electrical stimulation (DES) procedures. Particularly, functional MRI (fMRI), DES and diffusion tensor imaging (DTI) allowed the in vivo study of functional organization and white matter (WM) connections. The integration of data provided by these different techniques opened a new door in the study of the brain, leading neuroscientists and neurosurgeons in the connectomic era. This conceptual evolution renewed the interest also for the structural study of brain connections with blunt dissection, in order to improve and confirm data provided by DTI.

Considering that DES is, since now, the only direct and specific method to explore the functional role of subcortical bundles, we aimed to a study integrating blunt dissection, according to the technique described by Klingler, DTI and DES during neurosurgical procedure for resection of lowgrade gliomas (LGGs). Aims of the study are:

l) definition of course and terminations of the main WM fascicles;

2)            production of antomo-topographical data, including course and reciprocal relationships of different association, projection and connection bundles, in order to produce anatomofunctional details for the improvement of surgical approach to intra-axial lesions.

3)            computation of the first functional atlas of the human WM and of a probabilistic map of WM resectability, using data provided by DES during awake surgery with intra-operative neuropsychological monitoring.