Optic Tract as an Upper Limit in Amygdalectomy: Microsurgical Study

Authors

Guillermo Garcia-Oriola, Department of Neurosurgery, Clinical University Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain.
Santino Ottavio Tomasi, Department of Neurosurgery, Christian Doppler Klinic, Paracelsus Medical University, Salzburg, Austria.
Federico Gallardo, Department of Neurosurgery, Hospital de Alta Complejidad en Red El Cruce S.A.M.I.C., Buenos Aires, Argentina.
Giuseppe Emmanuele Umana, Department of Neurosurgery, Trauma and Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Peter A. Winkler, Department of Neurosurgery, Christian Doppler Klinic, Paracelsus Medical University, Salzburg, Austria.

Document Type

Article

Abstract

BACKGROUND: In surgeries involving resection of the amygdala, despite clear relations established with the medial, lateral, anterior, posterior, and inferior segments, the upper limit remains controversial. The optic tract (OT) has been anatomically considered as a good landmark immediately inferior to the striatopallidal region. This anatomic structure has barely been explored by microsurgical study, generating uncertainty about the exact relationship with the surrounding structures. OBJECTIVE: To describe the OT in its entire length through microsurgical study, showing its superior, inferior, medial, and lateral relationships and highlighting its value as a landmark in superior amygdala resection. METHODS: Microsurgical anatomic dissection of the OT, from its origin in the chiasm to the lateral geniculate nucleus was performed in 8 alcohol-fixed human hemispheres, showing its different segments and relations. Photographs were taken from different angles to facilitate surgical orientation. RESULTS: We performed a dissection of the OT, showing its position relative to caudate and hippocampal formations. We exposed the structures related to the OT superiorly (striatopallidal region and superior caudate fasciculus), inferiorly (head of the hippocampus, amygdala, anterior choroidal artery, perforating artery branch of the anterior choroidal artery, terminal stria, and basal vein), medially (internal capsule and midbrain), and laterally (temporal stem [uncinate and inferior fronto-occipital fascicle], anterior perforated substance, and superior caudate fasciculus). CONCLUSION: To date, there is a paucity of articles describing the anatomy of the OT from a neurosurgery perspective. In this study, we describe the microsurgical anatomic path of the OT, as a reliable upper limit landmark for amygdala resection.

Medical Subject Headings

Amygdala (anatomy & histology, diagnostic imaging, surgery); Cerebral Arteries (surgery); Cerebral Veins (anatomy & histology); Humans; Optic Tract (surgery); White Matter (anatomy & histology)

Publication Date

7-1-2022

Publication Title

Operative neurosurgery (Hagerstown, Md.)

E-ISSN

2332-4260

Volume

23

Issue

1

First Page

e42

Last Page

e48

PubMed ID

35486869

Digital Object Identifier (DOI)

10.1227/ons.0000000000000208

Recommended Citation

Garcia-Oriola, Guillermo; Tomasi, Santino Ottavio; Gallardo, Federico; Umana, Giuseppe Emmanuele; Lawton, Michael T.; and Winkler, Peter A., "Optic Tract as an Upper Limit in Amygdalectomy: Microsurgical Study" (2022). Neurosurgery. 1588.
https://scholar.barrowneuro.org/neurosurgery/1588