COMMENTARY

Commentary: Fiber Microdissection Technique for

Demonstrating the Deep Cerebellar Nuclei and
Cerebellar Peduncles
Eduardo Carvalhal Ribas, MD,

A
rcângelo Piccolomini and Volcher is related to extensive integrated and plastic

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∗‡
PhD
Coltier were probably the first networks.6 This connectivist view is based on
Kaan Yağmurlu, MD§ anatomists to describe the encephalon functional cortical epicenters, called “topical
∗
Division of Neurosurgery, Hospital
as composed of 2 types of substances: a grayish organization” (from Greek, where tops means
das Clínicas da Faculdade de Medicina and softened structure at its surface and a more local), connected by short and long white matter
da Universidade de São Paulo, São whitish, hard, and compact inner structure. fibers, called “hodological organization” (from
Paulo, Brazil; ‡ Hospital Israelita Albert They were named initially “cerebrum” and Greek, where hodos means road). This model,
Einstein, São Paulo, Brazil; § Departments
of Neuroscience and Neurosurgery,
“medulla,” and after as gray and white matters of jointly called “hodotopic,” is paramount to
University of Virginia, Charlottesville, the brain, respectively.1 know the function of each nervous region and
Virginia The fine inner architecture of the encephalon, also how these regions are connected.6,7
composed of a multitude of white matter Dr Yasargil emphasizes the need to under-
Correspondence:
Eduardo Carvalhal Ribas, MD, PhD,
fibers forming bundles and connecting different stand the complex 3-dimensional organization of
R. Abílio Soares, regions, creates a homogeneous, amorphous, and the white matter fibers because this knowledge
569. Apt 121. CEP 04005-002, compact structure when no unique method to can be applied by neurosurgeons to safeguard
São Paulo – SP. Brazil. preserve and harden the specimen is applied. them during surgeries and encouraged Dr Ture
Email: [email protected]
Progressively, the main white matter fiber to renew interest in this technique in recent
Received, September 22, 2020. bundles were described as several methods were years.2,8,9 At the same time, magnetic resonance
Accepted, September 27, 2020. experienced to individualize and separate this diffusion tensor images (DTIs) were introduced
Published Online, January 12, 2021. compact arrangement. As examples, Marcello and made possible to identify the main white
Malpighi worked on brains boiled in water to matter fiber bundles in Vivo.10 Each of these
C Congress of Neurological Surgeons

2021. All rights reserved.

demonstrate the presence of these fibers in 1669 methods has limitations, and both can be used
For permissions, please e-mail: and Raymond Vieussens traced the continuity combined to increase the global understanding
[email protected] of pyramidal tracts from corona radiata fibers, of these fibers.11-15
to the internal capsule, cerebral peduncles, pons, The superior cerebellar peduncle contains the
and the pyramids of the medulla by “scraping” major efferent (output) system of the cerebellum
the white matter, a technique first described by and is located medial to the middle and inferior
Nicolaus Steno.1-3 cerebellar peduncles.16 The only afferent (input)
The authors of this study4 remind us that tract in the superior cerebellar peduncle is the
Joseph Klingler made an essential breakthrough anterior spinocerebellar tract.17
in fiber dissection by first preparing the The middle cerebellar peduncle is formed
specimens with formaldehyde and freezing by the transverse pontine fibers, which are
protocols and later dissecting its fibers in divided into a superficial and a deep group
successive layers.5 This method allows metic- based on their location to the corticospinal tract
ulous dissections and precise delineation of the and their distribution in the cerebellum.16
white matter fibers, giving Klingler the capacity The deep transverse pontine fibers run
to describe several subcortical connections. His immediately lateral to the inferior cerebellar
monumental work is compiled at the “Atlas peduncle.
Cerebri Humani,” published in 1956.5 The The inferior cerebellar peduncle is formed by
development of other methods and the difficulty the restiform (rope-like) and the juxtarestiform
of making these dissections caused this technique bodies, which are purely afferent and mainly
to be neglected for some decades.2 efferent systems, respectively. The restiform body
The contemporary model that explains the receives the posterior spinocerebellar tract from
functional organization of the encephalon the spinal cord and the trigeminocerebellar,

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RIBAS AND YAĞMURLU

cuneocerebellar, reticulocerebellar, and olivocerebellar tracts from 2. Ture U, Yasargil MG, Friedman AH, Al-Mefty O. Fiber dissection technique:
the medulla.18 lateral aspect of the brain. Neurosurgery. 2000;47(2):417-427.
3. Agrawal A, Kapfhammer JP, Kress A, et al. Josef Klingler’s models of white
From a functional point of view, the cerebellum can be divided matter tracts: influences on neuroanatomy, neurosurgery, and neuroimaging.
into 3 functional lobes defined by their related pertinent cerebellar Neurosurgery. 2011;69(2):238-254.
cortex, deep cerebellar nuclei, and connections to the rest of the 4. Pruthi N, Kadri PAS, Türe U. Fiber microdissection technique for demon-
strating the deep cerebellar nuclei and cerebellar peduncles. Oper Neurosurg.
nervous system (through the cerebellar peduncles).17 The vestibu- 2021;20(2):E118-E125.
locerebellum, associated with balance and gait functions, has the 5. Ludwig E, Klingler J. Atlas Cerebri Humani. Der innere Bau des Gehirns dargestellt
fastigial and lateral vestibular nuclei as main cerebellar nuclei auf Grund makroskopischer Präparate / The Inner Structure of the Brain Demon-
and the inferior cerebellar peduncle as its main efferent route. strated on the Basis of Macroscopical Preparations. Boston, MA: Little, Brown and
Company; 1956.
The spinocerebellum, responsible for coordinating activities of the 6. Mesulam MM. Large-scale neurocognitive networks and distributed processing for
limbs, has the emboliform and globose nuclei, which are together

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attention, language, and memory. Ann Neurol. 1990;28(5):597-613.
called interposed nucleus, as its main cerebellar nuclei and the 7. De Benedictis A, Duffau H. Brain hodotopy: from esoteric concept to practical
surgical applications. Neurosurgery. 2011;68(6):1703-1723.
inferior and superior cerebellar peduncles are its main afferent
8. Yasargil MG, Ture U, Yasargil DC. Impact of temporal lobe surgery. J Neurosurg.
and efferent routes, respectively.18 The neo- or cerebro-cerebellum 2004;101(5):725-738.
is related to motor planning and coordination of voluntary activ- 9. Ture U, Yasargil MG, Pait TG. Is there a superior occipitofrontal fasciculus? A
ities; its main nucleus, afferent pathway, and efferent pathway microsurgical anatomic study. Neurosurgery. 1997;40(6):1226-1232.
10. Basser PJ, Mattiello J, LeBihan D. Estimation of the effective self-diffusion tensor
are the dentate, middle, and superior cerebellar peduncles, from the NMR spin echo. J Magn Reson B. 1994;103(3):247-254.
respectively.17,18 11. Martino J, De Witt Hamer PC, Berger MS, et al. Analysis of the subcompo-
The article brings beautiful dissection pictures and is useful to nents and cortical terminations of the perisylvian superior longitudinal fasciculus:
consolidate and replicate the internal cerebellar structures. Future a fiber dissection and DTI tractography study. Brain Struct Funct. 2013;218(1):
105-121.
articles should combine anatomic findings with clinical cases or 12. Fernandez-Miranda JC, Rhoton AL Jr, Alvarez-Linera J, Kakizawa Y, Choi C,
neuroimaging studies to correlate results and distinguish them de Oliveira EP. Three-dimensional microsurgical and tractographic anatomy
from previously published papers. of the white matter of the human brain. Neurosurgery. 2008a;62(6 Suppl 3):
989-1026.
13. Ribas EC, Yagmurlu K, Wen HT, Rhoton AL. Microsurgical anatomy of
Funding the inferior limiting insular sulcus and the temporal stem. J Neurosurg.
2015;122(6):1263-1273.
This study did not receive any funding or financial support.
14. Ribas EC, Yağmurlu K, de Oliveira E, Ribas GC, Rhoton A. Microsur-
gical anatomy of the central core of the brain. J Neurosurg. 2017;129(3):
Disclosures 752-769.
The authors have no personal, financial, or institutional interest in any of the 15. Yagmurlu K, Vlasak AL, Rhoton AL Jr. Three-dimensional topographic fiber tract
drugs, materials, or devices described in this article. anatomy of the cerebrum. Oper Neurosurg. 2015;11(2):274-305.
16. Yagmurlu K, Rhoton AL Jr, Tanriover N, Bennett JA. Three-dimensional micro-
surgical anatomy and the safe entry zones of the brainstem. Oper Neurosurg.
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