Contents I J. C. Tamraz, Y. G. Comair Atlas of Regional Anatomy of the Brain Using MRI Softcover Edition Contents III J. C. Tamraz, Y. G. Comair Atlas of Regional Anatomy of the Brain Using MRI With Functional Correlations Foreword by Hans Otto Lüders With 458 Figures in 817 Separate Illustrations 123 1234 IV Contents Jean C. Tamraz, MD, PhD Professor and Chairman Department of Neuroradiology Hotel-Dieu de France Hospital Saint-Joseph University Beirut, Lebanon Youssef G. Comair, MD, FRCSC Professor and Chief Division of Neurosurgery American University of Beirut Consultant Neurosurgeon The Cleveland Clinic Foundation 44122 Cleveland, Ohio, USA ISBN 3-540-27876-1 Springer-Verlag Berlin Heidelberg New York ISBN 978 3-540-27876-4 Springer-Verlag Berlin Heidelberg New York Library of Congress Cataloging-in-Publication Data Tamraz, J. C. (Jean Chucri), 1954- Atlas of regional anatomy of the brain using MRI : with functional correlations / J.C. Tamraz and Y.G. Comair. p. ; cm. Includes bibliographical references and index. ISBN 3540640991 (hardcover; alk. paper) ISBN 3540278761 (softcover; alk. paper) 1. Brain--Anatomy--Atlases. 2. Brain--Magnetic resonance imaging--Atlases. I. Comair, Y. G. (Youssef G.) [DNLM: 1. Brain--anatomy & histology--Atlases. 2. Magnetic Resonance Imaging--Atlases. WL 17 T159a 2000] QM455.T35 2000 611’.81’0222--dc21 99-044535 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. 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Cover-Design: Studio Calamar Typesetting: Verlagsservice Teichmann, Mauer Printed on acid-free paper – 21/3151xq – 5 4 3 2 1 Contents V Foreword The anatomical dissections of Mundini dei Luzzi in 1316, mark the beginning of an era extending over more than 5 centuries in which the study of the brain was limited, almost exclusive1y, to description of its gross anatomy derived from the inspection of gross anatomical specimens. In the 19th century, new techniques like histology and electrical stimu1ation were developed allowing the fi rst cor- relation studies of cortical anatomy and brain function. Shortly thereafter, the development of recording techniques of evoked potentials and spontaneous brain waves (EEG) further enhanced our understanding of brain function as a function of its anatomical correlation. One major limitation of all these studies was that at that time no technique was available to defi ne the anatomy of the brain without its direct visualization. In other words, precise anatomo- functional correlation studies were only possible in experimental studies in animals, the unusual setting of human craniotomies and by careful clinico-pathological studies. These last studies also shed some light on the functions of structures that had been affected by a pathological process, and in the late 19th century and early 20th century, research efforts of clinical neuroscientists focused on anatomo-functional cor- relation studies making brain anatomy one of their pillars. However, soon these research techniques reached a limit and, progressively research efforts focused on pathogenesis, therapeutics and the development of clinical diagnostic tech- niques. Clinicians soon realized that precise knowledge of brain anatomy was not necessarily an essential clinical tool and brain anatomy classes in neuroscience curricula became only of secondary importance. However, technological advances that had its beginnings in the early 1950’s eventually lead to a reversal of this trend. A pioneer role in this development was played by the French school lead of Talairach and Bancaud. Taking advantage of newly developed imaging techniques, Talairach realized that angiography could be used effectively to defi ne “non-invasively” the sulcal anatomy of the brain. This led to the development of the “Talairach Atlas”, which even today, can be applied practically. Equally important, however, was the collaboration of T alairach with Bancaud that established functional correlations of the anatomical studies of T alairach. These pioneer studies of Talairach and Bancaud certainly led to signifi - cant contributions of our understanding of human anatomy and its physiological correlates. Unfortunately, the studies had only a limited impact in the general clinical neurosciences since they were only applicable to a very selected number of patients. Recent neuroimaging developments, particularly high resolution MRI, pro- vided the tools necessary to make detailed brain anatony available to all neu- roscientist on a routine basis. This availability, and the expanded understand- ing of human anatomo-neurophysiological correlates, has led to a resurgence of the interest of clinical neurophysiologist in gross human brain anatomy and its functional corre1ates. Tamraz and Comair’s book on regional anatomy of the human brain using MRI, is certainly a welcome addition that fulfi lls our growing need for books VI Contents correlating anatomy, function and MRI. There are two facts that make this book particularly appealing for clinicians. Both authors are busy clinicians who, on a daily basis, apply the information provided in the book to their clinical practice. This assures that all the information provided has immediate clinical relevance. In addition, the book is greatly infl uenced by Professor Tamraz and Professor Comair’s exposure to the Paris and Montreal’s schools, respectively, both stress- ing brain anatomy and its relationship to neurophysiology. The immediate clini- cal practicality of the book and the stress on correlating anatomy and function, make this book a unique and valuable contribution to the clinical neuroscience community, and should become a standard textbook for trainees in the clinical neurosciences. The clinical neurosciences will greatly profi t from the practical approach to gross neuroanatomy, neuroimaging and correlative neurophysio logy offered in this book. Hans O. Lüders Chairman and Professor Department of Neurology The Cleveland Clinic Foundation Contents VII Preface To Claire, Caroline and Eve JC T To Liliane, Andréa and Marc Elie YG C Imaging of the human nervous system has traditionally attracted clinicians interested specifi cally in the fi elds of neurology, neurosurgery and radiology. However, interest has suddenly widened to include neurophysiologists, computer scientists, biophysicists and developers of biomedical technology. Several factors are responsible for this phenomenon. We believe that the most important is the development of magnetic resonance imaging (MR). Angiography and ventriculography visualized brain cavities and computer tomography offered uni-dimensional views of structures. With MR, however, structures came to life. Suddenly patients could walk out of the machine with an atlas-like image of their brain. This advance revived the interest in correlating morphology with function. Progress in reformatting techniques has facilitated the study of morphology. Details of the sulcal and gyral anatomy of the brain and its individual variations can be seen thanks to surface- and volume-rendering techniques that have al- lowed us to extract the brain out of its envelopes. The functional areas can there- fore be readily identifi ed by the trained eye. The core brain structures are visually dissected given the high contrast between gray and white matter. Activation studies have traditionally been performed by expensive, labor-in- tensive techniques that do not visualize the details of morphology. Functional MR has the capability of combining morphology and function in a process similar to the mapping performed in the operating room by pioneering neurosurgeons who identifi ed eloquent cortical areas. In less than two decades a remarkable evolution in brain science has occurred and impacted on the diagnosis, natural history and treatment of disease process- es. MR is presently a tool used for diagnosis and treatment. The purpose of this book is to facilitate the study of brain anatomy by formu- lating a methodological analysis of functionally oriented morphology. Since the study of the human cortex has not received much attention in radiological or neurosurgical atlases, we have devoted a large part of this work to the study of the surface anatomy of the brain. Following an introductory chapter on the gyral and sulcal development and organization, functional areas are studied separately in four chapters, each devoted to essential cortical function. Primary motor cortex, speech, limbic system and vision are discussed individually. In addition to the standard sectioning methods, imaging of functional areas relied on extensive use of 3-D rendering and the introduction of innovative oblique sections display- ing the temporalization process of the cerebral surface and core brain structures. These oblique cuts have the advantage of displaying in few images important cor- tical areas such as the primary motor-sensory cortex, the speech-related perisyl- vian areas and the amygdalar-hippocampal memory structures. In order to appreciate the temporal evolution of brain imaging the fi rst chapter reviews the progression in visual depiction of brain structures from rudimentary to cross-sectional and fi nally to realistic and precise illustrations, reminiscent of the progress in neuroimaging. This introduction is followed by an overview of VIII Contents the major referential brain systems and a proposal for a sylvian reference plane that is, in our view, the most natural way of studying brain structures in cross section. The fi nal chapters include three new MR atlases. The fi rst comprises coronal sections acquired perpendicular to the proposed sylvian orientation. This is fol- lowed by two oblique approaches acquired along the forniceal plane and the ven- tricular plane. The study of brain anatomy stands as a linking factor in the multidisciplinary effort to understand brain function. We hope that this book can contribute to- wards this crucial task. Jean C. Tamraz Youssef G. Comair Acknowledgments It is obvious that this volume could not have been fi nished without the published fi ndings and morphological, functional and imaging materials derived from collaborative works developed over the past 20 years by highly specialized teams in Paris, Montreal and Cleveland. I am deeply indebted to my mentors in Paris for their invaluable teaching and encourage- ment. They had a profound infl uence on my academic course in neuroanatomy and neuro- radiology: Professors André Delmas, Chairman of Anatomy at the Institut d’Anatomie; E mmanuel A. Cabanis, Head of Neuroradiology at the Centre Hospitalier National d’Ophtal- mologie des Quinze-Vingts who trained me in neuroradiology; and Roger Saban, Honorary Professor at the Museum National d’Histoire Naturelle, who introduced me to the fi elds of comparative anatomy and anthropology. The anatomical material included is part of a pre- vious work developed under the leadership of E.A. Cabanis at the Institut d’Anatomie, and the primate brains and teratologic specimens are derived from the historical collections ob- tained from the Laboratory of Comparative Anatomy of the Museum in Paris. I would also like to express my deep gratitude to Professor Alex Coblentz, Director of the Centre Uni- versitaire Scientifi que et Biomédical des Saints-Pères, for his major support and counseling, and to Professors Georges Salamon, Ugo Salvolini, Henri Duvernoy, Marie-Germaine Bousser and O livier Lyon-Caen who greatly contributed to our training in the fi elds of neuroimaging, neuroanatomy and clinical neurological sciences. Finally, I am extremely grateful for the col- laborative work of Dr. Claire Outin-Tamraz at Trad Hospital, who provided us with part of the MR material to complete this book, and I have also benefi ted in the last few years from discussions at Hôtel-Dieu de France with my colleagues in the Departments of Neuroscience and Imaging. JCT Essential contributions to human brain morphology, function and structural organiza- tion were made by successive generations of functional neurosurgeons. I was fortunate enough to train at the Montreal Neurological Institute, where some of these essential ad- vances were made. It was a pleasure to train under Professor André Olivier, a master neuro- surgeon and anatomist. Long before MR allowed us to see sulcal and gyral anatomy in vivo, Professor O livier’s teaching of stereoangiography made these structures visible and allowed us to c omprehend the complex three-dimensional anatomy of the structures and the vari- ous pathologies that were subsequently dealt with in the operating room. The unique milieu of the Montreal Neurological Institute and the close collaboration between neuroradiology and n eurosurgery was a model followed in this book. The content of this book stems from a desire to apply brain anatomy to our clinical practice. At the Cleveland Clinic Foundation, I was priviledged to be associated with Professor Hans Lüders. Our frequent discussions and his profound knowledge of applied electrophysiology and functional localization encouraged us to go ahead with this project. Finally, I am particularly indebted to my colleagues in the epilepsy and neuroradiology programs in Montreal and Cleveland, in particular, Professors Romeo Ethier, Denis Melanson and Paul Ruggieri. YGC The authors express their sincere gratitude to the publisher, Springer-Verlag, especially Dr. Ute Heilmann and her co-workers, Mrs. Wilma Mc Hugh, Dr. Catherine Ovitt and Mr. Kurt Tei- chmann, for their help and unfailing patience during the preparation and publication of this atlas. Contents IX Contents 1 Historical Review of Cross-Sectional Anatomy of the Brain. . . . . . . . . . . . 1 2 Cephalic Reference Lines Suitable for Neuroimaging. . . . . . . . . . . . . . . . . . 11 I Cranial Reference Lines and Planes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 A Historical Background and Overview . . . . . . . . . . . . . . . . . . . . . . . . . 11 B The Need for a Consensus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 C Classifi cation of the Cephalic Reference Planes. . . . . . . . . . . . . . . . . 13 D The Choice of a Nomenclature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 II Brain Horizontal Reference Lines and Planes . . . . . . . . . . . . . . . . . . . . . 13 A The Bicommissural Reference Plane. . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1 Biometric Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . . 17 B The Delmas and Pertuiset Reference Plane. . . . . . . . . . . . . . . . . . . . . 22 1 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . . 22 2 Topometric Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 C The Neuro-ocular Plane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 1 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . . 24 2 Topometric and Biometric Findings. . . . . . . . . . . . . . . . . . . . . . . . . 27 D The Callosal Plane. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 E The Chiasmatico-Commissural Plane . . . . . . . . . . . . . . . . . . . . . . . . . 29 1 Biometric Findings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 2 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . . 31 F Anatomic and Physiologic Reference Planes. . . . . . . . . . . . . . . . . . . . 35 1 The “Plan Vestibulaire Horizontal” . . . . . . . . . . . . . . . . . . . . . . . . . . 38 2 The “Plan des Axes Orbitaires” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 III Brain Vertical Reference Lines and Planes . . . . . . . . . . . . . . . . . . . . . . . . 39 A The Anterior Commissure-Mamillary Planes. . . . . . . . . . . . . . . . . . . 39 1 The Commissuro-Mamillary Reference Line. . . . . . . . . . . . . . . . . . 39 2 The Commissuro-Mamillary Plane. . . . . . . . . . . . . . . . . . . . . . . . . . 40 B The Commissural-Obex Reference Plane . . . . . . . . . . . . . . . . . . . . . . 41 1 Biometric Findings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 2 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . . 42 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3 Brain Cortical Mantle, Ventricles and White Matter Core . . . . . . . . . . . . . . 51 I Historical Notes and Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 II Cytoarchitecture and Brain Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 A Gross Morphology and Fissural Patterns of the Brain . . . . . . . . . . . 56 X Contents 1 Gross Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 2 Brain Sulcation: Classifi cations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 3 Sulcal and Gyral Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 B The Lateral Surface of the Cerebral Hemisphere. . . . . . . . . . . . . . . . 57 1 Lateral Fissure of Sylvius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 2 Central Sulcus (Rolando) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 3 Inferior Frontal Sulcus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 4 Superior Frontal Sulcus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 5 Precentral Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 6 The Intraparietal Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 7 Superior Temporal Sulcus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 8 Frontomarginal Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 C Gyri of the Lateral Surface of the Cerebral Hemisphere. . . . . . . . . . 78 1 The Frontal Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 a Inferior Frontal Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 b Middle Frontal Gyrus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 c Superior Frontal Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 d Precentral Gyrus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 2 The Parietal Lobe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 a Postcentral Gyrus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 b Inferior Parietal Gyri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 c Superior Parietal Gyrus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 3 The Temporal Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 a Superior Temporal Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 b Middle Temporal Gyrus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 c Inferior Temporal Gyrus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 4 The Occipital Lobe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 5 The Insula of Reil. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 D The Mesial Surface of the Cerebral Hemisphere . . . . . . . . . . . . . . . . 83 1 Cingulate Sulcus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 2 Parieto-occipital Sulcus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 3 Calcarine Sulcus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 4 Rostral Sulci . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 5 Gyri of the Mesial Surface of the Cerebral Hemisphere . . . . . . . . 86 a The Gyrus Rectus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 b The Cingulate Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 c The Medial Frontal Gyrus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 d The Paracentral Lobule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 e The Precuneus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 f The Cuneus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 g The Lingual Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 E The Basal Surface of the Cerebral Hemisphere . . . . . . . . . . . . . . . . . 93 1 The Frontal Orbital Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 a Olfactory Sulcus and Gyrus Rectus. . . . . . . . . . . . . . . . . . . . . . . . 93 b Orbital or Orbitofrontal Sulci and Gyri . . . . . . . . . . . . . . . . . . . . 93 2 The Temporal Basal Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 a Collateral Sulcus and Parahippocampal Gyrus. . . . . . . . . . . . . . 93 b Occipitotemporal Sulcus and Fusiform Gyrus . . . . . . . . . . . . . . 96 F White Matter Core and Major Association Tracts . . . . . . . . . . . . . . . 96 III Vascular Supply of the Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 A The Arterial Supply of the Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 1 The Internal Carotid Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101