Surgical Anatomy and Technique

GENERAL

Microsurgical Anatomy of the Optic Radiation and

Related Fibers in 3-Dimensional Images
Richard Gonzalo Parraga,
MD*
Guilherme Carvalhal Ribas,
MDk
Leonardo Christiaan Welling,
MD*
Raphael Vicente Alves, MD*
Evandro de Oliveira, MD,
PhD*
*Institute of Neurological Sciences,
Microneurosurgery Laboratory, Beneficencia Portuguesa Hospital, Sao Paulo,
SP, Brazil; Department of Surgery-LIM
02, University of Sao Paulo Medical
School, Sao Paulo, SP, Brazil; Microneurosurgery Laboratory, Beneficencia
Portuguesa Hospital, Sao Paulo, SP, Brazil;
kInstitute of Neurological Sciences,
Neurosurgeon Hospital Israelita Albert
Einstein, Sao Paulo, SP, Brazil; Department of Neurosurgery, State University of
Campinas-UNICAMP, Campinas, SP, Brazil
Correspondence:
Evandro de Oliveira, MD, PhD,
Instituto de Ciencias Neurologicas,
Praca Amadeu Amaral,
27, 5 Andar, CEP 01327-010,
Sao Paulo, SP, Brazil.
E-mail: icne@uol.com.br
Received, August 15, 2011.
Accepted, November 30, 2011.
Published Online, March 26, 2012.
Copyright 2012 by the
Congress of Neurological Surgeons

BACKGROUND: The fiber dissection technique provides unique 3-dimensional anatomic knowledge of the white matter.
OBJECTIVE: To examine the optic radiation anatomy and its important relationship
with the temporal stem and to discuss its findings in relation to the approaches to
temporal lobe lesions.
METHODS: We studied 40 cerebral hemispheres of 20 brains that had been fixed in
formalin solution for 40 days. After removal of the arachnoid membrane, the hemispheres were frozen, and the Klingler technique was used for dissection under magnification. Stereoscopic 3-dimensional images of the dissection were obtained for
illustration.
RESULTS: The optic radiations are located deep within the superior and middle temporal gyri, always above the inferior temporal sulcus. The mean distance between the
cortical surface and the lateral edge of the optic radiation was 21 mm. Its fibers are
divided into 3 bundles after their origin. The mean distance between the anterior tip of
the temporal horn and the Meyer loop was 4.5 mm, between the temporal pole and the
anterior border of the Meyer loop was 28.4 mm, and between the limen insulae and the
Meyer loop was 10.7 mm. The mean distance between the lateral geniculate body and
the lateral margin of the central bundle of the optic radiation was 17.4 mm.
CONCLUSION: The white matter fiber dissection reveals the tridimensional intrinsic
architecture of the brain, and its knowledge regarding the temporal lobe is particularly
important for the neurosurgeon, mostly because of the complexity of the optic radiation and related fibers.
KEY WORDS: Fiber dissection, Microsurgical anatomy, Optic radiation, Sagittal stratum, Surgical approaches,
Temporal stem, Visual deficits
Neurosurgery 71[ONS Suppl 1]:ons160ons172, 2012

emporal lobe surgery has been developed

further over the years, particularly as a result
of the development of microsurgical techniques, magnetic resonance images, and new brain
mapping techniques.1-6
The intrinsic brain structure is composed of
myelinized fibers that are collected together in 3
basic types of fascicles or tracts: The association
fibers connect the different cortical areas in the
same hemisphere; the commissural fibers connect
both hemispheres; and the projection fibers link
the different brain areas to the brainstem and to the
spinal cord.7-10 Diffusion tensor images can
provide the delineation of these fibers and their
relations with intra-axial and extra-axial lesions.11
This study was performed according to the
Klingler8,9 dissection technique because the water
expansion resulting from freezing spreads the

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DOI: 10.1227/NEU.0b013e3182556fde

fibers, facilitating the dissection of the fiber tracts.

The temporal lobe and the optic radiation anatomy
are illustrated with 3-dimensional stereoscopic
anaglyphic images.12-16

MATERIALS AND METHODS

Forty normal brain hemispheres were fixed in
formalin for at least 40 days,8,10 and then the arachnoid
membrane and vessels were removed under the
magnification (6-40) provided by a M900 D.F.
Vasconcellos microscope (D.F Vasconcellos SA, So
Paulo, SP, Brazil). The hemispheres were frozen at
215!C for at least 14 days, and dissections were done
with wooden spatulas of different sizes. The dissection
started at the lateral temporal surface as described
by Tre et al,10 and the basal surface was dissected
up to the floor of the temporal horn. Ultimately,
the dissection continued after the removal of the

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ANATOMY OF THE OPTIC RADIATION

ependymal layer to identify the optic radiation origin along the pulvinar
and lateral geniculate body and along their course up to the superior and
inferior edges of the calcarine fissure. Furthermore, the Meyer loop, the
amygdala, the anterior commissure, and other structures related to the
temporal stem were also identified and dissected (Figure 1).8,10,15-18
It is not always possible to separate the different fiber systems from
each other and, in particular, to always obtain a reliable anatomic
differentiation within the so-called sagittal stratum,9,10 despite the use of
meticulous dissection microtechniques. For instance, exposure of a given
fiber tract often results in the destruction of another one.
The following measurements were done: (1) the optic tract length and
diameter, (2) the distance between the tip of the Meyer loop and the
temporal pole, (3) the distance between the anterior tip of the temporal
horn and the anterior edge of the Meyer loop, (4) the distance between
the lateral geniculate body and the anterior edge of the Meyer loop, (5) the
distance from the cortical surface to the optic radiation lateral edge at the
level of the geniculate lateral body, and (6) the length of the lateral aspect
of the optic radiation (Figure 1).

Stereoscopic images were obtained12-14,19,20 with a Nikon D40

camera and the following lenses: AF-S Nikkor 18 to 55 mm 1:3.5 to
5.6 GII ED and AF-S VR Micro-Nikkor 105 mm f/2.8 G (Nikon Corp,
Sendai, Japan). The callipygian software was used to develop the
anaglyphic images (Callipyan 3D; 2003, Robert Swirsky), and the
statistical analysis of the findings was performed with SPSS 15.0 software
(SPSS Inc, Chicago, Illinois).

RESULTS
The Optic Tract
The optic tract follows a posterolateral trajectory after leaving
the optic chiasm toward the external border of the thalamus. Its
average length was 30.7 mm. The anterior half-diameter was 3.7
mm and the posterior half-diameter was 5.5 mm. The majority of
its fibers reached the lateral geniculate body, which is a small ovoid
mass located under the pulvinar of the thalamus and anterolateral
to the medial geniculate body. A minority of fibers were found
reaching the pulvinar, the pretectal nucleus, and the superior
colliculi (Figure 2).
The Optic Radiations
The optic radiation fibers are constituted by axons from neurons of
the lateral geniculate body and from the pulvinar of the thalamus that
reach the calcarine cortex (Brodmann area 17) within the superior and
inferior lips of the calcarine fissure. Each optic radiation is composed
of fibers from the temporal ipsilateral and the nasal contralateral
retinal halves. Its average length was 95 mm. It constitutes part of the
posterior thalamic peduncle; passes under the lentiform nucleus as
fibers of the sublenticular part of the internal capsule, above the stria
terminalis and the tail of the caudate nucleus; and joins the sagittal
stratum that forms the lateral ventricular wall.
The optic radiation fibers can be divided into 3 portions after its
origin: the anterior bundle, the central bundle, and the posterior
bundle.21

FIGURE 1. Inferior view of the optic radiation with the measurements that were
done. A-B, the distance between temporal pole (TePo) and the anterior edge of the
Meyer loop. C-D, distance between the anterior wall of temporal horn and the
anterior edge of the Meyer loop. E-F, distance between the anterior edge of
the Meyer loop and the lateral geniculate body (LatGeBo). G-H, distance
between the lateral geniculate body and the lateral edge of the optic radiation. I-J,
distance between the cortical surface of the middle temporal gyrus and lateral edge
of the optic radiation. K-L, length of the optic radiation. AntB, anterior bundle;
Atr, atrium of lateral ventricle; CenB, central bundle; HippoHead, head of the
hippocampus; PostB, posterior bundle.

NEUROSURGERY

The Anterior Bundle (Meyer Loop)

After its origin, the fibers that constitute the anterior bundle
follow an anterolateral direction along the roof of the temporal horn,
lateral to the amygdala and perpendicular to the anterior commissure. The distance from the ambient gyrus (uncus) to the Meyer loop
was 22 mm (Figure 3). Anterior to the temporal horn, the fibers
shift backward, characterizing the Meyer loop, assuming a posterolateral course, hence becoming lateral to the temporal horn and to
the atrium, and ending along the inferior lip of the calcarine fissure.
The distance between the temporal pole and the anterior edge of
the Meyer loop was 28.4 mm (20-33 mm). The anterior border
was about 4.5 mm (2-7 mm) anterior to the temporal horn in all
specimens. At this level, the anterior commissure fibers were found
to be intermingled with the optic radiation fibers.
The distance between the limen insulae and the Meyer loop or
anterior bundle was 10.7 mm (7-13 mm). The average length from
the anterior edge of the Meyer loop and the lateral geniculate body
was 21 mm (18-28 mm).

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PARRAGA ET AL

FIGURE 2. Images in 3 (A) and 2 (B) dimensions. Inferolateral view of the

right hemisphere. The lenticular nucleus, anterior commissure (AntCom), occipitofrontal, superior longitudinal (SupLongFasc), and uncinate fascicles have
been partially removed to expose the corona radiate (CoRa), internal capsule,
optic radiation (OptRad), and optic tract (OptTr). AntLimb, anterior limb of the
internal capsule; CoFo, column or pillar of the fornix; CoStrFi, cortical striatal
fibers; MaBo, mammillary body; Put, putamen.

The Central Bundle

The central bundle initially follows a lateral direction crossing
superiorly the roof of the temporal horn and then turns sharply,
following a posterior course lateral to the atrium and to the
occipital horn, passing above and through the inferior longitudinal
fasciculus, and ending at the lateral aspect of the occipital pole. Its
anterior third covers the auditory radiation, and below the central
bundle lies the tapetum medially, which is separated from the
ventricular cavity only by the ependymal layer (Figures 4 and 5).
The distance between the lateral geniculate body and the central
bundle was 17.4 mm.
The Posterior Bundle
The posterior bundle courses posteriorly, forming the lateral
wall and part of the roof of the atrium and occipital horn, ending
along the superior lip of the calcarine fissure (Figures 4 and 5).

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FIGURE 3. Images in 3 (A) and 2 (B) dimensions. View of the roof of the left
temporal horn, where the ependyma, tapetum, and choroid plexus have been
partially removed to disclose the origin and trajectory of the bundles of optic
radiation (OptRad). The anterior bundle (AntB; red), central bundle (CenB;
yellow), and posterior bundle (PostB; green) are shown. LatGeBo, lateral
geniculate body; MeGeBod, medial geniculate body; OptTr, optic tract; Pulv,
pulvinar of thalamus; UncFasc, uncinate fasciculus.

Relationships of the Optic Radiation With the Temporal

Sulci and Gyri at the Lateral Surface
The optic radiation is located within the depth of the middle
and superior temporal gyri, always above the level of the inferior
temporal sulcus (Figure 6). The mean distance between the
cortical surface of the middle temporal gyrus and the lateral edge
of the optic radiation was 21 mm.
Relationships With the Temporal Stem and
Sagittal Stratum
Laterally, the parahippocampal gyrus is contiguous with the
fusiform gyrus and with the remainder of the basal surface of the
brain. Posteriorly, it continues along the cingulate gyrus. Medially,
it runs under the thalamus along the natural space comprising
the perimesencephalic cistern.22 Anteriorly, its uncal portion is
superiorly incorporated into the lateral most aspect of the

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ANATOMY OF THE OPTIC RADIATION

FIGURE 4. Images in 3 (A) and 2 (B) dimensions. Lateral view. Optic

radiation (OptRad) of the left hemisphere; the section of the superior longitudinal
fasciculus (SupLongFasc) allows exposure of the central (CenB) and posterior
bundles (PostB), which end at the lateral aspect of occipital pole and superior lip
of the calcarine fissure, respectively. AntCom, anterior commissure; CaN, caudate
nucleus; CoRa, corona radiata; DiBandBr, diagonal band of Broca; GloPa,
globus pallidus; IntCap, internal capsule.

FIGURE 5. Images in 3 (A) and 2 (B) dimensions. Magnified view of the

trajectory of the central and posterior bundles. The tapetum constitutes the
medial roof of the ventricular atrium. CenB, central bundle; OptRad, optic
radiation; PostB, posterior bundle; SupLipCaF, superior lip of the calcarine
fissure; SupLongFasc, superior longitudinal fasciculus; Spl, splenium of the
corpus callosum.

frontobasal region via a well-defined neural peduncle anterior to

the inferior horn of the lateral ventricle.
Anteriorly and externally, this true temporal peduncle is composed of the cortex of the transverse insular gyrus, which crosses the
limen insulae, connecting the insular cortex to the posteromedial
orbital lobule.23 Internally, it consists of the uncinate fascicle (which
joins the frontal and temporal lobes),24 occipitofrontal fasciculus
(which are located immediately posterior to the uncinate fascicle;
Figure 7), amygdalofugal fibers (which are composed of the ventral
extensions of the amygdala that project to the septothalamohypothalamic region),25 nucleus of the stria terminalis (situated under
the head of the caudate nucleus),26-28 and fibers of the anterior
commissure. Medially, there is the superior extension of the
amygdala, which forms the anterior half of the uncus and extends
posteriorly over the head of the hippocampus and then superiorly
and medially toward the globus pallidus.29

Posterolaterally, this temporal peduncle is contiguous with the

layers of fibers called the sagittal stratum,9,10 which covers the
inferior horn and ventricular atrium. All of these structures
collectively join the temporal lobe to the remainder of the cerebral
hemisphere beneath the insula. The so-called sagittal stratum
consists of the fronto-occipital fascicle, the posterior thalamic
peduncle (which contains the optic radiation), and the fibers that
compose the anterior commissure. The layer of callosal fibers
known as the tapetum lies under the optic radiation and then
constitutes the layer that is immediately underneath the sagittal
stratum (Figures 8 and 9). The sagittal stratum is situated inferior
to the inferior limiting sulcus of the insula, forming the roof and
lateral wall of the inferior horn, and also constitutes the lateral
wall of the ventricular atrium (Figure 8). Superficial to the sagittal
stratum is the subcortical white matter of the entire neocortical
portion of the temporal lobe.

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PARRAGA ET AL

FIGURE 6. Images in 3 (A) and 2 (B) dimensions. Lateral view. The superior,
middle temporal, angular, and occipital gyri were removed. Observe the optic
radiation located deep to the superior and middle temporal gyri, above the inferior
temporal sulcus. CS, central sulcus; Inf. Temp. Sulcus, inferior temporal sulcus;
InfLimS, inferior limiting sulcus; ITG, inferior temporal gyrus; MFG, middle
frontal gyrus; OptRad, optic radiation; PostCG, postcentral gyrus; PreCG,
precentral gyrus; SPLob, superior parietal lobe; TePo, temporal pole.

Relationships With the Other Fascicles

The optic radiation is also related with other also important fascicles
within the white matter: the anterior commissure, the acustic radiation,
and the uncinate, occipitofrontal, and superior longitudinal fascicles.
The Anterior Commissure
The anterior commissure is made up of fibers that connect the
anterior and mesial aspects of both temporal lobes. It forms
a compact, round bundle structure at the midline and extends
laterally, somewhat like the handlebars of a bicycle. It crosses in
front of the fornix columns (some fibers of the fornix pass
anteriorly to the anterior commissure toward the septal nuclei)
and extends laterally along the temporal stem, posteriorly to the
uncinate fascicle, and anteriorly and superiorly to the temporal
horn of the lateral ventricle, fanning into the temporal gyri.
Bilateral anterior extensions (anterior crus) connect both olfactory
systems, creating a real olfactive commissure.22,25,30,31 The lateral

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FIGURE 7. Images in 3 (A) and 2 (B) dimensions. Lateral view of left

hemisphere. Parts of the superior longitudinal fasciculus (SupLongFasc) were
removed to expose the corona radiata and the sagittal stratum (SagStr). Occipitofrontal (OcFrFasc) and uncinate fasciculus (UncFasc) can be identified
passing along the basal portion of the insular cortex. AntCom, anterior commissure; CoRa, corona radiate; GloPa, globus pallidus.

extension passes along the basal portion of the globus pallidus,

perpendicular to the optic radiation and medial to the uncinate
fascicle. Some fibers of the lateral extension anteriorly reach the
uncinate fascicle and the temporal pole, but most of its fibers
follow a posterior direction, joining the occipitofrontal fascicle
and becoming part of the sagittal stratum.10,18,31 The lateral
extension of the anterior commissure covers the anterior and
central bundles of the optic radiation, and when it reaches the
dorsal aspect of the temporal lobe, the anterior commissure fibers
become diffusely spread like a fan (Figure 10). The fibers of the
anterior commissure are superior and also partially intermingled
with the fibers of the optic radiation. The exposure of the optic
radiation then requires the removal of the most superior fibers of
the anterior commissure (Figure 11).
Acustic Radiations
The acustic fibers course through the sublenticular portion of
the internal capsule and end along the transverse temporal gyri

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ANATOMY OF THE OPTIC RADIATION

FIGURE 8. Images in 3 (A) and 2 (B) dimensions. Lateral view of the left
hemisphere. The vertical segment of the superior longitudinal fasciculus
(SupLongFasc) was removed, and a window in the sagittal stratum (SagStr) was
created to expose the tapetum. CoRa, corona radiata; ExtCap, external capsule;
ExtrCap, extreme capsule; LoG, long gyri of insula.

FIGURE 9. Images in 3 (A) and 2 (B) dimensions. Medial view of the left
hemisphere. The ependyma of the lateral ventricle and left atrium was removed.
Note the relation of the tapetum with the thalamic peduncles. The tapetum lies
underneath the optic radiation along the lateral wall of the atrium. AntCom,
anterior commissure; CN III, cranial nerve III; Corp. Call., corpus callosum;
MaBo, mammillary body; Sub. Nucl., subthalamic nucleus.

(Heschl gyrus). They are related superiorly to the temporal horn,

the atrium, the optic radiation, and the anterior commissure
(Figure 8).25,31

Occipitofrontal Fasciculus
The occipitofrontal fasciculus is a large association bundle of
fibers that connects the frontal and occipital lobes. It passes along
the basal portion of the insula and the claustrum, immediately above
the uncinate fascicle (Figure 7), and there was no defined limit
between the occipitofrontal and the uncinate fascicles, with their
merging in the extreme and external capsules.10,24,31,34 It coursed
parallel to and above the optic radiation in all specimens.

Uncinate Fascicle
The uncinate fasciculus, which has its name because of its
hooklike shape, is approximately 2 mm thick at the level of the limen
insulae (Figure 7).24 Its posterosuperior margin is adherent to the
occipitofrontal fascicle just under the putamen and the claustrum.
The uncinate fascicle joins the temporal stem and lies under the
cortex of the limen insulae (anterior transverse gyrus of the
insula)10 and anterior to the Meyer loop, anterior commissure,
occipitofrontal fasciculus, and inferior thalamic peduncle. It mostly
connects the anterior and medial aspects of the temporal lobe with
the orbital portion of the frontal lobe.17,24,31-33 The uncinate
fasciculus was found to be anterior to the optic radiation anterior
bundle (the Meyer loop) in all specimens.

NEUROSURGERY

Superior Longitudinal Fasciculus

The superior longitudinal fasciculus, or arcuate fascicle, is a large
association bundle located around the sylvian fissure and the
insula, which connects the frontal, parietal, temporal, and occipital
lobes. Along its temporal course, it covers the sagittal stratum
(Figure 7), which includes the optic radiation fibers, the anterior
commissure, and the occipitofrontal bundle. The superior
longitudinal fasciculus can be followed along the wall of the

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PARRAGA ET AL

FIGURE 11. Images in 3 (A) and 2 (B) dimensions. Magnified lateral view.
The internal capsule was partially removed to expose the head and body of the
caudate nucleus. The portion of the ventricular frontal horn anterior to the head
of the caudate can be appreciated. AntCom, anterior commissure; CaN, caudate
nucleus; CoRa, corona radiata; DiBandBr, diagonal band of Broca; GloPa,
globus pallidus; IntCap, internal capsule; NuclAccumb, nucleus accumbens;
OptRad, optic radiation; SepPel, septum pellucidum; SupLongFasc, superior
longitudinal fasciculus.
FIGURE 10. Images in 3 (A) and 2 (B) dimensions. Anterolateral view of the
left hemisphere. The occipitofrontal and the uncinate fasciculi and the putamen
were removed to expose the anterior commissure. The diagonal band of Broca
(DiBandBr) and its junction with the amygdala are inferior to the lateral aspect
of the anterior commissure (AntCom). CoRa, corona radiata; GloPa, globus
pallidus; HippoHead, head of the hippocampus; IntCap, internal capsule; SagStr,
sagittal stratum; SupLongFasc, superior longitudinal fasciculus.

lateral ventricle, within the depth of the middle frontal and the
inferior parietal and middle temporal gyri, encircling the insula in
a C shape (Figure 12).10,22,31 Two segments can be identified
according to their fiber orientation: the horizontal segment in the
depth of the middle frontal gyrus and inferior parietal lobule and
a vertical segment that runs along the posterior portion of the
inferior parietal lobule and the superior and middle temporal
gyri.15 It is important to highlight that the vertical segment always
covers the sagittal stratum and therefore the optic radiation.

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Inferior Longitudinal Fasciculus

This fasciculus extends from the occipital lobe to the temporal
pole, within the depth of the fusiform gyrus.22,25 It was found that
along its course the inferior longitudinal fasciculus lies inferior
and lateral to the optical radiations and inferior and parallel to the
temporal horn.

Relationships With the Ventricles

In all the hemispheres studied, the optic radiation covered the
roof and the lateral wall of the temporal horn, atrium, and occipital
horn and the floor of the atrium and occipital horn. The anterior
border of the Meyer loop was always anterior to the tip of the
temporal horn. The medial walls of these ventricular compartments were not related to the optic radiation except at the level of

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FIGURE 12. Images in 3 (A) and 2 (B) dimensions. Lateral view of left
hemisphere. The vertical segment of the superior longitudinal fasciculus
(SupLongFasc) has been removed to expose the optic radiation (OptRad).
AntCom, anterior commissure; CoRa, corona radiata; GloPa, globus pallidus;
IntCap, internal capsule; POS, parieto-occipital sulcus; PreCu, precuneus; Cu,
cuneus.

the lateral geniculate body. The floor of the temporal horn was also
not related to the optic radiation.

DISCUSSION
The Optic Radiation and Its Main Relationships
The origin, course, and termination of the optic radiation were
dissected and described for the first time by the great French
neuroanatomist Louis Pierre Gratiolet (1815-1865); it received its
name in 1854.10,35 The Italian anatomist Bartholomeo Panizza
(1785-1867) demonstrated the visual pathway from the eye to the
occipital cortex using the fiber dissection technique in 1855.10
The first description of the optic radiation course within the
temporal lobe with its anterior fibers going anteriorly and then
curving posteriorly was provided by Flechsig in 1896, who called
it the temporal knee,35 and posteriorly in 1907 by Meyer,36 who
called it the temporal loop. The relationships between the optic
radiation and its more related structures became clearer with the

NEUROSURGERY

white matter dissection refinement provided by Klingler in 1935

(Figure 13).8-10,35
The individual features of the optic radiation cannot be defined
precisely by use of the fiber dissection technique because of the dense
network between its fibers and the fibers of the uncinate fascicle,
occipitofrontal fasciculus, anterior commissure, inferior thalamic
peduncle (which contains the amygdalothalamic fibers), posterior
thalamic peduncle (which contains the optic radiation), temporopontine, and occipitopontine, particularly in the area of the so-called
sagittal stratum.10 In addition, the dissection and exposure of each
fiber tract often result in the destruction of other fiber tracts.35
However, the major bulk of the optic radiation was always
identified and dissected in all our specimens, corroborating its
division in anterior, central, and posterior bundles as previously
described by Ebeling and Reulen.21
The Meyer loop is formed by the anterior bundle of the optic
radiation fibers that are directed forward from the lateral geniculate
body toward to the temporal pole and located anterior to and around
the tip of the temporal horn roof in the lateral ventricle. It is the most
vulnerable part of the optic radiation in terms of the approaches to the
temporal horn and the temporomedial region. Damage to this
anterior bundle often results in superior homonymous quadrantanopic visual field deficits,21,37-39 and it occurs in 50% to 90% of
cases after anterior temporal lobectomies.40
The exact fiber course of the Meyer loop is controversial. Some
authors describe these fibers as also being anterior to the temporal
horn tip36,41,42; others indicate that these fibers reach only the
level of the temporal horn tip.43-45 The most anterior limit of the
Meyer loop has also been at the center of debate; it is estimated to
be anywhere from 22 to 37 mm posterior to the temporal
pole.16,21 Penfield46 noticed that lesions , 60 mm from the
temporal tip were not likely to produce a field defect. Falconer
and Wilson47 suggested that the Meyer loop anterior limit
location is about 45 mm from the temporal pole tip. Bjork and
Kugelberg43 estimated the anterior limit to be between 30 and 40
mm. Marino and Rasmussen43 reduced the safely resected area
length and reported that the smallest defect occurred with
a resection of 40 mm. The anterior edge of the Meyer loop was
28.4 mm (20-33 mm) from the temporal pole in our study.
Ebeling and Reulen21 described the Meyer loop as being
located from 10 mm ahead to 5 mm behind the temporal horn
tip. We observed in our study that the fibers extended ahead of
the temporal horn tip in all specimens (average, 4.5 mm).
Sincoff et al48 found that the optic radiation inferior edge is
never below the inferior temporal sulcus. These authors described
the lateral wall and temporal horn tip and roof as being
completely covered by the optic radiation and the floor and
medial wall of the temporal horn as being free from the optic
radiation, except the level of the lateral geniculate body, similar to
our findings (Figure 14A).
Regarding the so-called temporal stem, although controversial,35 a well-defined neural peduncle constituted by the uncinate
fasciculus fibers of the occipitofrontal fasciculus, amygdalofugal
fibers, and fibers of the anterior commissure can always be

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FIGURE 13. Images in 3 (A) and 2 (B) dimensions. Basal view of the neural visual pathways. The temporal gyrus has been
removed bilaterally, preserving the optic radiations (OptRad). The temporal stem has been removed, exposing the Meyer loop and
the trajectory of its fibers that reach the inferior lip of the calcarine fissure (InfLipCaF). In the left temporal horn, the ependyma
has been removed, and the tapetum can be seen along the atrium. AntCom, anterior commissure; AntLimb, anterior limb of the
internal capsule; LatGeBo, lateral geniculate body; OpCh, optic chiasm; OptTr, optic tract; PreCu, precuneus; UncFasc,
uncinate fasciculus.

identified anterior to sagittal stratum, connecting the mesial

aspect of the temporal lobe with the basal forebrain.
In the literature, this set of structures has been given the generic
and controversial name of temporal stem described in different
ways. According to Duvernoy,49 the temporal stem consists of
only a thin layer of white matter situated between the ventricular
cavity and the fundus of the superior temporal sulcus. Wen
et al29 stated that the term refers only to the connections
between the temporal lobe and the insula, excluding the superior
extension of the amygdala in the direction of the globus pallidus
and the limen insulae. Ture et al50 defined the temporal stem
as the portion of white matter that penetrates the temporal lobe
between the anterior border of the insula and the inferior horn,
composed of the fronto-occipital fascicle and the anterior
thalamic peduncle. We agree with this assessment because this
true temporal peduncle constitutes a very well-defined anatomic
feature that distinguishes the temporal lobe from the other
morphologically similar white matter connections between the
cerebral lobes, including the other connections of the temporal
lobe itself.

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From a topographical perspective, it is notable that the sagittal

stratum corresponds to the set of fibers that cover the inferior horn
and atrium of the ventricle, inferior and posterior to the insula,
whereas the temporal stem is situated anterior to the inferior horn,
connecting the anteromedial temporal portion to the basolateral
frontal portion of the brain.
According to this concept and our findings, the so-called
temporal stem itself lies medially and anteriorly to the optic
radiation, and the sagittal stratum contains the temporal portion of
the optic radiation.
Considerations Regarding Approaches to the
Temporal Horn
There are many microneurosurgical corridors toward the
inferior or temporal horn that were usually developed primarily
for the surgical treatment of temporal lobe epilepsy. They are all
based on the initial description of the transtemporal transventricular removal of the amygdala and of the hippocampus by
Niemeyer51 in 1958 and currently can be divided into 3 groups
of approaches: transsylvian, lateral, and subtemporal approaches.

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ANATOMY OF THE OPTIC RADIATION

commissure, occipitofrontal fasciculus, and potentially the

anterior aspect of the Meyer loop (Figure 14B).
Vajkoczy et al54 proposed the transsylvian-transcisternal for the
en bloc resection of the mesial structures, particularly for the
treatment of patients with hippocampal sclerosis. With this
technique, the anterior hippocampus and the amygdala are resected
en bloc through the division of the rhinal sulcus, with the
preservation of the laterobasal surface integrity of the temporal lobe.
Coppens et al55 described the transsylvian anteromedial
approach to access the temporal horn, through a small incision
in the pyriform cortex, to reach the amygdala medially to the
uncinate fascicle, limen insulae, and optic radiation. Choi et al56
identified a triangular area under the sylvian fissure floor to reach
the temporal horn, medial to the Meyer loop and lateral to the
optic tract. Its base is formed by the limen insulae level and its
apex by the anterior border of the lateral geniculate body; the
amygdala was located in the anterior portion of this triangle.

FIGURE 14. A, illustration showing a summary of the optic radiation

relations with the sulci, gyri, and lateral ventricle. The anterior bundle (red),
central bundle (yellow), and posterior bundle (green). CaF, calcarine fissure;
Inf. Temp. Sulcus, inferior temporal sulcus; ITG, inferior temporal gyrus;
MTG, middle temporal gyrus; STG, superior temporal gyrus; Sup. Temp.
Sulcus, superior temporal sulcus; TeHo, temporal horn. B, photograph showing
a left cerebral hemisphere in 3 dimensions. The exposure gained through
approaches to the temporal horn and trigone. Pterional/transsylvian, transventricular approaches (red), transtemporal and subtemporal approaches
(yellow), supracerebellar transtentorial approach (green), and parieto-occipital
interhemispheric approach (blue).

Transsylvian Transventricular
The transsylvian transventricular approach proposed by
Yasargil and colleagues37,52,53 along or just lateral to the limen
insulae and to the inferior limiting sulcus avoids damage to the
dorsal cortical surface but damages the uncinate fascicle, anterior

NEUROSURGERY

Lateral Transtemporal Approaches Through the Superior,

Middle, or Inferior Temporal Gyrus
The lateral approaches when done through the middle temporal
gyrus can lead to contralateral quadrantanopia (Figure 14B).
The lateral wall of the temporal horn is located 22 to 26 mm
from the cortical surface at this level, and visual deficit occurred in
about 7% of the patients submitted to this technique.21,24,31 It is
also important to consider that in the dominant hemisphere the
middle temporal gyrus has connections with the angular gyrus,
which, together with the parietal and the occipital lobes, plays an
important functional language role. Olivier57 described in 1991
the transsulcal approach through the superior temporal sulcus,
which also implies possible visual deficits and language impairments because the language areas can extend along the dominant
superior temporal gyrus until 5 to 6 cm behind the temporal pole.4
The approach to the inferior horn through the inferior temporal
gyrus can be made 3 cm posterior to the temporal pole and avoids
damage to the visual and language pathways,58 also according to
our findings.
Subtemporal Approaches Through the Uncus and
Parahippocampal Gyrus and Through the Fusiform Gyrus
Park et al59 described the subtemporal transparahippocampal
approach to perform amygdalohippocampectomies (Figure 14B).
A cortical incision is made in the uncus, 1 to 1.5 cm posterior to
the point where the third nerve crosses the tentorial edge for the
exposure of the temporal horn, and the anterior hippocampus is
removed subpially. They reported an operative morbidity
consisting of a contralateral homonymous quadrant visual defect
in 1 patient and memory impairment in 1 patients among 8
patients. In 1993, Hori et al60 proposed a similar approach
through the fusiform gyrus for the treatment of temporal lobe
epilepsy with some modifications such as dividing the tentorium
in an effort to reduce retraction on the temporal lobe, emphasized
measures to avoid damage to the vein of Labb, and advocated the
en bloc excision of the fusiform gyrus to open the temporal horn.

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PARRAGA ET AL

According to Yeni et al,61 the incidence of the superior

quadrantanopia is 50 to 90% after an anterior temporal lobectomy.
Renowden et al reported 50% of incomplete quadrantanopia after
selective amygdalohippocampectomies, in contrast to the Yasargil
et al62 series in which only 1 of 73 patients developed a visual
deficit after transsylvian selective amygdalohippocampectomies.
The temporal horn and atrium may also be reached through the
supracerebellar transtentorial approach, thus avoiding lesions of
the optic radiation (Figure 14B).
Considerations Regarding Approaches to the Trigone
Fornari et al63 proposed a parietal transcortical approach to the
trigone through the superior parietal gyrus. According to these
authors, such parieto-occipital approaches are not the cause of visual
damage because the optic radiation lies more inferolateral to the
ventricle. A similar approach was proposed by Ribas et al64 through
the opening of the intraparietal sulcus started anteriorly at the
meeting point of the postcentral and intraparietal sulci, because this
meeting point has a very close relationship with the ventricular
trigone and can easily be found underneath the skull about 6 cm
anterior to lambda and 5 cm lateral to the sagittal suture.
Nagata and Sasaki65 described a lateral transsulcal approach to the
atrium through a horizontal cortical incision made at the posterior
aspect of the insular cortex. For these authors, the advantages of
such a lateral transsulcal approach are a direct and wide operative
field, the use of a definite anatomic landmark, easy exposure of the
choroid plexus, and no damage to the optic radiation.
The parieto-occipital interhemispheric approach was described
by Yasargil and colleagues.66,67 Through a large exposure of the
parasplenial area, the trigone can be approached through a small
cortical incision made just anterior to the parieto-occipital sulcus
(Figure 14B). Rhoton30 described the same approach, although
specifying the cortical incision over the isthmus cingulum,
without compromising the optic radiation that lies lateral to
the ventricle. Mahaney and Abdulrauf68 found that the best point
to open the cingulum for this approach is located 5 mm
superiorly and laterally to the falcotentorial meeting point.

CONCLUSION
The white matter dissection technique reveals the intrinsic
architecture of the brain. The detailed knowledge provided by this
technique about the temporal lobe helps the surgeon be more
familiar with the important optic radiation fibers and their related
structures and to choose the best approach for each case.
Disclosure
The authors have no personal financial or institutional interest in any of the
drugs, materials, or devices described in this article.

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COMMENTS

he study of white matter tracts of the brain using the technique of fiber
dissection as described by Klingler has gained important interest in
neurosurgical literature over the past decade. Numerous studies have been
presented to illustrate the course of association fibers, commissural fibers,
and projection fibers and their interaction. This growing interest was
initiated by the emergence of magnetic resonance diffusion tensor imaging. This technique allows us to visualize the same white matter tracts
in vivo. Seeing these tracts on magnetic resonance images sparked an interest in exploring the brain with the fiber dissection technique in the
neuroanatomy laboratory. However, as everyone who has experience with
the Klingler dissection technique and with diffusion tensor imaging is
aware, both techniques are very dependent on the expertise of the investigator. They very much show what is looked for and therefore should
be regarded as illustrative rather than investigative. Nevertheless, both
techniques help to increase the knowledge of the anatomy of the white
matter tracts. This knowledge has become essential for performing surgical
procedures on the brain. This is especially true for epilepsy surgery and
glioma surgery. Because the results of neurosurgical procedures are no
longer measured only by evaluating motor function and visual fields but
also by detailed neuropsychological and language testing, it has become
clear that every single area of white matter is essential for a normal function
of the human brain.
The authors present a detailed study of the white matter tracts of the
temporal and occipital lobe, with emphasis on the optic radiation. Although the subject has been studied numerous times, the images in this
work are of superb quality, showing the course of the different tracts in
great detail, in both 2- and 3-dimensional images. Meticulous microneurosurgical techniques require hours of practice in the laboratory. The
same is true for the fiber dissection technique. The authors describe the
results of their dissection on 40 hemispheres, whereas other studies

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PARRAGA ET AL

published were performed on only 20 or 10 hemispheres. Very likely, the

experience gained during these hours in the neuroanatomy laboratory has
led to the expertise that produced such fine results. Moreover, the different
measurements of the course of the optic radiation relative to external
landmarks are very helpful in deciding on the right approach to reach the
mesial temporal structures and the trigone of the lateral ventricle.
Johannes van Loon
Leuven, Belgium

his is an excellent anatomic delineation of the optic radiation. The 3dimensional images obtained by the authors by laborious and meticulous fiber dissection reveal not only the basic topography but also an
unexpected location of the fibers that should be considered at surgery, ie,
the anterior extended Meyer loop with an anterior edge that was only 20
mm from the temporal pole. Although the current status of magnetic
resonance diffusion tensor tractography makes it possible to depict the

ons172 | VOLUME 71 | OPERATIVE NEUROSURGERY 1 | SEPTEMBER 2012

optic radiation in vivo,1,2 fiber dissection and 3-dimensional documentation are of high value to surgeons and of significance in terms of
information on the relationship between the surgical anatomy and
physical sensations.
Satoru Shimizu
Sagamihara, Japan

1. Taoka T, Sakamoto M, Nakagawa H, et al. Diffusion tensor tractography of the

Meyer loop in cases of temporal lobe resection for temporal lobe epilepsy:
correlation between postsurgical visual field defect and anterior limit of Meyer loop
on tractography. AJNR Am J Neuroradiol. 2008;29(7):1329-1334.
2. Wang YX, Zhu XL, Deng M, et al. The use of diffusion tensor tractography
to measure the distance between the anterior tip of the Meyer loop and the
temporal pole in a cohort from Southern China. J Neurosurg. 2010;113(6):
1144-1151.

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