open access

Ahead of Print
REVIEW ARTICLES
Published online: 2018-12-05
Submitted: 2018-08-14
Accepted: 2018-09-14
Get Citation

Klingler’s method of brain dissection: review of the technique including its usefulness in practical neuroanatomy teaching, neurosurgery and neuroimaging

Grzegorz Wysiadecki, Edward Clarke, Michał Polguj, Robert Haładaj, Andrzej Żytkowski, Mirosław Topol
DOI: 10.5603/FM.a2018.0113
·
Pubmed: 30536356

open access

Ahead of Print
REVIEW ARTICLES
Published online: 2018-12-05
Submitted: 2018-08-14
Accepted: 2018-09-14

Abstract

Klingler’s technique was discovered in the 1930s. It is a modified method of brain fixation and dissection, based on freezing and thawing of the brain tissue, subsequent peeling away of white matter fibers and the gradual exposure of white matter tracts. The added value of this technique is that it is carried out in a stratigraphic manner; This fact makes it an invaluable tool for an in-depth understanding of the complex anatomical organization of the cerebral hemispheres.

The purpose of this paper is to provide a review of Klingler’s method while taking into account the original description of the technique and its value for medical training. The historical background, the concise outline of white matter organization, as well as our own experience in using this procedure for research and teaching activities were also included.

The fiber dissection technique may still be considered an excellent complementary research tool for neuroanatomical studies. Numerous detailed observations about the white matter topography and spatial organization have been recently made by applying this method. Using this technique may also improve understanding of the three-dimensional intrinsic structure of the brain, which is particularly important both in under- and postgraduate training in the field of neuroanatomy.

Abstract

Klingler’s technique was discovered in the 1930s. It is a modified method of brain fixation and dissection, based on freezing and thawing of the brain tissue, subsequent peeling away of white matter fibers and the gradual exposure of white matter tracts. The added value of this technique is that it is carried out in a stratigraphic manner; This fact makes it an invaluable tool for an in-depth understanding of the complex anatomical organization of the cerebral hemispheres.

The purpose of this paper is to provide a review of Klingler’s method while taking into account the original description of the technique and its value for medical training. The historical background, the concise outline of white matter organization, as well as our own experience in using this procedure for research and teaching activities were also included.

The fiber dissection technique may still be considered an excellent complementary research tool for neuroanatomical studies. Numerous detailed observations about the white matter topography and spatial organization have been recently made by applying this method. Using this technique may also improve understanding of the three-dimensional intrinsic structure of the brain, which is particularly important both in under- and postgraduate training in the field of neuroanatomy.

Get Citation

Keywords

fiber dissection technique; Klingler' s technique; neuroanatomy; white matter; tractography

About this article
Title

Klingler’s method of brain dissection: review of the technique including its usefulness in practical neuroanatomy teaching, neurosurgery and neuroimaging

Journal

Folia Morphologica

Issue

Ahead of Print

Published online

2018-12-05

DOI

10.5603/FM.a2018.0113

Pubmed

30536356

Keywords

fiber dissection technique
Klingler's technique
neuroanatomy
white matter
tractography

Authors

Grzegorz Wysiadecki
Edward Clarke
Michał Polguj
Robert Haładaj
Andrzej Żytkowski
Mirosław Topol

References (64)
  1. Agrawal A, Kapfhammer JP, Kress A, et al. Josef Klingler's models of white matter tracts: influences on neuroanatomy, neurosurgery, and neuroimaging. Neurosurgery. 2011; 69(2): 238–52; discussion 252.
  2. Arantes M, Arantes J, Ferreira MA. Tools and resources for neuroanatomy education: a systematic review. BMC Med Educ. 2018; 18(1): 94.
  3. Avecillas-Chasin JM, Rascón-Ramírez F, Barcia JA. Tractographical model of the cortico-basal ganglia and corticothalamic connections: Improving Our Understanding of Deep Brain Stimulation. Clin Anat. 2016; 29(4): 481–492.
  4. Bertani GA, Bertulli L, Scola E, et al. Optic radiation diffusion tensor imaging tractography: an alternative and simple technique for the accurate detection of meyer's loop. World Neurosurg. 2018; 117: e42–e56.
  5. Bozkurt B, Yagmurlu K, Middlebrooks EH, et al. Microsurgical and tractographic anatomy of the supplementary motor area complex in humans. World Neurosurg. 2016; 95: 99–107.
  6. Böttger J, Schäfer A, Lohmann G, et al. Three-dimensional mean-shift edge bundling for the visualization of functional connectivity in the brain. IEEE Trans Vis Comput Graph. 2014; 20(3): 471–480.
  7. Catani M. Principles of white matter organization. In: M Husain and JM. Schott (eds) Oxford Textbook of Cognitive Neurology and Dementia. Oxford University Pres Oxford Medicine Online. 2016.
  8. Chang BS, Molnár Z. Practical neuroanatomy teaching in the 21st century. Ann Neurol. 2015; 77(6): 911–916.
  9. Chowdhury F, Haque M, Sarkar M, et al. White fiber dissection of brain; the internal capsule: a cadaveric study. Turk Neurosurg. 2010; 20(3): 314–322.
  10. Corrivetti F, Froelich S, Mandonnet E. Endoscopic Approach of the Insula Through the Anterior Middle Temporal Gyrus: A Feasibility Study in the Laboratory. Oper Neurosurg (Hagerstown). 2017 [Epub ahead of print].
  11. da Carpi JB. Isagoge breves. Benedictus Hector, Bologna. 1523; 56.
  12. De Benedictis A, Duffau H, Paradiso B, et al. Anatomo-functional study of the temporo-parieto-occipital region: dissection, tractographic and brain mapping evidence from a neurosurgical perspective. J Anat. 2014; 225(2): 132–151.
  13. De Benedictis A, Nocerino E, Menna F, et al. Photogrammetry of the human brain: a novel method for three-dimensional quantitative exploration of the structural connectivity in neurosurgery and neurosciences. World Neurosurg. 2018; 115: e279–e291.
  14. de Castro I, Christoph Dd, dos Santos DP, et al. Internal structure of the cerebral hemispheres: an introduction of fiber dissection technique. Arq Neuropsiquiatr. 2005; 63(2A): 252–258.
  15. Dini LI, Vedolin LM, Bertholdo D, et al. Reproducibility of quantitative fiber tracking measurements in diffusion tensor imaging of frontal lobe tracts: A protocol based on the fiber dissection technique. Surg Neurol Int. 2013; 4: 51.
  16. Estevez ME, Lindgren KA, Bergethon PR. A novel three-dimensional tool for teaching human neuroanatomy. Anat Sci Educ. 2010; 3(6): 309–317.
  17. Feigl GC, Hiergeist W, Fellner C, et al. Magnetic resonance imaging diffusion tensor tractography: evaluation of anatomic accuracy of different fiber tracking software packages. World Neurosurg. 2014; 81(1): 144–150.
  18. Fernández-Miranda JC, Rhoton AL, Alvarez-Linera J, et al. Three-dimensional microsurgical and tractographic anatomy of the white matter of the human brain. Neurosurgery. 2008; 62(6 Suppl 3): 989–1026; discussion 1026.
  19. Finger S. Minds Behind the Brain: A History of the Pioneers and Their Discoveries. Oxford University Press, Oxford, New York 2000: 54–60.
  20. Gross ChG. Brain, Vision, Memory. Tales in the History of Neuroscience. The MIT Press, London 1998: 1–41.
  21. Haładaj R, Wysiadecki G, Polguj M, et al. Bilateral muscular slips between superior and inferior rectus muscles: case report with discussion on classification of accessory rectus muscles within the orbit. Surg Radiol Anat. 2018; 40(7): 855–862.
  22. Hau J, Sarubbo S, Houde JC, et al. Revisiting the human uncinate fasciculus, its subcomponents and asymmetries with stem-based tractography and microdissection validation. Brain Struct Funct. 2017; 222(4): 1645–1662.
  23. Heimer L. The Human Brain and Spinal Cord. Functional Neuroanatomy and Dissection Guide. Springer-Verlag, New York, Berlin, Heidelberg 1995: 59–118.
  24. Ikeda M, Hossain MI, Zhou Li, et al. Histological detection of dynamic glial responses in the dysmyelinating Tabby-jimpy mutant brain. Anat Sci Int. 2018; 93(1): 119–127.
  25. Iturria-Medina Y. Anatomical brain networks on the prediction of abnormal brain states. Brain Connect. 2013; 3(1): 1–21.
  26. Jozefowicz RF. Neurophobia: the fear of neurology among medical students. Arch Neurol. 1994; 51(4): 328–329.
  27. Koutsarnakis C, Liakos F, Kalyvas AV, et al. The superior frontal transsulcal approach to the anterior ventricular system: exploring the sulcal and subcortical anatomy using anatomic dissections and diffusion tensor imaging tractography. World Neurosurg. 2017; 106: 339–354.
  28. Latini F, Hjortberg M, Aldskogius H, et al. The use of a cerebral perfusion and immersion-fixation process for subsequent white matter dissection. J Neurosci Methods. 2015; 253: 161–169.
  29. Latini F. New insights in the limbic modulation of visual inputs: the role of the inferior longitudinal fasciculus and the Li-Am bundle. Neurosurg Rev. 2015; 38(1): 179–189.
  30. Lohmann P, Piroth MD, Sellhaus B, et al. Correlation of Dynamic O-(2-[F]Fluoroethyl)-L-Tyrosine Positron Emission Tomography, Conventional Magnetic Resonance Imaging, and Whole-Brain Histopathology in a Pretreated Glioblastoma: A Postmortem Study. World Neurosurg. 2018; 119: e653–e660.
  31. Long J, Roberts DJH, Pickering JD. Preservation of cranial nerves during removal of the brain for an enhanced student experience in neuroanatomy classes. Clin Anat. 2014; 27(1): 20–24.
  32. Ludwig E, Klingler J. Atlas cerebri humani. S. Karger, Basel, New York 1956: 15–20.
  33. Martino J, De Witt Hamer PC, Vergani F, et al. Cortex-sparing fiber dissection: an improved method for the study of white matter anatomy in the human brain. J Anat. 2011; 219(4): 531–541.
  34. Mayo HM. A series of engravings intended to illustrate the structure of the brain and spinal cord in man. Burgess and Hill, London 1827.
  35. Meola A, Comert A, Yeh FC, et al. The controversial existence of the human superior fronto-occipital fasciculus: Connectome-based tractographic study with microdissection validation. Hum Brain Mapp. 2015; 36(12): 4964–4971.
  36. Naets W, Van Loon J, Paglioli E, et al. Callosotopy: leg motor connections illustrated by fiber dissection. Brain Struct Funct. 2017; 222(1): 661–667.
  37. Nooij RP, Hoving EW, van Hulzen ALJ, et al. Preservation of the optic radiations based on comparative analysis of diffusion tensor imaging tractography and anatomical dissection. Front Neuroanat. 2015; 9: 96.
  38. Pascalau R, Popa Stănilă R, Sfrângeu S, et al. Anatomy of the limbic white matter tracts as revealed by fiber dissection and Tractography. World Neurosurg. 2018; 113: e672–e689.
  39. Persaud TV, Loukas M, Tubbs RSA. A history of Human Anatomy. Second Edition. Charles C Thomas Publisher, Ltd., Springfield, IL, 2014: 12.
  40. Peuskens D, van Loon J, Van Calenbergh F, et al. Anatomy of the anterior temporal lobe and the frontotemporal region demonstrated by fiber dissection. Neurosurgery. 2004; 55(5): 1174–1184.
  41. Poliakov AV, Albright E, Hinshaw KP, et al. Server-based approach to web visualization of integrated three-dimensional brain imaging data. J Am Med Inform Assoc. 2005; 12(2): 140–151.
  42. Rhoton A. The supratentorial cranial space: microsurgical anatomy and surgical approaches. Neurosurgery. 2002; 51(suppl_4).
  43. Sarubbo S, Basso G, Chioffi F, et al. Technical, anatomical, and functional study after removal of a symptomatic cavernous angioma located in deep wernicke's territories with cortico-subcortical awake mapping. Case Rep Neurol Med. 2013; 2013: 835029.
  44. Sarubbo S, De Benedictis A, Maldonado IL, et al. Frontal terminations for the inferior fronto-occipital fascicle: anatomical dissection, DTI study and functional considerations on a multi-component bundle. Brain Struct Funct. 2013; 218(1): 21–37.
  45. Sarubbo S, De Benedictis A, Milani P, et al. The course and the anatomo-functional relationships of the optic radiation: a combined study with 'post mortem' dissections and 'in vivo' direct electrical mapping. J Anat. 2015; 226(1): 47–59.
  46. Silva SM, Andrade JP. Neuroanatomy: The added value of the Klingler method. Ann Anat. 2016; 208: 187–193.
  47. Skadorwa T, Kunicki J, Nauman P, et al. Image-guided dissection of human white matter tracts as a new method of modern neuroanatomical training. Folia Morphol. 2009; 68(3): 135–139.
  48. Sporns O, Chialvo DR, Kaiser M, et al. Organization, development and function of complex brain networks. Trends Cogn Sci. 2004; 8(9): 418–425.
  49. Swanson L. Neuroanatomical Terminology. A Lexicon of Classical Origins and Historical Foundations. Oxford University Press, Oxford, New York 2014.
  50. Szmuda T, Rogowska M, Słoniewski P, et al. Frontal aslant tract projections to the inferior frontal gyrus. Folia Morphol. 2017; 76(4): 574–581.
  51. Ten Donkelaar HJ, Broman J, Neumann PE, et al. Towards a Terminologia Neuroanatomica. Clin Anat. 2017; 30(2): 145–155.
  52. Türe U, Yaşargil MG, Pait TG. Is there a superior occipitofrontal fasciculus? A microsurgical anatomic study. Neurosurgery. 1997; 40(6): 1226–1232.
  53. Türe U, Yaşargil MG, Friedman AH, et al. Fiber dissection technique: lateral aspect of the brain. Neurosurgery. 2000; 47(2): 417–26; discussion 426.
  54. Vergani F, Mahmood S, Morris CM, et al. Intralobar fibres of the occipital lobe: a post mortem dissection study. Cortex. 2014; 56: 145–156.
  55. Verhaeghe A, Decramer T, Naets W, et al. Posterior Quadrant Disconnection: A Fiber Dissection Study. Oper Neurosurg (Hagerstown). 2018; 14(1): 45–50.
  56. Vesalius A. Andreae Vesalii Bruxellensis, scholae medicorum Patauinae professoris De humani corporis fabrica libri septem. Ex officina Joannis Oporini, Basel 1543: 605–609.
  57. Willis T. Dr. Willis's Practice of physick, being the whole works of that renowned and famous physician: containing these eleven several treatises, viz. I. Of fermentation. II. Of feavers. III. Of urines. IV. Of the accension of the blood. V. Of musculary motion. VI. Of the anatomy of the brain. VII. Of the description and use of the nerves. VIII. Of convulsive diseases. IX. Pharmaceutice rationalis, the first and second part. X. Of the scurvy. XI. Two discourses concerning the soul of brutes. (…) With forty copper plates / The Pharmaceutice new translated [as also the remainder, by Samuel Pordage], and the whole carefully corrected. Printed for T. Dring, C.Harper, and J. Leigh, London 1684.
  58. Wu Y, Sun D, Wang Y, et al. Segmentation of the cingulum bundle in the human brain: a new perspective based on DSI tractography and fiber dissection study. Front Neuroanat. 2016; 10: 84.
  59. Wysiadecki G, Polguj M, Topol M. An unusual variant of the abducens nerve duplication with two nerve trunks merging within the orbit: a case report with comments on developmental background. Surg Radiol Anat. 2016; 38(5): 625–629.
  60. Wysiadecki G, Małkiewicz A, Rożniecki J, et al. Anatomical variations of the insular gyri: A morphological study and proposal of unified classification. Clin Anat. 2018; 31(3): 347–356.
  61. Wysiadecki G, Haładaj R, Polguj M, et al. Bilateral extensive ossification of the posterior petroclinoid ligament: an anatomical case report and literature review. J Neurol Surg A Cent Eur Neurosurg. 2019; 80(2): 122–126.
  62. Zemmoura I, Serres B, Andersson F, et al. FIBRASCAN: a novel method for 3D white matter tract reconstruction in MR space from cadaveric dissection. Neuroimage. 2014; 103: 106–118.
  63. Zemmoura I, Blanchard E, Raynal PI, et al. How Klingler's dissection permits exploration of brain structural connectivity? An electron microscopy study of human white matter. Brain Struct Funct. 2016; 221(5): 2477–2486.
  64. Zhang J, Tian L, Zhang Li, et al. Relationship between white matter integrity and post-traumatic cognitive deficits: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2019; 90(1): 98–107.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By  "Via Medica sp. z o.o." sp.k., Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl