0:01
Welcome to SNI Digital Innovations in Learning in association with UCLA Neurosurgery. Linda Liao, chairwoman and its faculty are pleased to bring you the UCLA Department of Neurosurgery 101
0:22
lecture series on neurosurgery and clinical and basic neuroscience.
0:30
This series of lectures are provided free to bring the advances in clinical and basic neuroscience to physicians and patients everywhere. One out of every five people in the world suffer from a
0:49
neurologically related disease. The lecture is given by Noriko Salomon. Professor, Radiology, neural radiology, the David Geffen School of Medicine at UCLA, Los Angeles, California, United
1:08
States of America.
1:12
Good morning, everybody. So I'm Noriko Salmon, I'm a neuro-radiologist. So I'm going to talk about I'm doing this every year, but another me of the SABR attacks, so
1:26
using MRI, I don't have any disclosures for this talk. So the objective of this is, anatomy is always important for the neurosurgeons and radiologists. So we use lots of MRI to identify tumors and
1:46
strokes and stuff, and important to know where is the location of the disease, and oftentimes
1:56
what we are seeing is what kind of tumor is what kind of disease it is. Maybe it's not as important as where the location is because this is how it matters for the patients and then the how to
2:10
approach those disease processes. Maybe the most fundamental thing for the neurosurgeon to know. So to review basic anatomy for know the primary cortex, where the primary cortex look like in MRI.
2:25
And then of course, I know that my brother is a neurosurgeon, my father was a neurosurgeon. And then I know the neurosurgeon, the view of the neurosurgeon is very different from a
2:36
radiology view. But I'm gonna show you that, how to identify the cell side to define the cortex, using MRI. And then sometimes those things can be correlated well to the patient. And then while
2:54
the CT and MRI, most of the studies you see is actual plane. the CT was an OM line or orbital mirror line. So this is what the most anatomically decent line, which is mostly corresponding to ACPC
3:11
line in MRI. And the ACPC line has been around for, since a new MOSF program era. And I'm maybe the last person who I've seen the training in your MOSF program So, you know, I'm not as young as I
3:30
look.
3:34
So the ACPC line was a very important location. And then, so it's important to identify that's where the ACPC line is. And then we always teach technologies to, first things to teach is where the
3:47
ACPC line is. And then that line is the base of the axial plane So, go to the midline, and you can see the cobscallosum and the phonics and the phonics. going to come down to the memory body areas.
4:01
And then eventually, along the anterior portion of this phonics line, this is where the round structure, which traversing right and left, that's the anterior commissure. Poster commissure is the
4:14
superior edge of the supercurricular. So this round structure, this is a posterior commissure. And then you identify this, and you draw a line. And that's going to be your axial plane
4:27
If you look at this in an automobile specimen,
4:31
this specimen, I prepared by myself. And then I took a picture by myself. So I'm using this for the last 20 years, 25 years. So this is AC. This is PC. And then this AC-PC line distances about
4:47
27 millimeters in Anglo-Saxon people. And in Japanese, it's 25 millimeters So that's why we have a round shape brain. you've noticed. So the eventually the different rays have a different distance
5:07
but this ACPC plane is the fundamental axial plane and then coronal plane is going to be this perpendicular to this, right? And then so if you look at the coronal plane, the coronal plane is always
5:21
difficult to identify which structures are and then so I'm going to add this year for the coronal plane or a foot underneath me as well. And then the ACPC plane in the, the convenient stuff is if
5:36
you're thinking about the broker, then we're going to get some. Broker is always on tell you to the AC line and then the brainic is always posterior to or just posterior to at the level of the
5:50
posterior commissure line. So under posterior commissure it's located in the center of the brain and then central circus runs between AC and PC. So, if you are looking at the clone of plane, enter
6:06
to the AC or postulate the PC line, the anatomy is very simple, because superior middle inferior frontal gyrite, superpart all of you, inferior part all of you, which is supermogenizing the
6:19
angular gyrite. Those are very simple, well aligned anatomy And in between, AC and PC have obliquely oriented pre - and post-central gyrite line up. So, the anterior to the AC line and posterior
6:36
to the PC line, and then in between has a very different look in coronal brain, for example. And temporal lobe and occipital lobes are gonna contiguous structures and then kinda line up until
6:47
posteriorly. So, this is also very easy to see, yes All right, I just thought that perhaps
6:56
for junior or people of medical students, ab scans are not aligned like this. No, pet scans are aligned like this. Pet scans that, or M-line, which is about about 10 or
7:09
15 degrees different. So it's close enough, but it's a little different angle.
7:20
Petrus bone, right? They try to light it up so you don't get as much petrus bone, ironing artifact So the thing is CAT scan. In more eyes, you're just gonna use the
7:34
plane, which you already do the side rope plane to
7:42
place the slices. But CAT scan is usually placed on the patient And then the scan line is aligned to kind of inflow stuff or into the, you know. lateral margin of the orbit, and then the external
8:02
orbit now, right? So that's the assimilate to most closest line to the ACPC line, if you will. So eventually the anatomy and those, the ORM line is, because already ACPC lines already existed as
8:20
a fundamental plane. So, and try to assimilate to the ACPC line and ORM lines across this And then that was able to identify from the, you know, externally. So that's how the CT scan was
8:37
organized. Anyway,
8:41
so the things you can see in the brain and different complement has different functions, as we all learned in medical school, that, you know, difference from liver or lung,
8:57
They also have a different compartment of brain, has different lobes, and then has different functions, which matters to our life. So first, these idiotypical primary cortexes, which is sensory
9:11
motor and then all different visual cortex. And that's the things you have to know where it is. And then so to know the motor sensory cortex, you have to know where the central sulcus is And the
9:24
auditory and visual cortex, chalcary, fissure, and the facial gyrus has a very peculiar shape. So you're able to easily identify your bone. And
9:35
the, after this identifying this primary cortexes, the adjacent to those cortices has a unimodal associative cortex, which is the associated motor, helps motor and associative sensory, helps
9:48
sensory cortex And then, so the long range zone is also very close to the sensory motor cortex. but which is important thing about this associate cortex is, for example, this
10:03
from the visual cortex. The visual cortex function is important to have, but even you can see something. If you are not able to have a associated cortex to help that visual cortex associate with
10:24
other cortices, you can interpret your visual information to a
10:33
real function. So, for example, visual cortex, there's a what pathway and where pathway and what pathway is communicated to the memory function. So what you see in the visual information, you
10:44
know what this is. You can name this thing and you can identify, you can recognize those objects where passways, you are able to get
10:56
your visual information to the visual spatial information, so you know where you are, you know where to go, and you can see your body position, you can see the space orientation. So those
11:09
functions are more important. So not only preserving the visual cortex, no particular radiation, but also you have to be aware of this in field of adrenal fasciculus, so that communication to the
11:24
inferior portion of language, so that you are able to name objects and recognize face. So that's how the associated cortex are important. And you have this hetero model high order cortex, which is
11:41
inferior from temporal parietal lobe or prefrontal cortex, which has motivation, inhibition and motion control and reading writing calculation. It's much high order cortex.
11:56
Of course, those are the most important function that's human being has. And then, so that's the purpose of when you see the tumor, which lobe it belongs to. And then you're removing the tumor,
12:12
what can happen. And then that's what you have to think every time you look at the imaging. And the, so the, this is the Syrian fissure and then central circles, pre-central circles,
12:25
post-central circles, those three cells are in the Syrian fissure, just kind of the fundamental cell size that you have to identify always. And severe fissure also has a posterior branch and a
12:36
vertical branch. This vertical branch of the Syrian fissure is, is your friend and if you identify this, you can navigate yourself very easily. And then so I just emphasize this vertical branch of
12:49
the Syrian fissure, especially in an axial plane, easy to see. It's a deep focus. And then if you.
12:56
find this posterior to this is a presentral sulcus. So finding this
13:03
baricle branch of the subramagiolysis you are able to reach a central sulcus. The other way to find the central sulcus in this particular region is the, you find the subramagiolysis but a lot of
13:15
bunch of subramagiolysis, very low branch of subramagiolysis ends and then that forms the
13:21
superimaginative gyrus. I'll tell you a margin of the superimagiolysis post-central sulcus, so when you see the post-central sulcus you also get to the central sulcus. So if you look at the severe
13:31
and fissure portion of the
13:35
axial plane, you are able to see a vertical branch and then that's usually leads to the central sulcus, for example, anterior to this pre-central sulcus, the anatomy is pretty simple. Superio,
13:49
middle, inferior frontal gyrus kind of one, two, three and the video too that it all can wind up. So there's the post-central sulcus. It's also super paratolobul, which is pretty curious. And
14:01
if you're paratolobulus, super marginalized non-giorgiosa, like a medial to lateral aspect, and then also lined up nicely. So,
14:09
and then
14:12
eventually the,
14:15
so I'm just focusing on those
14:19
sulcus to find those sulcus. And then otherwise you have a, it's very fun to sulcus join the pre-centro sulcus, interpret sulcus join the post-centro sulcus, and then these are also very easy to
14:33
find until post-josaucyes. So, this is also can be used for high convexity slices to define where the central sulcus is. So,
14:47
when you cut the Stacey PC line, then you can see in an actual plane, you can see the AC and PC,
14:55
weight model,
14:58
the lines. And then so you can confirm this is nicely scanned in the ACPC line. So when you have a ACPC plane of the brain and if you're cutting half, then you can see the frontal lobe and parietal
15:12
lobe. And then
15:15
temporal lobe is in a very easy way. So this is the best orientation that you may have, right? And so here's some of the tips for the, when you're looking at the coronal brain, say you go to the
15:29
brain cutting and then the pathology is cut in the brain in the coronal and you have no idea where the central sulcus is, right?
15:37
When you are in the very, very frontal areas, again, superior, medial, inferior frontal GI area, you know, mid-right to the lateral and then you have one, two, three and then kind of line up.
15:47
So that's much easy. If you go very posteriorly, then you see the super parietal lobe, interpret orthogonous and if you apply the robot which it is.
15:59
one is angular gyros, if it's a little bit more anteriorly, you can see the squirmary gyros, instead of angular gyros. So either you have a cut, very anterior cut, more posterior, in the
16:09
coronal brain is very simple. And then you see that the infra-tubion structures, you have to know where the temporal lobe to explore of margin is. But superior middle, inferior temporal gyros,
16:24
free-to-form gyros, parapocomposgyros, become more posteriorly superior middle, inferior occipular gyros, free-to-form gyros, and lean wall gyros. So there's one, two, three, four, five,
16:35
temporal and occipular gyros are contiguous. So that's also easy to see in coronal. So to find the central focus in coronal plane, then you just find the threshold gyros. The threshold gyros is,
16:47
you see the suduro is this kind of superior indentation. Coronal is also superior indenting.
16:54
and primary auditory cortex. When you see the heterogeneous, if you go up, that's the central sulcus, okay? So you see this in the ACPC plane, even if you find the heterogeneous, this is where
17:08
the central sulcus lined up, right? This is how you orient. This is where the central sulcus is. Well,
17:17
and then the problem is pre-centriose, post-centriose are kind of obliquely oriented So that's why you have to know a little bit more than this, right? So where you have a sea level, until
17:29
commissioner level, intercommission is also organized very easy to identify. You can see from the temporal lobe, the temporal lobe and these structures. And this time, this is you go higher up
17:41
when the most lateral component here is middle frontal gyrus. And then so this is still have a super frontal gyrus and middle frontal gyrus. And then most inferior component, if your frontal gyrus,
17:52
this is already a presentral gyrus is coming in. So until commissioner level, there is no longer broken zone or, you know, if your frontal gyrus. So that's one thing in how to remember. And then
18:04
when you go to the mammillary body level, the mammillary body is also easy to identify in the coronal plane. When you see this, majority of the lateral portion is a presentral gyrus Okay, so
18:17
that's all presentral gyrus, and then some of the singlet and the presubular contral gyrus, right? So that's under commensurate level and mammillary body level. And then you go to the posterior
18:27
commensurate level. Then you see this portion
18:33
is the post-central gyrus, right? And then this is when you see the presentral robot, right? So the prosentral robot leg area is you see this in the post-posterior commensurate level and the
18:47
clonal plane. Then you go to the cross argument, this is when you see the super marginal gyrus, and then after that is you can just see a simple superior parietal, inferior parietal rubule. So
19:02
this is how you have to kind of identify yourself. So I think this is a kind of, you know,
19:10
simple tip, but it's good enough to help you where you are and orient yourself Now, I'm back to the actual plane, the frontal, when you look in the frontal lobe, of course you have to identify
19:24
where the center of focus is. And then also, a single gyrus is easy to see in such a real plane, but actual plane can be very confusing. And then of course, we all have to know where the Broca's
19:36
area is, right? Central circles, you see a higher up in the high convexity areas. It's easy to see the superior frontal circles. When you see the superior frontal circles, the prefrontal sulcus
19:47
kind of merges this presentral sulcus.
19:51
and then so posterior to this is a central circus. Or if you use the interpretive circus, this under-poster orientation circus, this is a majesty post-central circus, which is post-central circus.
20:02
So therefore this is a central circus. And the central circus has this characteristic or mega-shaped knob that's where the found some areas. And so these characteristic features are also helpful for
20:18
to define the central circus And the, also the, when the region, you know the ones, the region is in the pre-central circus. You have to know where those things are. And then, you know,
20:30
pre-centralized region in the hand versus face will be different. You just really wanted to preserve the hand areas, but the face motor, maybe it's much less important, if you will. So that, and
20:44
then the face region is humongous, it's very large.
20:51
hand is also large, but it's kind of more high, higher area of the slices. So the way you see is, well, once you start seeing a ventricle that's already in the face zone. So you see the high
21:07
convexity in the above the ventricle level, that's where the hand and, you know, if you go to more superior industrial portion is. And then the medial aspect, this is paracental rubber, is a
21:19
kind of low extremity location. So the low extremity one, this is where the paracental rubber is. And then in the middle right structures around the corpse cross of this singlet gyrus, singlet
21:30
gyrus is surrounded by the singlet sulcus. Here, and singlet sulcus is kind of merges to a, uh, climbing up to the superior is of this course of marginal sulcus and then going out. And then when
21:42
these singlet sulcus go out, then just, until you have just about, you know, It's 7 millimeters. I'll tell you what the disease is.
21:50
a small notch. This is the end of the central sulcus at the midline. And then this is a sensory and then molar portion of the foot areas, right? So that's the, that's called the procentral lobule
22:04
here. So this is where the procentral lobule is. That's the end of the cross-marginal sulcus here, right? And so a procentral lobe is easy to define. So this is the example of tumor, which is
22:17
enhancing and it almost looks like an extra-axial, but if you look at the T2 value imaging, it's kind of imaginary. It's an intra-axial plane in kind of cortical surface of the medial aspect of
22:30
this lobe. And then so where exactly it is, this is super frontal sulcus here, super frontal sulcus here, and then this is a procentral sulcus and therefore this is a central sulcus, this is in
22:39
the precentral gyrus. So this is a precentral gyrus
22:43
and then midline portion of the presenters, therefore, this is the motor component of the present role of your and this was ended up to be a PXA, but you know, those are the important areas that
22:57
the meningoma can happen very often to push the paracental lobules so that you can see the low extremity weakness. So that's where the paracental lobule is. Now, if you're going down to a, this
23:15
super official level, our instrument level, then you see lots of insinuation, then which one is central surface is kind of difficult to see. So this is how you use the subion feature. And then so
23:28
subion feature, this
23:31
is the interior area, so this is the subion feature here. So subion feature starts here and then ends here. So subion feature starts here at the end here. So end of the subion feature, this is
23:40
where the
23:43
spromagiogenesis, and then anterior-modion spromagiogenesis is post-central surface So central surface is anterior to it, right? So if you do this, the Cibion fissure here and this here and this
23:54
is from my joint gyrus, so this is a post-central sulcus, therefore this is a central sulcus, right, or you can just use this particle branch, the particle branch of the Cibion fissure is this
24:04
thing here. See, you have from the surface to the insular surface. So this is always very easy to see. So all the rest is like ended in the center, and then so only one piece is to the insular
24:17
surface So this is a particle branch of the silicon fissure. When you find this,
24:25
posterior to this is a presentous focus. Right? Therefore, this is a central focus. So that's much easy to see. So this one, you can see this in CT scan, you can see this in all the axial scan.
24:37
So once you know where the particle branch is, this is presentous focus, therefore this is a central focus. Okay? That's the, you know, maybe that this is easier. you can learn from this
24:50
lecture, and you can just find the central focus, no problem, right? Single gyrosies, of course, if you look at the corona and surgery review, the single gyrosies above the corpus callosum,
25:00
this is single gyros, so this is what a seizure patient with a tumor in the single gyros. And then, but if you don't have a surgery and corona view, which is rare, in these days, we have a very
25:13
good 3D technology can help you to navigate everywhere, but to see a single gyros in actual is so that if you look at the corona in sagittal, see the single gyros is the above corpus callosum,
25:28
right? And then the ending a, so the inferior to the super-frontal gyros. So the super-frontal gyros, you have to identify where the super-frontal gyros ends and then where the single gyros starts,
25:41
right? So super-frontal gyros is a always have a best to be a fan of Salka's letter to it. So when you see the
25:51
to this, this is super frontal gyrus. So in this slide, so super frontal focus ends here. So this is super frontal gyrus. This is middle frontal gyrus. This portion is no longer super frontal
26:03
gyrus. Even this is contiguous, right? So this is super frontal gyrus and then this is already single gyrus because you don't have a super frontal focus next to it, right? So this is super
26:15
frontal focus here, right? So that's a super frontal gyrus here. And then this is single gyrus. And then this one is very straightened. That's the corpus callosum, right? So under single gyrus
26:28
here and then this is posterior single gyrus here, right? So just to see the super frontal gyrus and single gyrus is just to pay attention to in actual, pay attention to super frontal focus, right?
26:42
So this one was read as super frontal gyrus mass, but if you look, you see the super frontal ends here. So, this is already in the same page address.
26:53
So, this person has a kind of limbic seizures, present with limbic seizures, not a frontal type of seizures. And then, so, if the read was super frontal gyrus mass, it just doesn't fit well to
27:09
the limbic seizures, for example But this is indeed in the involving the signatures, right? That's all you've got in your genome. So, Broca's area is, again, you use a vertical branch of the
27:24
seugan fissure, right? Broca's area is inferior frontal gyrus, or posterior dionvularis, and parapsoparacularis, right? So, it's an lateral aspect of the inferior frontal gyrus.
27:35
Parapsorbitalis is an inferior aspect of the inferior frontal gyrus So, um, you just, uh, this is the, uh, sulcus between the inside and the core core. So, this is the vertical branch of the
27:47
sukana fishein. Here, so brokers are post-operularies is posterior to this particle branch, post-trionularies is anterior to this particle branch, right? So that's
28:01
the open-operularies and trionularies. So once you find the vertical range of the artificial, then post-operularies, this is a post-operularies. And then you know this is a central source, right?
28:10
Presenter does post-center does, right? That's post-trionularies.
28:15
This is very easy, right? So this is a gurialma here in the
28:20
prefrontal gyrus area. So is this involving the bronchoxone? Well, most likely is. But you can say much more implicitly, you see this is a vertical branch here. Presenterococcus, this is
28:31
centralococcus. You see? You know how easy this is? And then so this is in post-trionularies, right? So this is the vertical branch, post-operularies is intact, but trionularies is involved,
28:44
right? So that's how you have to.
28:48
you have no problem in identifying those, right? So now, if you go down to this size, then you can get the covering the issue. So this is a temporal lobe here. But just above the temporal lobe
29:02
in this portion, which as we are just talking about, barcode, browser, sugar, fissure, free central circles, central circles. This is, if you want to apologize, partial percocularis and
29:13
triangularis. That's called a percular zone, right? So, operacrum is a end of the each south side, this pre-central circle, central circle, central circles. There's a tissue at the end.
29:27
That's called, this is a frontal percrom, central percrom and parietal percrom. So, that's what the, you know, the configuration creating those names, and then those are a percular zone. So,
29:41
therefore, in the left hemisphere,
29:45
the parts of the apparatus of the infant or gyrus. part of the Broca's area, it's part of the frontal parochrome.
29:53
And then so that all these areas of the regions can be very tricky to describe. And then sometimes those things are very close to temporal lobe, so somebody says like, this is a temporal lobe mass.
30:05
And of course, if you look at the coronal view, this is not the temporal lobe mass. This is above the zebrafish ion, this is
30:14
the parocharism. And then, so again, how to see this is a vertical branch here, it's kind of hard to see in T1, but vertical branch in pre-centrocyx, post-centrocyx. So this is in the central
30:26
program
30:29
of the region. It's in the central program. This patient has a focal cortical dyspregia in this location. Again, this is the vertical branch of the zebrafish ion. So pre-centrocyx, and central
30:40
sulcus, right? So if
30:44
you see this, also this is in the frontal program.
30:49
focal cortical dyspregia involving the frontal and then kind of partial in a central pyrgium. And then you know where the central sulcus is. So definitely this is involving the kind of face to the
31:01
mouth area
31:04
of the presentral gyrus, right? Now moving on to the temporal lobe. So temporal lobe and hospital of the contiguous and then you have a super middle infill temporal gyrus which is MCA tatery ones
31:15
in the lateral aspect Free form gyrus temporal occipital lobe kind of shares these free form shapes gyrus that's gonna into the inferior surface. And the prior temporal gyrus is contiguous to the
31:28
lingual gyrus is the most medial aspect. And it becomes sitting on the top of the prior temporal gyrus. And temporal lobe also contains hetero gyrus which is primarily more auditory cortex. And
31:39
then when you get the area is a posterior portion of the superior temporal gyrus on the left side, right? So that's it. We'll need to get the poster to the poster commissioner. the perimidal
31:49
infill temporal gyrite, which is very easy to identify. And then temporal pole is a continuation of this
31:58
super middle temporal gyrite kind of crawling up anteriorly, right? So therefore, the most anterior portion temporal lobe, there is no phygiform gyrite. You see? So this is the superior middle
32:09
infill temporal gyrite going and moving anteriorly. So that's the forming a temporal pole areas, right? That's the anchors where the amygdala is. You see, anterior to the middle, this is a
32:22
temporal pole, which contains a superior middle infill temporal gyrite. Therefore, temporal pole is MCA territory, right? And then the phygiform gyrite starts with a above, around the posterior
32:35
to the mammary body level, the cerebral pyrongolable And then, so between inferior temporal sulcus and corotero sulcus, which is
32:43
a deep important sulcus.
32:47
medial to this is a parable composition, right? And then you can see the weak cleft here. So this is where all the temporal occipital band drain into the transverse sinus. And then so
32:59
this is called the anterior occipital notch or pre-oxpiral notch. This device, this line device, the temporal lobe and occipital lobe. So superior medial inferior temporal jaw, right? Become a
33:09
superior inferior occipital jaw, right here, up to here, right? And fission majority is kind of going both sides. And then peripheral temporal jaw become the lower jaw
33:20
after this line, okay? So chrono view is superior medial inferior temporal jaw, peripheral temporal jaw is very easy to see the one, two, three, four, five. And then on the top of the
33:33
peripheral temporal jaw, this is the hippocampus sitting on, right? So now the axial will be difficult to see where you are. So you use a what you have in the same level So, it's a pure
33:45
temperature, but you'll see the salami. So if you see the thalamus, laterally, this is super temporal gyrus. Mid-brain librarians, you have a mid-brain. So if you see the M in mid-brain, this
33:54
is M in the mid-temporal gyrus, right? And then, immediately, you can see the hippocampus. The pons, if you see the pons, this is already inferior temporal gyrus
34:04
laterally, and then you can feed it from gyrus, and the most immediately there is a very proper pompos gyrus. That's all, you see the thalamus level, mid-brain level, and pons level, you know
34:12
where you are in the level of the temporal gyrus And the same thing for the occubular gyrus, right? So you see the superior temporal gyrus here, middle temporal gyrus here, inferior temporal gyrus
34:24
here, and inferior temporal gyrus here. So the sarger of inferior gyrus goes more medially, and you see that
34:31
this is a collateral sulcus, and inferior gyrus is mostly inferior portion, right? And then that's the parypo-compos gyrus, and the hippocampus sitting on the top of the parypo-compos gyrus. Okay,
34:39
so you have to know that, you just can always look through each gyrus which you are in the. temporal rope. And then, so this is a focal cortical dyspregia in the prior procomposia in the free form
34:52
gyrus here. You see, if you look at this asymmetry is very obvious, right? But this has been missed in like four years. Because people, people look for the hippocampus, you see the hippocampus
35:05
is also
35:07
asymmetric. People look for the hippocampus, but it doesn't pay attention to much of the rest of the temporal rope. But if you are consensiously looking for superior medial infia temporal jive of
35:17
free from n-partum bone, which I understand, this is obviously abnormal. The temporal rope, quite a matter, is orientation and then hazeness is seen in those areas. Right? So this person has a
35:32
dyspregia. And the hippocampus is also abnormal, but this dyspregia is causing seizures mostly. The hippocampus It has a very complicated structure and head. big and then kind of briefly oriented
35:47
in the body and the tail is kind of growing up, right. So, and then, so to find in actual planning for campus is always you look for the midbrain, so rather with the midbrain you can see the head
35:59
and body and tail of the campus, right. So that when you see this is midbrain level you see the hippocampus that already, right, and then the within the hippocampus so this Ontario to this several
36:13
people and quote this is the campus here that's the amygdala, right, so the anterior to the amygdala is the temporal pole here, and then the posterior to the amygdala this is a football head.
36:25
Football head is kind of laterally oriented, so you see the cerebral pyrongolable in the coronal plane you can see the head of the hippocampus If you move to the tegmentum portion of the midbrain,
36:37
then you see the body of the hippocampus. Right? And then tail of the hippocampus is kind of crawling up underneath the sprainum of the corpus course. correct. So they just kind of perpendicular
36:46
turn. So this is
36:52
the tail of the hippocampus and then just crawling up underneath the sprain of the corpus call zone. The underneath the sprain of the corpus call zone has a hippocampal commissure. And then so that
37:02
those phonics are communicated underneath the sprain of the corpus call zone called hippocampal commissure
37:09
So this is, for example, Bichpokompo, square losses. And you see the superior middle in your temporal gyrus. This is a free-form gyrus. And then this is a peripheral gyrus. And this is a
37:21
temporal gyrus.
37:23
Now, this is a solubus fable. So this is super temporal gyrus. This is super temporal gyrus. You can see the dilated vessels and entangled vessels. This is ABM. And then it's not in the lateral
37:34
location. This is more the deep location, which is posted to the intra. So she has posted to the intra. This is where the head show gyrus is. So this person has a head show gyrus ABM.
37:46
The natural gyrus has a very characteristic shape of the kind of little knob on the near the posterior to the inksrap. And this is obliquely runs. So you see in axial, this rectangular shape,
38:00
obliquely run location that's just superior to the superior temporal gyrus, right? So this
38:08
one is also the thumbs level, but this rectangular shape is what you look for And then the dominant hemisphere on the left side is always larger than the right side.
38:20
This is the patient with the tumor, the D net, and then involving these thumbs level in the super temporal gyrus. And then, but this rectangular shape location, this is the head shoulder. So
38:34
this mass is in the super temporal gyrus, but also involving the head shoulder. It's very difficult to deal with the surgery We will need to find a solution. And that is super temporary address.
38:48
And then you find the postal commissioner. So this is where the postal commissioner level is, right? So if you draw a line and then that's the well-naked stone, usually located to that or to the
39:00
atrium of the lateral ventricle, for example. So that's where the well-naked stone, right? So now you know where the broker is and where the well-naked is. So this is how you orient yourself in
39:13
actual planes So if you're looking at the function MRI, so this is where you look for the activities around those areas. Now, moving to the parietal lobe, posterior to the central sulcus,
39:26
posterior to the central sulcus, posterior is posterior is programing sensory cortex, superior parietal lobule, and
39:33
then supermagenesis and angiogitis. So those four parietal lobes, right? Then you see that once you find the central sulcus, then you can see the posterior to it and post central gyrus.
39:46
Post-angerous has a, you know, in broad-man zone, it's three, three, B1, two, and then so this is one gyrus, but you have different communication coming to, input coming to the different zone
39:59
of the cortex, right? So, anterior valet, that's where the most is a typical sensory input comes, and then this one and two top and then posterior valet of the post-central gyrus is much higher
40:13
function So, when you do a, you feel this, you feel that, and so the sensory stuff is mostly the anterior valet thing, and then posterior portion is much higher function, so you can just two
40:27
point discrimination, or
40:30
you give the patient in a different texture of the object, and then, you know, is this soft, and then kind of a very cool type of surface, and then a much more sophisticated sensory input needed
40:43
So to test the upper right here, upper right here. So this patient has a metastasis here and then remove that stuff and so
40:51
remember this one component patient has completely intact sensory, but if you, if you give the object in a different shape or kind of a little bit more complicated sensory input patient is have a
41:04
difficulty identifying those So, for example, so, you know, have those, you know, a little bit detailed and help me can help you to correlate with the critical symptoms So, you see the
41:18
middle aspect, middle to the interpret or circus. And then in the middle line, so you see the single address here and then the close margin of circus goes up, and then so posterior to this between
41:32
close margin of circus and the middle line, that's the preconyls. That's the important pathway for the, the way a pathway from the video call this go to the sensory motor. direction.
41:49
And then the, so the anterior to the part of the fascia is a preconyls or a single gyrus and posterior to this is occipital lobe, mostly the
42:02
cunels. Precunels name is that because it's anterior to the cunels, which is this part of the occipital lobe of the chargary fascia. Right? Infia pylderob is super marginal gyrus and angular gyrus.
42:12
It's easy to identify that in the sagittal view, because super marginal gyrus is the end of the chargary fascia. So
42:19
use for the cerebral fissure, end of the cerebral fissure. This is a super marginal gyrus comes. If you follow the prior to the cerebral fissure, it's super temporal sulcus, end of the super
42:29
temporal sulcus. That's where you find angular gyrus. So, angular gyrus is always posterior to it. So if you look at the axial view, so
42:38
this is what the super marginal gyrus mass is, do not this is super marginal gyrus. So, which one is the central sulcus, right? So, So, if you have ACPC plane,
42:51
actual plane, and then you just have a ventricle here, and then you see that middle of the ventricle, you have a little kind of
42:58
narrow portion. That's where the draw around here, and then this is what the central circle is. Okay, so that's why the ACPC plane is very important, because it makes your life easier So the
43:14
central circle, so this therefore this is a post central circle until you imagine of the post is super major devices post central circles right. So that's what the.
43:25
It's about the four o'clock location in the ACPC plane stuff in the left side. So, and then this is your address, and then this is go to the superior parietal worldview In coronal view, if you see
43:39
the
43:42
color of praxis and hm rarobentrico, that's where the super major addresses. This is the curriculum here, and then.
43:50
This one now is more posteriorly located, and then so you don't no longer see the ventricle. So this is a quickness here, and this is angular gyrus. So how do you know this is confirmed? This is
44:02
angular gyrus. Again, you draw a line here, and this is a central circus. This is a post central circus. So that's a super marginal gyrus, and then this is angular gyrus Okay.
44:15
This is angular gyrus around the fiber clock location. Right, occipital lobe is you have to know the pre-oxpiral notch to divide the temporal lobe to the occipital lobe. And midline structure is
44:27
very easy because there's a part of the picture. So that's divide the parietal lobe to the occipital lobe. But you have to identify this So this one goes poster to Ontario orientation in actual
44:39
plane. And then after that is continuous and then car coefficient in the engage areas, which is a continuation of the parietal composure. The cardigan official is kind of parallel to the
44:51
ACPC line. So it's very hard to identify. So I'll tell you how to see the where the cardigan official is. So this is the central plane. You have paradox official here, right? And then this is
45:05
how you're up, going down, going down, slice is going down, right? So then when you see this, so this is how you see the pyreconials and then, you know, this is occipital lobe So there is no
45:18
occipital lobe here because this is
45:25
a prytoic surfisher, right? And this is a prytoic surfisher. This is a prytoic surfisher. So the, when you, based on the where the prytoic surfisher is posterior to the prytoic surfisher, this
45:32
is occipital lobe. So the pink is occipital lobe, right? And then anterior to this is a prytoal lobe here, superiorly, but if you go down, then you can see the symbiosis in between So, post it
45:45
to the spring you may say. So then this is occipital lobe, right? This one is you have a single gyrus. This is the
45:58
pre-cunus and occipital lobe. This is, there is no occipital lobe. So this is in the gyrus and pre-cunus,
46:04
right? So you have to know where the paradox of official look like. So that's the paradox of official in axial claim, right? So this one looks like an occipital lobe, but eventually this is where
46:15
the paradox of official is. So that's the occipital lobe. This is a posterior singlet gyrus. So this mass is in the posterior singlet gyrus, right? So if you look at the sagittal, that's where
46:27
the posterior singlet gyrus mass is. That's not the pre-cunus mass. This is not the occipital lobe mass.
46:34
Yeah. And then part of the official just help you to say this is not the occipital lobe mass
46:42
So the pre-oxpiral notch is you see it always see the vein because all the. brain drain into the transfer sinus, right? So that's all the brain drain into transfer sinus. So if you transfer sinus
46:53
from bosses, that's why you can see the experimental of the temporal pole, you have anywhere, you can see the hemorrhage, then you have to think of the transfer sinus from bosses, right? So this
47:04
is what you see, you see the brain here, you see the brain here, this is the brain here. So that's and then you go to this is the transfer sinus, right? So all these veins are seen here in the
47:12
ontology So this is temporal lobe, this is occipital lobe, temporal lobe and
47:17
become occipital lobe, right? This is whether Bena Blabe, for example, also joins here at this point to the
47:29
transfer sinus, okay? In chronobule products, she should look like this kind of x-shaped mass area at circles. So above this pink line, this is a parietal lobe. So this is a pre-genius, this is
47:36
angular gyrus, superior, middle, inferior gyrus, from gyrosine, this is a lingo gyros, right? And then the
47:46
you go to the different slices, you can see above the color-current fissure, you can have the q-nails, for example. The axial plane, the paradox of fissure ends here, and then you see a below
48:01
the spring with the corpus course. So you have to see the spring with the corpus course, and you don't have a color-current fissure yet. You have to go to the slice below the spring with the corpus
48:11
course, and then this line here, this is a color-current fissure, right? So you just have to know the which level of the axial plane you're dealing with. So this one here is - this is a posterior
48:23
commissural level, for example. Then you can see the big color-current fissure here, this person here. And then so that one is easy to identify where the color-current fissure is, because this
48:33
person's color-current fissure is very, very enlarged, right? So underneath the spring with the corpus course, when we are close to the posterior commissural level is on the axial plane, then you
48:44
can see that we're at the car bank.
48:47
Right, so in summary, in axial plane. So, you know, the central circus can be a best one. And then you can see the super frontal circus, you know, during the presenters circus, interpreters
49:00
are joined the post-central circus. And then you can find the central circus. You follow the central circus. Well, you can just see the ACPC plane draw a line in the center. This is the central
49:09
circus, right? And then you see the part of the official goes from poster to the Ontario So if you see this, poster to this is an occipital rope, right? And then
49:21
above the
49:24
ventricular level, this is a hand area. Once you get the ventricle, this is a face area. You see the cobscorsum, anterior to the posterior to the corsum. You can see the singlet gyrus here and
49:33
there. When you end the super frontal circus, this is a super frontal gyrus, but this is a singlet gyrus, right? So we're the singlet gyrus. Identifying a singlet gyrus is important. When you
49:45
see the insular lateral to this is opium, you can see the vertical branch. This is a pre-central surface. This is central surface. This is a broken stone. And that's the hessal gyrus, right? So
49:56
that,
49:58
and then if you go to the salamous level, this
50:02
is the upper temporal gyrus, and then posterior to the posterior commissure, this is the renequis zone. And then the midbrain level is the middle temporal gyrus, conservals in fuel temporal gyrus
50:13
Midbrain temporal gyrus level has a co-campus, and the infill temporal gyrus level has a free G-phone and polypropyl compound gyrus, right? And
50:24
then the anterior occipital notch, a pre-oxial notch, that's temporal rope, become occipital rope. And then once you pass the sprenum level in the posterior
50:34
commissure portion, then near the posterior commissure location, this is where you can see the car groin feature, right? So
50:43
that's good enough. already. So thank you very much for your attention. I hope this helps for your practice. Thank you.
50:59
Yes, psychology, they say that the ladies use two hemisphere rather than one hemisphere. And that's, they said, because the cortisol syndrome is thicker in treatment than men. Do you see that in
51:16
the imaging that they have a thicker cortisol or something? Well, you know, in this, in this day, that's a very sensitive, you know, mother, but yes, I do. Yeah, so I think, you know, in
51:30
general, the, so the cortisol syndrome has a different component. And so the isms of the cortisol syndrome just before the posterior body of the cortisol. That portion is male is skinnier than
51:41
female
51:43
So, we are always, you know, we are, we are smarter that.
51:50
Yes, so that's some differences. Yes.
51:56
Excellent.
51:58
back to the, uh, just so everyone knows again, like, the two or three MRI scans are not done on the ACPC one. No. They're oblique. So just can't assume anything, but if you see oblique, you
52:09
wonder what that means. It's being done. I had in line with the, uh, high-asyl and optic nerves and it would, when it comes down to you, it actually is the yield that you displayed, but
52:20
everything that you saw here is necessarily applied to every amount of the MRI scan. Yeah. So you just really have to identify the ACPC and you have to put that line, then that's what the brain
52:31
tumor is, ACPC line. So the stroke is not the ACPC line stroke. You're just going to throw the patient in and just scan them, you know, because they're in a hurry. So it's not always in the ACPC
52:42
line, but in pituitary is for Dr. Borkstein that we just do obliquely, that's, you know, the sphenoidal contortical view. So it's very, very oblique And that's MPH for the pituitary scale.
53:03
Thank you very much for having me.
53:08
We hope you enjoyed this presentation. The material provided in this program is for informational purposes and is not intended for use as diagnosis or treatment of a health problem or as a substitute
53:25
for consulting a licensed medical professional.
53:33
Please fill out your evaluation of this video to obtain CME credit. This recorded session is available free on snidigitalorg.
53:46
Send your questions or comments to osmondsnidigitalorg from
53:56
UCLA Neurosurgery and supported by the James I. and Carolyn R. Osmond Educational Foundation, owner of SNI and
54:08
SNI Digital and the Waymaster Corporation. Producers of the Leading Gen Television Series, silent majority speaks, role models and medical news network.
54:28
Thank you.
View Transcript
Listen to Podcast