This unique volume is a comprehensive, well-illustrated study of the organization of the white matter pathways of the brain. Schmahmann and Pandya have analyzed and synthesized the corticocortical and corticosubcortical connections of the major areas of the cerebral cortex of the rhesus monkey. The result is a detailed understanding of the constituents of the cerebral white matter and the organization of the fiber tracts. The findings from the 36 cases studied are presented on a single template brain, facilitating comparison of the locations of the different fiber pathways. The summary diagrams provide a comprehensive atlas of the cerebral white matter. The text is enriched by close attention to functional aspects of the anatomical observations. The clinical relevance of the pathways is addressed throughout the text and a chapter is devoted to human white matter diseases. The introductory account gives a detailed historical background. Translations of seminal original observations by early investigators are presented, and when these are considered in the light of the authors' new observations, many longstanding conflicts and debates are resolved. This scholarly book is an important addition to systems and cognitive neuroscience that will be of lasting value to neurobiologists, anatomists, neurologists, neurosurgeons, neuroradiologists, psychiatrists, psychologists, and to their students and trainees.

Fiber Pathways of the Brain

Understanding the long association pathways that convey cortical connections is a critical step in exploring the anatomic substrates of cognition in health and disease. Diffusion tensor imaging (DTI) is able to demonstrate fibre tracts non-invasively, but present approaches have been hampered by the inability to visualize fibres that have intersecting trajectories (crossing fibres), and by the lack of a detailed map of the origins, course and terminations of the white matter pathways. We therefore used diffusion spectrum imaging (DSI) that has the ability to resolve crossing fibres at the scale of single MRI voxels, and identified the long association tracts in the monkey brain. We then compared the results with available expositions of white matter pathways in the monkey using autoradiographic histological tract tracing. We identified 10 long association fibre bundles with DSI that match the observations in the isotope material: emanating from the parietal lobe, the superior longitudinal fasciculus subcomponents I, II and III; from the occipital-parietal region, the fronto-occipital fasciculus; from the temporal lobe, the middle longitudinal fasciculus and from rostral to caudal, the uncinate fasciculus, extreme capsule and arcuate fasciculus; from the occipital-temporal region, the inferior longitudinal fasciculus; and from the cingulate gyrus, the cingulum bundle. We suggest new interpretations of the putative functions of these fibre bundles based on the cortical areas that they link. These findings using DSI and validated with reference to autoradiographic tract tracing in the monkey represent a considerable advance in the understanding of the fibre pathways in the cerebral white matter. By replicating the major features of these tracts identified by histological techniques in monkey, we show that DSI has the potential to cast new light on the organization of the human brain in the normal state and in clinical disorders.

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Association fibre pathways of the brain: parallel observations from diffusion spectrum imaging and autoradiography.

The results of temporal lobectomy for medically refractory seizures are analyzed in 29 boys and 21 girls with a mean age of 15.8 years. The average age at onset of seizures was 7.5 years, and the time between onset and surgery averaged 8.3 years. Postoperatively, 27 patients (54%) were seizure-free, 12 patients (24%) had only occasional auras without loss of consciousness, five patients (10%) had fewer seizures, and six (12%) were unchanged. Therefore, 78% were essentially seizure-free and 88% benefited significantly from the operation. There was no significant change in the Wechsler Intelligence Scale scores before and after surgery; however, the shorter the time between seizure onset and surgery, the greater the likelihood of improvement in verbal and perceptual intelligence quotient. Social outcome was significantly improved, and a large percentage of patients were either in school or actively employed. Early consideration of temporal lobectomy in children with medically refractory seizures is recommended.

Temporal lobectomy in children with epilepsy.

The modern era of surgical epilepsy therapy probably began with the work of Victor Horsley in 1886, yet the role of surgery in the treatment of the epilepsies is only now becoming more widely accepted and is still underutilized. One reason for this is that only a limited number of epilepsy centres are engaged in such treatment; this is perhaps because some epileptologists and neurologists are afraid of the neurosurgeons’ encroachment into what they regard as a non-surgical domain. They then continue to neglect the good surgical results obtained if the patients are well screened. The major aspects of reporting this series are to discuss the criteria which must be met before considering surgery, the need to establish a proper diagnosis and the need for immaculate surgical techniques. These three factors provide the basis for a successful outcome following operation.

Selective amygdalohippocampectomy: indications, investigative technique and results.

Of 166 consecutive patients studied with depth electroencephalography (EEG), 87 had seizures arising from one temporal lobe and 23 had seizures arising independently from each temporal lobe. We retrospectively reviewed and compared those patients with unitemporal and those with bitemporal seizures. There was no statistically significant differences between the two groups in terms of age at onset of seizures, duration of epilepsy, localization of scalp EEG abnormalities, surgical results, or pathological findings. The bitemporal group, however, had significantly fewer patients with a history of febrile seizures (p less than 0.025). Two patients with bitemporal seizures were later found to have extratemporal lesions, and one an extrahippocampal temporal lesion, on magnetic resonance scans; one patient's extratemporal lesion was resected and all habitual seizures stopped. These findings suggest that a single pathophysiological process accounts for unitemporal and some bitemporal epilepsy, but that independent onset of seizures from each temporal lobe detected by depth EEG may also indicate extratemporal foci.

Comparison of bitemporal and unitemporal epilepsy defined by depth electroencephalography.

The Montreal Neuroligcal Institute’s experience with cortical resection for medically refractory temporal lobe epilepsy had grown to 1,102 patients as of the end of 1978, 932 in the non-tumoral category and 170 patients with tumors, including a few major vascular malformations. Follow-up data, (complete to date or to the patients’ death in over 80% of the patients) shows that 70% of those with 2 or more years of adequate follow-up data (median period 11 years) have experienced a complete or nearly complete reduction of the seizure tendency.

Surgical Aspects of Temporal Lobe Epilepsy Results and Problems

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Surgical Aspects of Temporal Lobe Epilepsy Results and Problems