VI. Learning unit: Cerebral metastases

Objectives and competencies

This syllabus introduces clinico-pathological relevancies cerebral metastasis in multidisciplinary approach. The anatomical chapter describes important tracts of the brain such as commissural, association, projection fibers/tracts. The pathological chapter introduces types and general features of malignant cancerous tumors tend to metastasize to the brain. The radiological chapter introduces general radiological characteristics of bran metastasis on CT and MR imaging. The clinical chapter offer insight into epidemiology, symptomatology, diagnosis, differential diagnosis and treatment modalities of malignant tumors affecting the CNS in multimedia enhanced environment with illustrations photos and tables.

Chapter VI./1.: Major tracts and tract systems of the brain

                                                                  Gábor Baksa

VI./1.1.: Introduction

On the cut surface of the human brain we can clearly separate the grey matter close to the surface and the much broader white matter under it. The former represents the cerebral cortex containing the neuron’s perikaryons, while the latter represents the medulla cerebri, containing the neuron’s peripheral projections, the axons. Of course the blood vessels and the glia cells providing the physical support system of the neural tissue appear in both the grey and the white matter.

Axons located in the white matter can be grouped into tracts based on their location, function and the brain areas they interconnect. Tracts can be commissural tracts connecting the two hemispheres, projection tracts radiating to cortical areas of specific functions or association tracts, connecting different regions of the same hemisphere. Within the projection tracts ascending and descending tracts can be distinguished, which connect each cortical region with the spinal cord, brain stem, basal ganglia or diencephalon.

Fibre dissection, a classic anatomical preparation technique has been commonly used to map white matter morphology, which provided a load of valid data concerning the rough fibre bundles and their directions. The more precise relationships of course only have been possible to find out with further animal studies and the defined testing of patients with specific diseases. In the following we will try to give a brief overview of these tract systems, keeping in mind their major topographical relationships to other brain structures.

The chapter structure

• VI./1.1.: Introduction

• VI./1.2.: The brain’s commissural tracts

• VI./1.3.: Association tracts

• VI./1.4.: Projection tracts

References

Clara: Das Nervensystem des Menschen

Duus: Neurologisch-topische Diagnostik

Hajdu: Vezérfonal a neuroanatómiához

Komáromy: Az agyvelő boncolása

Szentágothai – Réthelyi: Funkcionális anatómia

Szél: Klinikai anatómia

Szirmai: Neurológia

Villiger - Ludwig: Gehirn und Rückenmark

Yasargil: Microneurosurgery