Dissecting the default mode network: direct structural evidence on the morphology and axonal connectivity of the fifth component of the cingulum bundle

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  • 1 Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens;
  • 2 Department of Neurosurgery, National and Kapodistrian University of Athens;
  • 3 Department of Anatomy, Medical School, National and Kapodistrian University of Athens;
  • 4 Hellenic Center for Neurosurgical Research, “Petros Kokkalis,” Athens, Greece;
  • 5 Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada;
  • 6 Department of Neurosurgery, NYU School of Medicine, New York, New York;
  • 7 Departments of Radiology and
  • 8 Neurosurgery, School of Medicine, University of Thessaly, Larisa, Greece;
  • 9 Department of Neurosurgery, Mount Sinai Union Square, New York; and
  • 10 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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OBJECTIVE

Although a growing body of data support the functional connectivity between the precuneus and the medial temporal lobe during states of resting consciousness as well as during a diverse array of higher-order functions, direct structural evidence on this subcortical circuitry is scarce. Here, the authors investigate the very existence, anatomical consistency, morphology, and spatial relationships of the cingulum bundle V (CB-V), a fiber tract that has been reported to reside close to the inferior arm of the cingulum (CingI).

METHODS

Fifteen normal, formalin-fixed cerebral hemispheres from adults were treated with Klingler’s method and subsequently investigated through the fiber microdissection technique in a medial to lateral direction.

RESULTS

A distinct group of fibers is invariably identified in the subcortical territory of the posteromedial cortex, connecting the precuneus and the medial temporal lobe. This tract follows the trajectory of the parietooccipital sulcus in a close spatial relationship with the CingI and the sledge runner fasciculus. It extends inferiorly to the parahippocampal place area and retrosplenial complex area, followed by a lateral curve to terminate toward the fusiform face area (Brodmann area [BA] 37) and lateral piriform area (BA35). Taking into account the aforementioned subcortical architecture, the CB-V allegedly participates as a major subcortical stream within the default mode network, possibly subserving the transfer of multimodal cues relevant to visuospatial, facial, and mnemonic information to the precuneal hub. Although robust clinical evidence on the functional role of this stream is lacking, the modern neurosurgeon should be aware of this tract when manipulating cerebral areas en route to lesions residing in or around the ventricular trigone.

CONCLUSIONS

Through the fiber microdissection technique, the authors were able to provide original, direct structural evidence on the existence, morphology, axonal connectivity, and correlative anatomy of what proved to be a discrete white matter pathway, previously described as the CB-V, connecting the precuneus and medial temporal lobe.

ABBREVIATIONS BA = Brodmann area; CB-V = cingulum bundle V; CingI = inferior arm of the cingulum; CTTP = contralateral interhemispheric transfalcine transprecuneus approach; DMN = default mode network; FFA = fusiform face area; FrM = forceps major; ILF = inferior longitudinal fasciculus; POS = parietooccipital sulcus; PPA = parahippocampal place area; RSC = retrosplenial cortex; Slg = sledge runner fasciculus; STTS = supracerebellar transtentorial transcollateral sulcus.

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Contributor Notes

Correspondence Christos Koutsarnakis: Evangelismos Hospital, National and Kapodistrian University of Athens, Greece. ckouts@hotmail.co.uk.

INCLUDE WHEN CITING Published online April 24, 2020; DOI: 10.3171/2020.2.JNS193177.

Disclosures Dr. Hadjipanayis is a consultant for Synaptive and receives royalties from NX Development Corp.

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