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• W3147205629 abstract "To the Editor: We read with keen interest the article by Yoshino et al1 in the July issue of Neurosurgery, entitled “Visualization of Cranial Nerves Using High-Definition Fiber Tractography.” We congratulate the authors for displaying the cisternal portion of a cranial nerve (CN) and its connection of nuclei in the brainstem successfully by diffusion tensor imaging (DTI) tractography. However, even using high-definition fiber tractography, technical limitations of DTI tractography should not be ignored, of which one is the anatomic error in automatic calculation. As the authors noted in the legend of Figure 5, the fibers of the trigeminal nerve (CN V) did not correspond to normal structures; thus, these fibers into the cerebellum were considered to be false continuations into the middle cerebellar peduncle. In addition, decussation of the trochlear nerve (CN IV) between the bilateral inferior colliculus was not shown in Figure 4 and the orbital portion of the CN passing the cavernous sinus was not tracked as Figures 3 to 6 showed, which imply the insufficient tracking of DTI. Interestingly, the authors describe in Table 1 that the oculomotor nerve (CN III) is connected to the medial longitudinal fasciculus (MLF). The connection between CN III and the MLF was also displayed in Figure 3. We want to talk about this error from the views of neuroanatomy. According to the rule of neural connections, the nerve fibers consist of axons from neurons.2 Thus, the fibers of CN III arise from the oculomotor nucleus and the Westphal-Edinger nucleus to connect the intraocular and extraocular muscles. Whereas the fibers of the MLF mainly arise from the vestibular nucleus to connect the oculomotor nucleus, trochlear nucleus, abducens nucleus, accessory nucleus, and anterior horn neurons of the cervical cord. Mutual connections between the above nucleus in the brainstem and spinal cord also exist in the MLF.3 Synergic movement of the ocular and neck muscles is controlled by the above connection of the MLF. Direct connections between the MLF and ocular muscle do not exist. Obviously, it is also a false continuation of the fibers of CN III arising from the MLF directly. Limitations and potential artifacts associated with the technique can provide false and misleading information.1 Careful anatomic analysis is therefore essential to avoid the false. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article." @default.
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• W3147205629 date "2018-03-06" @default.
• W3147205629 modified "2023-10-18" @default.
• W3147205629 title "Letter: Visualization of Cranial Nerves Using High-Definition Fiber Tractography" @default.
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• W3147205629 doi "https://doi.org/10.1093/neuros/nyy025" @default.
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