in this discipline has been limited due to an incomplete knowledge of the functional anatomy of the brain. This highly integrated organ does not lend itself easily to study, as its morphology does not translate to its function 1 . This caveat was quickly acknowledged by the early neuro-anatomists such as Brodmann, who stated in 1909: "One thing must be stressed quite firmly: henceforth functional localization of the cerebral cortex without the lead of anatomy is utterly impossible in man as in animals… so, first anatomy, and then physiology; but if first physiology, then not without anatomy" 2 . Furthermore, there is now mounting evidence that the brain has the capacity to reorganize its functional networks in the face of an injury, or a ABSTRACT: Background: The brain functions as an integrated multi-networked organ. Complex neurocognitive functions are not attributed to a single brain area but depend on the dynamic interactions of distributed brain areas operating in large-scale networks. This is especially important in the field of neurosurgery where intervention within a spatially localized area may indirectly lead to unwanted effects on distant areas. As part of a preliminary integrated work on functional connectivity, we present our initial work on diffusion tensor imaging tractography to produce in vivo white matter tracts dissection. Methods: Diffusion weighted data and high-resolution T1-weighted images were acquired from a healthy right-handed volunteer (25 years old) on a whole-body 3 T scanner. Two approaches were used to dissect the tractography results: 1) a standard region of interest technique and 2) the use of Brodmann's area as seeding points, which represents an innovation in terms of seeds initiation. Results: Results are presented as tri-dimensional tractography images. The uncinate fasciculus, the inferior longitudinal fasciculus, the inferior fronto-occipital fasiculus, the corticospinal tract, the corpus callosum, the cingulum, and the optic radiations where studied by conventional seeding approach, while Broca's and Wernicke's areas, the primary motor as well as the primary visual cortices were used as seeding areas in the second approach. Conclusions: We report state-of-the-art tractography results of some of the major white matter bundles in a normal subject using DTI. Moreover, we used Brodmann's area as seeding areas for fiber tracts to study the connectivity of known major functional cortical areas.RÉSUMÉ: La tractographie dans l'étude du cerveau humain : perspective neurochirurgicale. Contexte : Le cerveau fonctionne comme un organe constitué en multiréseaux intégrés et les fonctions neurocognitives complexes ne sont pas restreintes à une seule zone du cerveau. Elles dépendent d'interactions dynamiques de différentes régions du cerveau opérant en réseaux de grande envergure. Ceci est particulièrement important dans le domaine de la neurochirurgie où une intervention à l'intérieur d'une zone très localisée peut provoquer indirectement des effets indésirables à distance. Nous présent...

Background:Prompt physical and occupational therapy is crucial in managing nonsurgical candidates with obstetrical brachial plexus injuries (OBPI). The objective of our study was to identify newborns suffering from nonoperative OBPI in need of a “fast-track” evaluation by a multidisciplinary team.Methods:This is a retrospective review of patients with OBPI from June 1995 to June 2015. All nonsurgical candidates (Narakas class 1) were included in the study. The Gilbert score and the Medical Research Council grading system were used to measure shoulder and elbow function, respectively. The relationship between shoulder and elbow functional outcomes and time delay to consultation was studied using analysis of variance and Welch’s tests. Various subgroups were studied based on OBPI risk factors: maternal diabetes, birth weight >4 kg, use of forceps, asphyxia, multiple comorbidities, and Apgar score at 1 and 5 minutes.Results:A total of 168 patients were included in this study. Mean follow-up time was 313.8 weeks (minimum: 52; maximum: 1072; SD: 228.1). A total of 19 patients had an Apgar scores <7 at 5 minutes. Time delay between birth and the first consult to our clinic had an impact on shoulder outcome in the subgroup of newborns with Apgar scores <7 at 5 minutes.Conclusions:The subgroup of newborns with an Apgar score <7 at 5 minutes shows improved long-term shoulder function when promptly examined by an OBPI clinic. We recommend a “fast-track” referral for this time-sensitive population.