White matter dissection with the Klingler technique: a literature review

Abstract

The aim of this literature review is to present a summary of the published literature relating the details of the different modifications of specimen preparation for white matter dissection with the Klingler technique. For this review, 3 independent investigators performed an electronic literature search that was carried out in the Pubmed, Scopus and Web of Science databses up to December 2019. Furthermore, we performed citation tracking for the articles missed in the initial search. Studies were eligible for inclusion when they reported details of at least the first 2 main steps of Klingler’s technique: fixation and freezing. A total of 37 full-text articles were included in the analysis. We included original anatomical studies in which human white matter dissection was performed for study purposes. The main three steps of preparation are the same in each laboratory, but the details of each vary between studies. Ten percent formalin is the most commonly used (34 studies) solution for fixation. The freezing time varied between 8 h and a month, and the temperature varied from − 5 to − 80 °C. After thawing and during dissections, the specimens were most often kept in formalin solution (13), and the concentration varied from 4 to 10%. Klingler’s preparation technique involves three main steps: fixation, freezing and thawing. Even though the details of the technique are different in most of the studies, all provide subjectively good quality specimens for anatomical dissections and studies.

Anatomical aspects of the insula, opercula and peri-insular white matter for a transcortical approach to insular glioma resection

“…In terms of awake craniotomy despite tumor localization, it is bene cial to expose the central sulcus to utilize the lowest and safest approach in terms of the risk of intraoperative seizure parameters for direct cortical and subcortical stimulation. Stimulation of the precentral gyrus results in positive responses on the lowest thresholds, and stimulation parameters are reproducible at the subcortical level [2,14]. Having parameters of the stimulation set, identi cation of the eloquent cortex within the frontal, temporal and parietal opercula can begin.…”

“…From a practical point of view, it is crucial to distinguish anomia from speech arrest. For this reason, the patient is asked to answer by providing a full sentence, such as "This is a…", and nally name the visualized object [14]. The objectnaming test is widely used to identify the posterior border of resection within the temporal lobe [31].…”

Anatomical aspects of the insula, opercula and peri-insular white matter for a transcortical approach to insular glioma resection

“…On its surface, the M2 (black dots) segment of the MCA, which supplies the insula (short perforators) and corona radiata (long perforators), is exposed. Above the insula, on the lateral surface of the hemispheres, the M3, M4, and M5 (black square-rectangular line) segments supplying the lateral surface of the hemisphere are also presented of the technique were described previously [18]. The assessment of cortical anatomy was performed with the naked eye, whereas white matter dissection was performed with microsurgical tools and microscopic magnification in a stepwise manner.…”

Revisiting the Morphology and Classification of the Paracingulate Gyrus with Commentaries on Ambiguous Cases

“…Image J image processing program (developed at the National Institutes of Health and the Laboratory for Optical and Computational Instrumentation) was used to measure the PCS length in ambiguous cases. Klingler's method of brain dissection and coronal brain sectioning were also used on three specimens, according to earlier descriptions [15][16][17][18].…”