White Fibers Anatomy for Approaches to Limbic Tumors

The limbic system is composed of cortical structures such as the orbitofrontal, subcallosal/septal areas, cingulate, parahippocampal, and dentate gyri, as well as the hippocampus and the amygdala. Different white matter structures connect them in a very peculiar belt-shape. The evolution of the central nervous system is responsible for the mediobasal location into the hemispheres of these regions, and that is the reason why limbic tumors require specific surgical approaches with the aim of resecting them, but also respecting as much as possible the surrounding neocortex and white matter tracts. Creating a wide surgical corridor, respecting the anatomy, and taking advantage of the patient’s positioning in the surgical bed are key concepts to achieve an adequate resection. Mapping techniques can be helpful in case we prefer to perform transcortical resections. However, our preference is for midline and basal routes trying to respect the healthy surrounding areas.