Gülsuna, Beste

Abstract Professor Albert J. Rhoton Jr., MD, is renowned for his groundbreaking dissections, marking a monumental achievement in the field of neuroanatomy. Alongside his anatomical contributions, he also passed on his knowledge and skills to numerous fellows, leaving behind a profound legacy. Despite the widespread recognition of his influence, little quantitative work has been done to characterize the scholarly impact of his alumni. Data were collected on Rhoton fellows, including fellowship years, country of origin, current institutions, and titles, practice settings, and leadership roles. Scholarly productivity was evaluated by assessing publication counts, including publications before and after the fellowship, and publications focused on surgical anatomy. Additionally, H-indices and citation counts were recorded. Other variables analyzed included ownership of a surgical anatomy laboratory, and participation in organizing hands-on courses. We analyzed 118 alumni from diverse countries. There was a significant increase in publication output following the fellowship, with publications rising from an average of 7 to 76 (p < 0.001). Fellows from high-income countries had higher research productivity than those from middle-income countries, with greater average H-index (p = 0.003), publication count (p = 0.01), and citation score (p = 0.003). Overall, 65% of fellows pursued academic practice, with 18% owning a laboratory and 30% involved in hands-on courses. Dr. Rhoton's mentorship has shaped a generation of neurosurgeons who continue his legacy. His fellows have established careers worldwide, leading in academia, professional organizations, and surgical training. Their global impact underscores the lasting value of structured mentorship in neurosurgery.

OBJECTIVE The term "sagittal stratum" was coined by Heinrich Sachs in 1892 to define a parasagittally oriented white matter layer at the temporo-occipital cortex. Although this term has been widely used for more than 100 years, the description, classification, borders, and involved fibers of the structure vary among authors and remain imprecise. Through fiber microdissection and tractography, the authors aimed to define the sagittal stratum and resolve the uncertainty by revealing the relationship of this structure to other cerebral white matter pathways and the orientation of fibers in it. METHODS Twenty postmortem human cerebral hemispheres were prepared according to Klingler’s method. Fiber dissections were performed under a surgical microscope and with microsurgical techniques. The results of dissection at each step were photographed with 2D and 3D imaging techniques, and 3D photogrammetry techniques were used to create a 360° model. Diffusion tensor imaging and 7T high-resolution MRI were used to confirm the findings. RESULTS This study revisited the 3D organization of white matter tracts in the sagittal stratum through fiber microdissection and tractography. The microneuroanatomical structure of the sagittal stratum and its special organization with fibers from all three fiber systems are demonstrated. The authors’ findings revealed that the sagittal stratum has two layers consisting of four different fiber tracts. Its external layer consists of a long association fiber and a commissural fiber, while its internal layer consists of intertwined projection fibers, including temporo-parieto-occipitopontine fibers and the posterior thalamic peduncle. Detailed microdissection also showed the location of the posterior thalamic peduncle in the most medial site of all posterior hemispheric projection fibers. CONCLUSIONS The structure of the sagittal stratum is distinctive in that it contains all three main fiber systems: association, commissural, and projection. Because of its expansive location in the temporal and occipital lobes, it can be damaged by most neurosurgical pathologies and procedures. The authors emphasize the significance of preserving the sagittal stratum during surgical interventions while also challenging the notion of a "silent" brain, suggesting that the current inability to fully comprehend cerebral function contributes to this misconception. Detailed knowledge of the complex white matter anatomy of the sagittal stratum can guide neurosurgeons in surgical planning and the selection of appropriate surgical approaches with intraoperative orientation for safe surgery and less comorbidity.