Neuroradiology and Functional Neuroanatomy: Correlating Anatomical, Brain Imaging and Clinical Studies

For the 12th year running the Neuroradiology and Functional Neuroanatomy course was held at The Hospital for Neurology and Neurosurgery in Queen Square, arguably the home of British neurology. All attendees were hoping to gain a better grasp on the complex disciplines of neuroanatomy and neuroimaging. We were not disappointed.

Why attend and who is it for?

We decided to attend the course as we are applying for neurosurgery and neurology specialty training posts and this course is ideal for building on our knowledge and understanding the anatomy and imaging of the nervous system, essential for our practice. There were a number of other neurosurgery, neurology and neuroradiology trainees in the audience,ranging from very junior to more senior level. The majority of attendees, however, were neuroscience researchers including PhD students and post-doctoral researchers.

Course Preparation

A basic understanding of neuroanatomy was essential and can make the course far more accessible.There was frequent reference to Nieuwenhuy’s The Human Central Nervous System with its excellent illustrations but a simple text such as Crossman & Neary Neuroanatomy: An Illustrated Colour Text covers many of the introductory topics.

Course Organisation and Structure

The course was organised by Professor Thomas Naidich (Neuroradiology Mount Sinai, New York), Professor Christopher Yeo (Behavioural Neuroscience, UCL) and Professor Tarek Yousry (Lysholm Department of Neuroradiology,Queen Square).The course was held over 4 days and consisted of a mixture of interactive lectures and practical sessions. Lectures covered a host of topics from basic neuroanatomy, the evolution and development of the nervous system, cellular and chemical structure of various brain regions and talks on MRI, fMRI and tractography.

Lecture Highlights

Following the welcome address, day one began with Professor Naidich discussing the surface anatomy of the brain on MRI. The interactive lecture had all those in the auditorium chanting key landmarks of gyri and sulci throughout,which made for enjoyable and surprisingly effective learning.When reviewing brain MRI in a clinical setting it is often difficult to orientate oneself to the depth of the slice and the specific area of the brain affected by a lesion (for example many can identify the preand post-central gyrus on lateral sagittal views but this is difficult on midline sagittal sections). Through highlighting several reference points, which exhibit minimal variation between patients/subjects, and their relation to

key areas such as the motor strip, we were able to systematically work through and orientate ourselves to key brain regions in different MRI planes.

We then considered imaging of normal and abnormal brain development and the embryological development of the cerebral hemispheres (Professor Griffiths, Sheffield).This covered the fundamentals of brain development and discussed the pathophysiology and nomenclature of abnormal hemisphere development. Professor Valvanis (Zurich) talked about the evolution of the brain and lessons that came from neuroimaging.

The anatomy of movement, vision, sleep and balance were covered in different sessions by experts in each field across the 4 days.All assumed basic background knowledge and then built upon this, finally covering controversial and frontier aspects in each field.

Imaging – Hands-On PACS

One of the highlights of the course was the ‘Hands on PACS’ sessions, where we were able to discuss clinical cases, practice using the PACS systems with specialist advice and test our ability to report MRI studies. In these sessions, cases were compiled with presenting symptoms and questions posed, asking us to localise the lesion (and confirm this on MRI), describe the lesion and attempt to make a diagnosis. A mixture of pathologies were presented, ranging from tumours and stroke to neuromigrational abnormalities.

Dissection – Hands-On Anatomy

The two ‘Hands-on Anatomy’ sessions were held at nearby University College London. Professor Yeo and Professor Naidich led the anatomy demonstration. In these sessions specimens were studied working from the surface anatomy towards deep structures discussed in lectures earlier that day, such as the basal ganglia. This helped orientate and bring to life the morning’s teaching sessions. Following this we were able to handle prepared brains in small groups to further familiarise ourselves with the anatomy. Several senior faculty members were available to provide individualised teaching and answer questions. These sessions were incredibly useful: allowing students to reinforce earlier lessons and visualise the 3 dimensional concepts.We were however not able to undertake our own dissection.

Conclusions

The course was very well organised,the lecturers and demonstrators were highly enthusiastic, and the content certainly helped us on our way towards a better understanding of neuroanatomy and neuroradiology. Moreover,the neuroscience lectures broadened our knowledge of current hot topics in research. With the themes varying each year, it would certainly be worthwhile to attend the course in order to keep one’s knowledge up-to-date.