Brainstem and Cranial Nerves: Pons

Mapping Intimacies ◽

10.1093/med/9780197512166.003.0009 ◽

2021 ◽

pp. 82-91

Author(s):

Kelly D. Flemming ◽

Paul W. Brazis

Keyword(s):

Blood Supply ◽

Basilar Artery ◽

Cranial Nerve ◽

Cranial Nerves ◽

Middle Cerebellar Peduncle ◽

Corticospinal Tracts ◽

Imaginary Line ◽

Cerebellar Peduncles ◽

Cerebellar Peduncle ◽

Pontomedullary Junction

The pons extends from the pontomedullary junction to an imaginary line drawn from the exit of cranial nerve IV. Dorsal to the pons lies the cerebellum, which receives information and projects information back to the brainstem through the inferior, middle, and superior cerebellar peduncles. Important structures at this level include the corticospinal tracts, corticopontocerebellar fibers traveling through the middle cerebellar peduncle, the cerebellum, and cranial nerves V through VIII. Blood supply to the pons is from the basilar artery and its perforating vessels.

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Brainstem and Cranial Nerves: Midbrain

10.1093/med/9780197512166.003.0010 ◽

2021 ◽

pp. 92-98

Author(s):

Kelly D. Flemming ◽

Paul W. Brazis

Keyword(s):

Substantia Nigra ◽

Red Nucleus ◽

Cranial Nerves ◽

Posterior Commissure ◽

Middle Cerebellar Peduncle ◽

Mammillary Bodies ◽

Imaginary Line ◽

Cerebellar Peduncle ◽

Trochlear Nucleus ◽

Inferior Colliculi

The midbrain (or mesencephalon) is the uppermost segment of the brainstem. This chapter reviews the important structures in the midbrain, including cranial nerves III and IV. The midbrain extends from the level of the trochlear nucleus to an imaginary line between the mammillary bodies and the posterior commissure. Important structures at this level include the cerebral peduncles, superior and inferior colliculi, red nucleus, substantia nigra, decussation of the middle cerebellar peduncle, and cranial nerves III and IV.

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Another Piece of the Puzzle of Anomalous Connectivity in Joubert's Syndrome

Neuropediatrics ◽

10.1055/s-0041-1732310 ◽

2021 ◽

Author(s):

Avner Meoded ◽

Marcia Kukreja ◽

Gunes Orman ◽

Eugen Boltshauser ◽

Thierry A.G.M. Huisman

Keyword(s):

White Matter ◽

Diffusion Tensor ◽

Three Dimensional ◽

Axonal Guidance ◽

Molar Tooth ◽

Superior Cerebellar Peduncle ◽

Corticospinal Tracts ◽

Cerebellar Peduncles ◽

Cerebellar Peduncle ◽

Magnetic Resonance Imaging Mri

AbstractWe report on the conventional and diffusion tensor imaging (DTI) findings of a 2-year-old child with clinical presentation of Joubert's Syndrome (JS) and brainstem structural abnormalities as depicted by neuroimaging.Conventional magnetic resonance imaging (MRI) showed a “molar tooth” configuration of the brainstem. A band-like formation coursing in an apparent axial plane anterior to the interpeduncular fossa was noted and appeared to partially cover the interpeduncular fossa.DTI maps and three-dimensional (3D) tractography demonstrated a prominent red-encoded white matter bundle anterior to the midbrain. Probable aberrant course of the bilateral corticospinal tracts (CST) was also depicted. Absence of the decussation of the superior cerebellar peduncles and elongated thickened, horizontal superior cerebellar peduncle (SCP) reflecting the molar tooth sign were also shown.Our report and the review of the published cases suggest that DTI and tractography may be very helpful to differentiate between interpeduncular heterotopias and similarly located white matter bundles corroborating the underlying etiology of axonal guidance disorders in the complex group of ciliopathies including JS. Our case represents an important additional puzzle piece to explore the variability of these ciliopathies.

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Complications of halo-pelvic traction

Journal of Neurosurgery ◽

10.3171/jns.1976.45.6.0716 ◽

1976 ◽

Vol 45 (6) ◽

pp. 716-718 ◽

Cited By ~ 11

Author(s):

Rodney A. Rozario ◽

Bennett M. Stein

Keyword(s):

Blood Supply ◽

Cranial Nerve ◽

Cranial Nerves ◽

Rapid Rate ◽

Content Type ◽

Cranial Nerve Palsies ◽

Fine Print

✓ When halo-pelvic traction is applied at a rapid rate it may induce cranial nerve palsies. The sixth, ninth, and tenth cranial nerves appear to be the most vulnerable. A proposed etiology is the stretching of these nerves resulting in a compromised blood supply with a consequent temporary paralysis which usually improves within 8 to 10 weeks.

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Stereotactic Transcerebellar Approach to Pontine Lesions through the Middle Cerebellar Peduncle

Interventional Neuroradiology ◽

10.1177/159101999900500103 ◽

1999 ◽

Vol 5 (1) ◽

pp. 19-25 ◽

Cited By ~ 3

Author(s):

F. Parker ◽

M.F. Levesque ◽

J. Bittoun ◽

D. Doyon ◽

M. Tadie

Keyword(s):

Clinical Outcome ◽

Mr Studies ◽

Neurological Deficits ◽

High Yield ◽

Low Grade ◽

High Grade ◽

Inappropriate Therapy ◽

Middle Cerebellar Peduncle ◽

Cerebellar Peduncle ◽

Pontomedullary Junction

A stereotactic approach to the pons through the middle cerebellar peduncle based on MR studies was used to biopsy 18 patients. The stereotactic coordinates and angles were defined with reference to three orthogonal planes (mid-sagittal, IVth ventricular floor and pontomedullary junction). The pathological diagnoses were in keeping with clinical outcome and comprised five high-grade astrocytomas, three low-grade astrocytomas, two glioblastomas multiforme, two oligodendrogliomas, two primitive neuroectodermic tumours, two lymphomas, one medulloblastoma, and one tuberculosis. This approach provides a high yield of positive histological diagnoses with little morbidity (transient neurological deficits in two cases) and thereby avoids inappropriate therapy.

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Progression of Pathological Changes in the Middle Cerebellar Peduncle by Diffusion Tensor Imaging Correlates With Lesser Motor Gains After Pontine Infarction

Neurorehabilitation and Neural Repair ◽

10.1177/1545968308331142 ◽

2009 ◽

Vol 23 (7) ◽

pp. 692-698 ◽

Cited By ~ 20

Author(s):

Zhijian Liang ◽

Jinsheng Zeng ◽

Cuimei Zhang ◽

Sirun Liu ◽

Xueying Ling ◽

...

Keyword(s):

Wallerian Degeneration ◽

Diffusion Tensor ◽

Percentage Reduction ◽

Middle Cerebellar Peduncle ◽

Absolute Value ◽

Pontine Infarction ◽

Cerebellar Peduncles ◽

Cerebellar Peduncle ◽

Over Time ◽

Pontine Infarct

Background. Wallerian degeneration in pyramidal tract following supratentorial stroke has been detected by some studies using diffusion tensor imaging (DTI), but the Wallerian degeneration in middle cerebellar peduncle after pontine infarction and its potential clinical significance remain to be confirmed. Methods. Seventeen patients with a recent focal pontine infarct underwent 3 DTIs at week 1 (W1), week 4 (W4), and week 12 (W12) after onset. Seventeen age-matched and gender-matched controls underwent DTI one time. Mean diffusivity and fractional anisotropy (FA) were measured in the basis pontis and bilateral middle cerebellar peduncles. Neurological deficit, motor deficit, functional independence, and limbs ataxia were assessed with the National Institutes of Health (NIH) Stroke Scale, Fugl-Meyer scale, Barthel Index, and the second part of International Cooperative Ataxia Rating Scale. Results. FA values at the bilateral middle cerebellar peduncles decreased significantly from W1 to W12 progressively ( P < .01). The patients improved on the NIH Stroke Scale, Fugl-Meyer scale, and Barthel Index over time ( P < .01). Greater absolute value of percentage reduction of FA at the bilateral middle peduncles, however, was associated with the less absolute value of percentage reduction of the NIH Stroke Scale and less increase in the Fugl-Meyer scale, as well as greater ataxia over time. Conclusions. Wallerian degeneration in the middle cerebellar peduncle revealed by DTI may hinder the process of neurological recovery following a focal pontine infarct.

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Hemangioblastoma of the pons and middle cerebellar peduncle

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19402 ◽

2019 ◽

Vol 1 (2) ◽

pp. V6

Author(s):

Satoshi Kiyofuji ◽

Harry J. Cloft ◽

Colin L. W. Driscoll ◽

Michael J. Link

Keyword(s):

Magnetic Resonance Imaging ◽

Hearing Loss ◽

Cranial Nerves ◽

Cystic Mass ◽

Preoperative Embolization ◽

Resonance Imaging ◽

Middle Cerebellar Peduncle ◽

History Of ◽

Cerebellar Peduncle ◽

Magnetic Resonance Imaging Mri

A 60-year-old man with a history of four prior operations for a left cerebellar/middle cerebellar peduncle hemangioblastoma presented with hearing loss, imbalance, and ataxia (de la Monte and Horowitz, 1989). Magnetic resonance imaging (MRI) demonstrated a 3-cm cystic mass with heterogeneous enhancement in the same location. We resected the mass via reopening of the retrosigmoid approach (Lee et al., 2014). Left cranial nerves IV, V, VII, VIII, IX, X, and XI were all well identified and preserved, and feeding arteries from the brainstem were meticulously coagulated and transected without violating the tumor-brainstem interface (Chen et al., 2013). Preoperative embolization greatly aided safe resection of the mass, whose pathology revealed recurrence of hemangioblastoma (Eskridge et al., 1996; Kim et al., 2006; Sakamoto et al., 2012).The video can be found here: https://youtu.be/3mZgY15xOZc.

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Resection of a Lower Clival Meningioma via Posterolateral Approach: Two-Dimensional Operative Video

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1714407 ◽

2020 ◽

Author(s):

Pinar E. Ocak ◽

Selcuk Yilmazlar

Keyword(s):

Cranial Nerve ◽

Cranial Nerves ◽

Posterolateral Approach ◽

Left Vertebral Artery ◽

Posterior Arch ◽

Upper Cervical Spine ◽

Two Dimensional ◽

Lower Cranial Nerve ◽

Complex Anatomy ◽

Microsurgical Resection

Abstract Objectives This study aimed to demonstrate resection of a craniovertebral junction (CVJ) meningioma via the posterolateral approach. Design The study is designed with a two-dimensional operative video. Setting This study is conducted at department of neurosurgery in a university hospital. Participants A 50-year-old woman who presented with lower cranial nerve findings due to a left-sided lower clival meningioma (Fig. 1). Main Outcome Measures Microsurgical resection of the meningioma and preservation of the neurovascular structures. Results The patient was placed in park-bench position and a left-sided retrosigmoid suboccipital craniotomy, followed by C1 hemilaminectomy and unroofing the lip of the foramen magnum, was performed. The dural incision extended from the suboccipital region down to the posterior arch of C2 (Fig. 2). The arachnoid overlying the tumor was incised, revealing the course of the cranial nerve (CN) XI on the dorsolateral aspect of the tumor. The left vertebral artery (VA) was encased by the tumor which was originating from the dura below the jugular foramen. The mass was resected in a piecemeal fashion eventually. At the end of the procedure, all relevant cranial nerves and adjacent vascular structures were intact. Postoperative magnetic resonance imaging (MRI) confirmed total resection and the patient was discharged home on postoperative day 3 safely. Conclusions Microsurgical resection of the lesions of the CVJ are challenging as this transition zone between the cranium and upper cervical spine has a complex anatomy. Since adequate exposure of the extradural and intradural segments of the VA can be obtained by the posterolateral approach, this approach can be preferred in cases with tumors anterior to the VA or when the artery is encased by the tumor.The link to the video can be found at: https://youtu.be/d3u5Qrc-zlM.

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Developmentally anomalous cerebellar encephalocele arising within the cerebellopontine angle and extending into the adjacent skull base in a pediatric patient

Child s Nervous System ◽

10.1007/s00381-020-05020-8 ◽

2021 ◽

Author(s):

Forrest A. Hamrick ◽

Michael Karsy ◽

Carol S. Bruggers ◽

Angelica R. Putnam ◽

Gary L. Hedlund ◽

...

Keyword(s):

Skull Base ◽

Pediatric Patient ◽

Cerebellopontine Angle ◽

Resonance Imaging ◽

Middle Cerebellar Peduncle ◽

Cerebellar Tissue ◽

Cerebellar Peduncle ◽

Histopathologic Analysis ◽

The Right ◽

Internal Acoustic Canal

AbstractLesions of the cerebellopontine angle (CPA) in young children are rare, with the most common being arachnoid cysts and epidermoid inclusion cysts. The authors report a case of an encephalocele containing heterotopic cerebellar tissue arising from the right middle cerebellar peduncle and filling the right internal acoustic canal in a 2-year-old female patient. Her initial presentation included a focal left 6th nerve palsy. Magnetic resonance imaging was suggestive of a high-grade tumor of the right CPA. The lesion was removed via a retrosigmoid approach, and histopathologic analysis revealed heterotopic atrophic cerebellar tissue. This report is the first description of a heterotopic cerebellar encephalocele within the CPA and temporal skull base of a pediatric patient.

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