Three-Dimensional Microsurgical Anatomy and the Safe Entry Zones of the Brainstem

2014 ◽  
Vol 10 (4) ◽  
pp. 602-620 ◽  
Author(s):  
Kaan Yagmurlu ◽  
Albert L. Rhoton ◽  
Necmettin Tanriover ◽  
Jeffrey A. Bennett
Keyword(s):  
Cranial Nerves ◽  
Three Dimensional ◽  
Surface Structures ◽  
Microsurgical Anatomy ◽  
Entry Zone ◽  
3 Dimensional ◽  
Cerebellar Peduncles ◽  
Fiber Dissection ◽  
Dissection Techniques ◽  
Dissection Technique

Abstract BACKGROUND: There have been no studies of the structure and safe surgical entry zones of the brainstem based on fiber dissection studies combined with 3-dimensional (3-D) photography. OBJECTIVE: To examine the 3-D internal architecture and relationships of the proposed safe entry zones into the midbrain, pons, and medulla. METHODS: Fifteen formalin and alcohol-fixed human brainstems were dissected by using fiber dissection techniques, ×6 to ×40 magnification, and 3-D photography to define the anatomy and the safe entry zones. The entry zones evaluated were the perioculomotor, lateral mesencephalic sulcus, and supra- and infracollicular areas in the midbrain; the peritrigeminal zone, supra- and infrafacial approaches, acoustic area, and median sulcus above the facial colliculus in the pons; and the anterolateral, postolivary, and dorsal medullary sulci in the medulla. RESULTS: The safest approach for lesions located below the surface is usually the shortest and most direct route. Previous studies have often focused on surface structures. In this study, the deeper structures that may be at risk in each of the proposed safe entry zones plus the borders of each entry zone were defined. This study includes an examination of the relationships of the cerebellar peduncles, long tracts, intra-axial segments of the cranial nerves, and important nuclei of the brainstem to the proposed safe entry zones. CONCLUSION: Fiber dissection technique in combination with the 3-D photography is a useful addition to the goal of making entry into the brainstem more accurate and safe.

Three-Dimensional Topographic Fiber Tract Anatomy of the Cerebrum

2015 ◽  
Vol 11 (2) ◽  
pp. 274-305 ◽  
Author(s):  
Kaan Yagmurlu ◽  
Alexander L Vlasak ◽  
Albert L Rhoton
Keyword(s):  
Three Dimensional ◽  
Central Core ◽  
3 Dimensional ◽  
Fiber Tracts ◽  
Nuclear Masses ◽  
Fiber Dissection ◽  
Dissection Technique ◽  
Human Brains ◽  
The Brain ◽  
Formalin Fixed

Abstract BACKGROUND The fiber tracts of the cerebrum may be a more important determinant of resection limits than the cortex. Better knowledge of the 3-dimensional (3-D) anatomic organization of the fiber pathways is important in planning safe and accurate surgery for lesions within the cerebrum. OBJECTIVE To examine the topographic anatomy of fiber tracts and subcortical gray matter of the human cerebrum and their relationships with consistent cortical, ventricular, and nuclear landmarks. METHODS Twenty-five formalin-fixed human brains and 4 whole cadaveric heads were examined by fiber dissection technique and ×6 to ×40 magnification. The fiber tracts and central core structures, including the insula and basal ganglia, were examined and their relationships captured in 3-D photography. The depth between the surface of the cortical gyri and selected fiber tracts was measured. RESULTS The topographic relationships of the important association, projection, and commissural fasciculi within the cerebrum and superficial cortical landmarks were identified. Important landmarks with consistent relationships to the fiber tracts were the cortical gyri and sulci, limiting sulci of the insula, nuclear masses in the central core, and lateral ventricles. The fiber tracts were also organized in a consistent pattern in relation to each other. The anatomic findings are briefly compared with functional data from clinicoradiological analysis and intraoperative stimulation of fiber tracts. CONCLUSION An understanding of the 3-D anatomic organization of the fiber tracts of the brain is essential in planning safe and accurate cerebral surgery.

scholarly journals Microsurgical anatomy and internal architecture of the brainstem in 3D images: surgical considerations

2016 ◽  
Vol 124 (5) ◽  
pp. 1377-1395 ◽  
Author(s):  
Richard Gonzalo Párraga ◽  
Lucas Loss Possatti ◽  
Raphael Vicente Alves ◽  
Guilherme Carvalhal Ribas ◽  
Uğur Türe ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Surgical Approaches ◽  
Detailed Knowledge ◽  
Microsurgical Anatomy ◽  
Descending Pathways ◽  
Brainstem Surgery ◽  
Point Of Entry ◽  
Cerebellar Peduncles ◽  
Dissection Technique ◽  
Internal Architecture

OBJECT Brainstem surgery remains a challenge for the neurosurgeon despite recent improvements in neuroimaging, microsurgical techniques, and electrophysiological monitoring. A detailed knowledge of the microsurgical anatomy of the brainstem surface and its internal architecture is mandatory to plan appropriate approaches to the brainstem, to choose the safest point of entry, and to avoid potential surgical complications. METHODS An extensive review of the literature was performed regarding the brainstem surgical approaches, and their correlations with the pertinent anatomy were studied and illustrated through dissection of human brainstems properly fixed with 10% formalin. The specimens were dissected using the fiber dissection technique, under ×6 to ×40 magnification. 3D stereoscopic photographs were obtained (anaglyphic 3D) for better illustration of this study. RESULTS The main surgical landmarks and their relationship with the cerebellum and vascular structures were identified on the surface of the brainstem. The arrangements of the white matter (ascending and descending pathways as well as the cerebellar peduncles) were demonstrated on each part of the brainstem (midbrain, pons, and medulla oblongata), with emphasis on their relationships with the surface. The gray matter, constituted mainly by nuclei of the cranial nerves, was also studied and illustrated. CONCLUSIONS The objective of this article is to review the microsurgical anatomy and the surgical approaches pertinent to the brainstem, providing a framework of its external and internal architecture to guide the neurosurgeon during its related surgical procedures.

Microsurgical Anatomy of the Optic Radiation and Related Fibers in 3-Dimensional Images

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. ons160-ons172 ◽  
Author(s):  
Richard Gonzalo Párraga ◽  
Guilherme Carvalhal Ribas ◽  
Leonardo Christiaan Welling ◽  
Raphael Vicente Alves ◽  
Evandro de Oliveira
Keyword(s):  
White Matter ◽  
Temporal Lobe ◽  
Lateral Geniculate Body ◽  
Microsurgical Anatomy ◽  
Optic Radiation ◽  
3 Dimensional ◽  
Important Relationship ◽  
Fiber Dissection ◽  
The Mean ◽  
Dissection Technique

Abstract BACKGROUND: The fiber dissection technique provides unique 3-dimensional anatomic knowledge of the white matter. OBJECTIVE: To examine the optic radiation anatomy and its important relationship with the temporal stem and to discuss its findings in relation to the approaches to temporal lobe lesions. METHODS: We studied 40 cerebral hemispheres of 20 brains that had been fixed in formalin solution for 40 days. After removal of the arachnoid membrane, the hemispheres were frozen, and the Klingler technique was used for dissection under magnification. Stereoscopic 3-dimensional images of the dissection were obtained for illustration. RESULTS: The optic radiations are located deep within the superior and middle temporal gyri, always above the inferior temporal sulcus. The mean distance between the cortical surface and the lateral edge of the optic radiation was 21 mm. Its fibers are divided into 3 bundles after their origin. The mean distance between the anterior tip of the temporal horn and the Meyer loop was 4.5 mm, between the temporal pole and the anterior border of the Meyer loop was 28.4 mm, and between the limen insulae and the Meyer loop was 10.7 mm. The mean distance between the lateral geniculate body and the lateral margin of the central bundle of the optic radiation was 17.4 mm. CONCLUSION: The white matter fiber dissection reveals the tridimensional intrinsic architecture of the brain, and its knowledge regarding the temporal lobe is particularly important for the neurosurgeon, mostly because of the complexity of the optic radiation and related fibers.

scholarly journals Microsurgical Anatomy of the Anterior Commissure: Correlations With Diffusion Tensor Imaging Fiber Tracking and Clinical Relevance

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. ons241-ons247 ◽  
Author(s):  
Johann Peltier ◽  
Sébastien Verclytte ◽  
Christine Delmaire ◽  
Jean-Pierre Pruvo ◽  
Eric Havet ◽  
...  
Keyword(s):  
Diffusion Tensor ◽  
Comparative Anatomy ◽  
Anterior Commissure ◽  
Diffuse Axonal Injury ◽  
Functional Anatomy ◽  
Microsurgical Anatomy ◽  
Cross Sectional ◽  
3 Dimensional ◽  
Fiber Dissection ◽  
Dissection Technique

Abstract BACKGROUND Detailed anatomy of the anterior commissure is unknown in the literature. OBJECTIVE To describe the anterior commissure with the use of a fiber dissection technique by focusing on the morphology (length and breadth of the 2 portions), the course, and the relations with neighboring fasciculi, particularly in the temporal stem. METHODS We dissected 8 previously frozen, formalin-fixed human brains under the operating microscope using the fiber dissection described by Klingler. Lateral, inferior, and medial approaches were made. RESULTS The anterior olfactive limb of the anterior commissure was sometimes absent during dissection. The cross-sectional 3-dimensional magnetic resonance rendering images showed that fibers of the anterior commissure curved laterally within the basal forebrain. The tip of the temporal limb of the anterior commissure was intermingled with other fasciculi in various directions to form a dense 3-dimensional network. CONCLUSION Functional anatomy and comparative anatomy are described. The anterior commissure can be involved in various pathologies such as diffuse axonal injury, schizophrenia, and cerebral tumoral dissemination.

Anatomy of the Anterior Temporal Lobe and the Frontotemporal Region Demonstrated by Fiber Dissection

Neurosurgery ◽  
2004 ◽  
Vol 55 (5) ◽  
pp. 1174-1184 ◽  
Author(s):  
Diedrik Peuskens ◽  
Johannes van Loon ◽  
Frank Van Calenbergh ◽  
Raymond van den Bergh ◽  
Jan Goffin ◽  
...  
Keyword(s):  
White Matter ◽  
Temporal Lobe ◽  
Anterior Commissure ◽  
Three Dimensional ◽  
Dimensional Structure ◽  
Surgical Approaches ◽  
Anterior Temporal Lobe ◽  
White Matter Tracts ◽  
Fiber Dissection ◽  
Dissection Technique

Abstract OBJECTIVE: The white matter structure of the anterior temporal lobe and the frontotemporal region is complex and not well appreciated from the available neurosurgical literature. The fiber dissection method is an excellent means of attaining a thorough knowledge of the three-dimensional structure of the white matter tracts. This study was performed to demonstrate the usefulness of the dissection technique in understanding the white matter anatomy and the effects of current surgical approaches on the subcortical structure of the region. METHODS: Seventeen brain specimens obtained at routine autopsy were dissected by use of Klingler's fiber dissection technique after preparation by fixation and freezing. The dissections were performed with an operating microscope and followed a stepwise pattern of progressive white matter dissection. RESULTS: The dissection is described in an orderly fashion showing the white matter tracts of the anterior temporal lobe and the frontotemporal region. An insight is gained into the three-dimensional course of the anterior loop of the optic radiation, the temporal stem, the anterior commissure, and the ansa peduncularis. CONCLUSION: The anterior temporal lobe and the frontotemporal region contain several important white matter tracts that can be uniquely understood by performing a white matter dissection of the region. Surgical procedures on the anterior temporal lobe differ substantially as to their repercussions on the subcortical white matter tract anatomy, as shown by the findings in this study.

Orbitomeningeal Band in Transcavernous Dissection and Anterior Clinoidectomy: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E414-E414
Author(s):  
Alvaro Campero ◽  
Matias Baldoncini ◽  
Juan F Villalonga ◽  
Amparo Sáenz
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Senior Author ◽  
Microsurgical Anatomy ◽  
Resonance Imaging ◽  
Superior Orbital Fissure ◽  
3 Dimensional ◽  
Magnetic Resonance Imaging Mri ◽  
Base Lesion

Abstract The orbitomeningeal or meningo-orbital band (MOB) has been described as the most superficial dural band responsible for tethering the frontotemporal basal dura to the periorbita.1,2 The MBO usually interferes with the surgical approach to the most profound areas of the anterior and middle skull base. It is known that there are no cranial nerves on the lateral surface of the superior orbital fissure; therefore, the neurosurgeon can cut the MOB without causing any neurological deficit and, at the same time, achieving fully exposure of the anterior clinoid process1-4 and/or the lateral wall of the cavernous sinus.5 The purpose of this video is to describe the microsurgical anatomy of the MOB and illustrate the technique for its detachment, accompanied by 2 illustrative cases. To achieve this, we use 3-dimensional recordings of 2 cadaveric specimens’ dissections performed by the senior author. Case 1: 58-yr-old female with left blindness. Magnetic resonance imaging (MRI) shows an anterior and middle skull base lesion with orbital compression. Case 2: 32-yr-old male presenting with headache and trigeminal neuralgia. The MRI revealed an hourglass-shaped lesion in the posterior and middle fossa. Both patients signed an informed consent and agree with the use of their images for research purposes. We used a step-by-step approach for an adequate and secure dissection of the MOB highlighting the anatomic structures involved in the process. This approach allows safe and adequate access to the deeper structures of the anterior and middle skull base.

THREE-DIMENSIONAL AND 2-DIMENSIONAL ENDOSCOPIC EXPOSURE OF MIDLINE CRANIAL BASE TARGETS USING EXPANDED ENDONASAL AND TRANSCRANIAL APPROACHES

Neurosurgery ◽  
2009 ◽  
Vol 65 (6) ◽  
pp. 1116-1130 ◽  
Author(s):  
Jonathan Roth ◽  
Ameet Singh ◽  
Gurston Nyquist ◽  
Justin F. Fraser ◽  
Antonio Bernardo ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Improve Patient Safety ◽  
Cranial Nerves ◽  
Three Dimensional ◽  
Abducens Nerve ◽  
Cranial Base ◽  
Endoscopic Endonasal ◽  
3 Dimensional ◽  
Fresh Cadaver ◽  
Wide Exposure

Abstract OBJECTIVE Endoscopic endonasal approaches provide an access method to the midline cranial base. To integrate these approaches into neurosurgical practice, the extent of their anatomic exposure must be compared with that provided by more traditional transcranial approaches. METHODS Ten fresh cadaver heads were studied. Both endonasal and transcranial approaches to the midline cranial base were performed. The midline cranial base was divided into several areas, and the relative exposure provided by each approach was described and presented in both 2-dimensional and 3-dimensional images. Limitations and advantages of each approach are discussed. RESULTS The endonasal approaches achieved a direct and wide exposure of the midline extracranial and intracranial cranial base anatomy. The main lateral limitations of the endonasal approaches were the optic nerves, lateral cavernous sinus, vidian nerve, internal carotid artery, abducens nerve in Dorello's canal, jugular tubercle, and hypoglossal canals. Limitations of the transcranial approaches were the neurovascular structures which lie in the operative corridor and create narrow working spaces. CONCLUSION The endonasal approaches achieve a direct and wide exposure of the midline cranial base bilaterally. Lateral exposure, beyond the cranial nerves and carotid artery, are challenging. Transcranial approaches are limited by the narrow corridors provided by the cranial nerves, and they do not visualize the contralateral paramedian cranial base very well. Three-dimensional endoscopes augment the spatial orientation and may improve patient safety and the learning curve for endoscopic approaches to the midline cranial base.

Three-dimensional microsurgical anatomy of cerebellar peduncles

2012 ◽  
Vol 36 (2) ◽  
pp. 215-225 ◽  
Author(s):  
Paolo Perrini ◽  
Giacomo Tiezzi ◽  
Maura Castagna ◽  
Riccardo Vannozzi
Keyword(s):  
Three Dimensional ◽  
Microsurgical Anatomy ◽  
Cerebellar Peduncles

Three dimensional anatomical microdissection of rat brain using fiber dissection technique

2014 ◽  
Vol 63 (2) ◽  
pp. 117-124 ◽  
Author(s):  
A. Akakin ◽  
B. Yılmaz ◽  
D. Akakin ◽  
N. Dagbasi ◽  
T. Kilic
Keyword(s):  
Rat Brain ◽  
Three Dimensional ◽  
Fiber Dissection ◽  
Dissection Technique

scholarly journals Internal structure of the cerebral hemispheres: an introduction of fiber dissection technique

2005 ◽  
Vol 63 (2a) ◽  
pp. 252-258 ◽  
Author(s):  
Igor de Castro ◽  
Daniel de Holanda Christoph ◽  
Daniel Paes dos Santos ◽  
José Alberto Landeiro
Keyword(s):  
Three Dimensional ◽  
Medial Aspect ◽  
Lateral Aspect ◽  
Critical Pathways ◽  
Brain Hemispheres ◽  
The Central Nervous System ◽  
Fiber Dissection ◽  
Dissection Technique ◽  
The Brain ◽  
Neuroimaging Techniques

The aim of this study is to introduce the fiber dissection technique and its importance in the comprehension of the three-dimensional intrinsic anatomy of the brain. A total of twenty brain hemispheres were dissected. Using Kingler's technique we demonstrated the intrinsic structures of the brain. The supra lateral aspect of the brain as well as the medial aspect were presented. The most important fiber systems were demonstrated. The use and comprehension of new neuroimaging techniques demand a better understanding of this fascinating anatomy. The knowledge acquired with this technique will improve our understanding of critical pathways of the central nervous system.

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