Microsurgical anatomy of the pineal region

1980 ◽  
Vol 53 (2) ◽  
pp. 205-221 ◽  
Author(s):  
Isao Yamamoto ◽  
Naoki Kageyama
Keyword(s):  
Cranial Nerves ◽  
Pineal Region ◽  
Superior Cerebellar Artery ◽  
Cerebral Vein ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Cerebellar Artery ◽  
Bridging Vein ◽  
Tentorial Notch ◽  
Relationship Of

✓ Thirty cadaver brains were examined under × 6 to 16 magnification in order to define the microsurgical anatomy of the pineal region, particularly the relationship of the pineal body, posterior cerebral artery, superior cerebellar artery, vein of Galen, basal vein of Rosenthal, internal cerebral vein, straight sinus, bridging vein, the size of the tentorial notch, and the third and the fourth cranial nerves. The infratentorial and supratentorial approaches to the pineal region are compared from the viewpoint of microsurgical anatomy.

The Microsurgical Anatomy of the Infratentorial Lateral Supracerebellar Approach to the Trigeminal Nerve for Tic Douloureux

Neurosurgery ◽  
1989 ◽  
Vol 24 (6) ◽  
pp. 890-895 ◽  
Author(s):  
Toshio Matsushima ◽  
Masashi Fukui ◽  
Satoshi Suzuki ◽  
Albert L. Rhoton
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Cerebellar Hemisphere ◽  
Superior Cerebellar Artery ◽  
Microsurgical Anatomy ◽  
Medial Side ◽  
Microsurgical Decompression ◽  
Cerebellar Artery ◽  
Relationship Of ◽  
Anatomical Information

ABSTRACT The increasing use of microsurgical decompression for trigeminal neuralgia has created a need for more detailed anatomical information about the approach. To define better this anatomy, 10 cerebellar specimens obtained at autopsy were examined, and intraoperative findings in 30 patients with trigeminal neuralgia were analyzed. Since the infratentorial subdural space on the tentorial cerebellar surface is exposed to explore the trigeminal nerve in the infratentorial lateral supracerebellar approach, attention was directed to the following: the anterolateral margin of the cerebellar hemisphere, bridging veins on the tentorial surface, superior petrosal veins, and relationships between blood vessels and the trigeminal nerve. The lateral mesencephalic segment of the superior cerebellar artery at or near the bifurcation often compressed the nerve laterally at more than one point. With this approach, the relationship of the superior cerebellar artery to the nerve could be observed from the medial side of the tentorial surface. The infratentorial lateral supracerebellar approach is discussed and compared to Dandy's cerebellar route.

Microsurgical anatomy of the great cerebral vein of Galen and its tributaries

2003 ◽  
Vol 99 (6) ◽  
pp. 1028-1038 ◽  
Author(s):  
Patrick Chaynes
Keyword(s):  
Venous Drainage ◽  
Pineal Region ◽  
Surgical Approaches ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Microsurgical Anatomy ◽  
Vein Of Galen ◽  
Content Type ◽  
Deep Cerebral Veins ◽  
Fine Print

Object. The deep cerebral veins may pose a major obstacle in operative approaches to deep-seated lesions, especially in the pineal region where multiple veins converge on the great cerebral vein of Galen. Because undesirable sequelae may occur from such surgery, the number of veins and branches to be sacrificed during these approaches should kept to a minimum. The purpose of this study was to examine venous drainage into the vein of Galen with a view to surgical approaches. If a vein hampering surgical access must be sacrificed, it can therefore be selected according to the smallest draining territory. Methods. The deep cerebral veins and their surrounding neural structures were examined in 50 cerebral hemispheres from 25 adult cadavers in which the arteries and veins had been perfused with red and blue silicone, respectively. Special consideration was given to the size and location of drainage of the vein of Galen and its tributaries. Conclusions. When a surgeon approaches the pineal region, several veins may hamper the access route. From posterior to anterior, these include the following: the superior vermian and the precentral or superior cerebellar veins, which drain into the posteroinferior aspect of the vein of Galen; and the tectal and pineal veins, which drain into its anterosuperior aspect. The internal occipital vein is the main vessel draining into the lateral aspect of the vein of Galen. It may be joined by the posterior pericallosal vein, and in that case has an extensive territory. To avoid intraoperative venous infarction, it is important to use angiography to determine the venous organization before surgery and to estimate the permeability and size of the branches of the deep venous system.

Microsurgical relationships of the superior cerebellar artery and the trigeminal nerve

1978 ◽  
Vol 49 (5) ◽  
pp. 669-678 ◽  
Author(s):  
David G. Hardy ◽  
Albert L. Rhoton
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Operative Therapy ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Content Type ◽  
Cerebellar Artery ◽  
Trigeminal Nerves ◽  
Relationship Of ◽  
The Relationship

✓ Compression and distortion of the trigeminal nerve by a tortuous and elongated superior cerebellar artery (SCA) is postulated to be a frequent cause of trigeminal neuralgia. This theory and the use of operative therapy in which the offending arterial loop is separated from the trigeminal nerve has created a need for more detailed information on the relationship of the SCA and the trigeminal nerve. In order to meet this need, 50 trigeminal nerves and the adjacent SCA were examined in 25 adult cadavers. Twenty-six of the 50 nerves examined had a point of contact with the SCA, but it was uncommon for the arterial contact to produce distortion of the nerve. In six instances, the contact was at the pontine entry zone of the trigeminal nerve, the site of arterial compression postulated to be associated with trigeminal neuralgia. Four trigeminal nerves (8%) had a point of contact with the anterior inferior cerebellar artery (AICA). The fact that large arteries are commonly in contact with the trigeminal nerve is important not only because of the controversial relationship of neurovascular contact to trigeminal neuralgia, but because of the possibility that major vessels may be encountered and injured during rhizotomy and other posterior fossa operations on the trigeminal nerve.

scholarly journals Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

2018 ◽  
Vol 79 (S 05) ◽  
pp. S415-S417
Author(s):  
M. Kalani ◽  
William Couldwell
Keyword(s):  
Cranial Nerves ◽  
Sudden Onset ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Cerebellar Artery ◽  
Sensory Disturbances ◽  
History Of ◽  
Supracerebellar Infratentorial Approach ◽  
The Right ◽  
Piecemeal Resection

This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg.

Microsurgical Anatomy of the Superior Cerebellar Artery

Neurosurgery ◽  
1980 ◽  
Vol 6 (1) ◽  
pp. 10-28 ◽  
Author(s):  
David G. Hardy ◽  
David A. Peace ◽  
Albert L. Rhoton
Keyword(s):  
Superior Cerebellar Artery ◽  
Microsurgical Anatomy ◽  
Cerebellar Artery

scholarly journals Microsurgical resection of ambient cistern arteriovenous malformation

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1
Author(s):  
Omar Choudhri ◽  
Michael T. Lawton
Keyword(s):  
Arteriovenous Malformations ◽  
Posterior Cerebral Artery ◽  
Cranial Nerves ◽  
Superior Cerebellar Artery ◽  
Technical Aspects ◽  
The Third ◽  
Cerebellar Artery ◽  
Basal Vein Of Rosenthal ◽  
Microsurgical Resection ◽  
Ambient Cistern

The middle tentorial incisural space, located lateral to the midbrain and medial to the temporal lobe, contains the ambient cistern through which courses the third, fourth, and fifth cranial nerves, posterior cerebral artery (PCA), superior cerebellar artery, and the choroidal arteries. Arteriovenous malformations (AVMs) in this compartment are supplied by the thalamogeniculate and posterior temporal branches of the PCA, and drain into tributaries of the basal vein of Rosenthal. We present a case of an AVM in this middle tentorial incisural space that persisted after embolization and radiosurgery, and was microsurgically resected through a subtemporal approach. This case demonstrates the anatomy of the middle incisural space and technical aspects in microsurgical resection of these rare AVMs.The video can be found here: https://youtu.be/V-dIWh8ys3E.

Quantitative assessment of vessel flow integrity for aneurysm surgery

1999 ◽  
Vol 91 (6) ◽  
pp. 1050-1054 ◽  
Author(s):  
Fady T. Charbel ◽  
Gabriel Gonzales-Portillo ◽  
William E. Hoffman ◽  
Lauren A. Ostergren ◽  
Mukesh Misra
Keyword(s):  
Blood Flow ◽  
Superior Cerebellar Artery ◽  
Aneurysm Surgery ◽  
Flow Measurements ◽  
Content Type ◽  
Aneurysm Clipping ◽  
Cerebellar Artery ◽  
Before And After ◽  
Vessel Flow ◽  
Improve Patient

✓ Quantitative measurement of blood flow in cerebral vessels during aneurysm surgery can help prevent ischemic injury and improve patient outcome. The authors report a case of a superior cerebellar artery (SCA) aneurysm in which perivascular microflow probes were used to measure blood flow quantitatively in both the SCA and the posterior cerebral artery before and after aneurysm clipping. Following aneurysm clipping, blood flow in the SCA was reduced to less than 25% of its initial baseline value. Prompt detection of compromised blood flow gave the surgeon the opportunity to adjust the clip and restore SCA flow to its preclipping value within 5 minutes of initial clip placement. Quantitative vessel-flow measurements were integral to the safe progression of the operation and may have prevented an adverse neurological outcome in this patient. The recommended surgical technique and the principle of operation are described.

Microvascular decompression for hemifacial spasm

1991 ◽  
Vol 75 (3) ◽  
pp. 388-392 ◽  
Author(s):  
Shinji Nagahiro ◽  
Akira Takada ◽  
Yasuhiko Matsukado ◽  
Yukitaka Ushio
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Anterior Inferior Cerebellar Artery ◽  
Vascular Compression ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Cerebellar Artery

✓ To determine the causative factors of unsuccessful microvascular decompression for hemifacial spasm, the follow-up results in 53 patients were assessed retrospectively. The mean follow-up period was 36 months. There were 32 patients who had compression of the seventh cranial nerve ventrocaudally by an anterior inferior cerebellar artery (AICA) or a posterior inferior cerebellar artery. Of these 32 patients, 30 (94%) had excellent postoperative results. Of 14 patients with more severe compression by the vertebral artery, nine (64%) had excellent results, three (21%) had good results, and two (14%) had poor results; in this group, three patients with excellent results experienced transient spasm recurrence. There were seven patients in whom the meatal branch of the AICA coursed between the seventh and eighth cranial nerves and compressed the dorsal aspect of the seventh nerve; this was usually associated with another artery compressing the ventral aspect of the nerve (“sandwich-type” compression). Of these seven patients, five (71%) had poor results including operative failure in one and recurrence of spasm in four. The authors conclude that the clinical outcome was closely related to the patterns of vascular compression.

Traumatic false aneurysm of the superior cerebellar artery simulating posterior fossa tumor

1977 ◽  
Vol 46 (3) ◽  
pp. 377-380 ◽  
Author(s):  
H. Howard Cockrill ◽  
John P. Jimenez ◽  
John A. Goree
Keyword(s):  
Posterior Fossa ◽  
False Aneurysm ◽  
Superior Cerebellar Artery ◽  
Content Type ◽  
Specific Diagnosis ◽  
Cerebellar Artery ◽  
Brain Scan ◽  
The Right ◽  
Angiographic Findings ◽  
Fine Print

✓ An example of traumatic false aneurysm of the right superior cerebellar artery is described. The chronicity of the clinical picture and a positive brain scan strongly suggested a posterior fossa neoplasm; however, the angiographic findings permitted a specific diagnosis to be made.

Posterior interhemispheric retrocallosal approach to pineal region and posterior fossa lesions in a pediatric population

2011 ◽  
Vol 7 (5) ◽  
pp. 527-533 ◽  
Author(s):  
Laurence Davidson ◽  
Mark D. Krieger ◽  
J. Gordon McComb
Keyword(s):  
Posterior Fossa ◽  
Postoperative Morbidity ◽  
Pediatric Population ◽  
Pineal Region ◽  
Cerebral Vein ◽  
Radiographic Evidence ◽  
Venous Infarction ◽  
Safety And Efficacy ◽  
Bridging Veins ◽  
Bridging Vein

Object The purpose of this study was to evaluate the posterior interhemispheric retrocallosal approach (PIRA) for its safety and efficacy in the resection of pineal region and posterior fossa lesions in children. Methods Twenty-nine PIRAs were performed in 26 children between March 1997 and March 2009, and these cases were retrospectively reviewed. There were 15 girls and 11 boys in the series. The median age at the time of surgery was 7 years (range 7 months–17 years). Twenty-seven cases were treated for tumor, 1 for loculated hydrocephalus, and 1 for an aneurysm. Results Of the 27 cases treated for tumor, there were 20 (74%) gross-total resections, 5 (19%) subtotal resections, and 2 (7%) biopsies. One bridging vein was sacrificed in 6 cases and 2 bridging veins were divided in 1 case, whereas in 3 cases there was sacrifice of a single deep cerebral vein. No patient developed radiographic evidence of venous infarction. Approach-related complications were low, and included 2 cases of transient homonymous hemianopia. There were no surgery-related deaths. Conclusions This approach allows for ample access to pineal region and posterior fossa lesions, with low postoperative morbidity.

Sign in / Sign up

Export Citation Format

Share Document