Abstract
Surgery of the brainstem is challenging due to the complexity of the area with cranial nerve nuclei, reticular formation, and ascending and descending fibers. Safe entry zones are required to reach the intrinsic lesions of the brainstem. The aim of this study was to provide detailed measurements for anatomical landmark zones of the ventrolateral surface of the human brainstem related to previously described safe entry zones. In this study, 53 complete and 34 midsagittal brainstems were measured using a stainless caliper with an accuracy of 0.01mm. The distance between the pontomesencephalic and bulbopontine sulci was measured as 26.94mm. Basilar sulcus-lateral side of pons (origin of the fibers of the trigeminal nerve) distance was 17.23mm, transverse length of the pyramid 5.42mm, and vertical length of the pyramid 21.36mm. Lateral mesencephalic sulcus was 12.73mm, distance of the lateral mesencephalic sulcus to the oculomotor nerve 13.85mm, and distance of trigeminal nerve to the upper tip of pyramid 17.58mm. The transverse length for the inferior olive at midpoint and vertical length were measured as 5.21mm and 14.77mm, consequently. The thickness of the superior colliculus was 4.36mm, and the inferior colliculus 5.06mm; length of the tectum was 14.5mm and interpeduncular fossa 11.26mm. Profound anatomical knowledge and careful analysis of preoperative imaging are mandatory before surgery of the brainstem lesions. The results presented in this study will serve neurosurgeons operating in the brainstem region.
Highlights
The anatomical organization of the human brainstem is a complex amalgam of compact neuronal groups and dispersed cell areas with varying cytoarchitecture
Safe entry zones are required to reach the intrinsic lesions of the brainstem
The study gives detailed measurements for anatomical landmark zones of the ventrolateral surface of the human brainstem such as the lateral mesencephalic sulcus, peritrigeminal area and inferior olive. Infratentorial lesions such as neoplastic lesions, vascular malformations and abscesses are important in the brainstem region due to the presence of important structures in this restricted area
Summary
The anatomical organization of the human brainstem is a complex amalgam of compact neuronal groups and dispersed cell areas with varying cytoarchitecture. The study gives detailed measurements for anatomical landmark zones of the ventrolateral surface of the human brainstem such as the lateral mesencephalic sulcus, peritrigeminal area and inferior olive. Infratentorial lesions such as neoplastic lesions, vascular malformations and abscesses are important in the brainstem region due to the presence of important structures in this restricted area. Cervicomedullary gliomas arise from the lower bulbus or the upper cervical spinal cord [8] These are operable, because they are slowly growing, low-grade gliomas [8, 1113]. Diffuse gliomas are not amenable to surgical resection because of location and infiltrative nature of tumors [8, 11,12,13, 16]. Two different surgical approaches can be performed in brainstem abscesses; stereotactic biopsy [2, 10, 21, 24, 27] and open craniotomy or microsurgery for therapeutic aspiration or abscess excision [24]
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