Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/326140
Type: Artigo
Title: Microsurgical Anatomy And Internal Architecture Of The Brainstem In 3d Images: Surgical Considerations
Author: Parraga
Richard Gonzalo; Possatti
Lucas Loss; Alves
Raphael Vicente; Ribas
Guilherme Carvalhal; Ture
Ugur; de Oliveira
Evandro
Abstract: 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 x6 to x40 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.
Subject: Brainstem
Fiber Dissection
Microsurgical Anatomy
Safe Entry Zone
Surgical Approaches
Posterior Fossa
Editor: Amer Assoc Neurological Surgeons
Rolling Meadows
Rights: fechado
Identifier DOI: 10.3171/2015.4.JNS132778
Address: http://thejns.org/doi/abs/10.3171/2015.4.JNS132778
Date Issue: 2016
Appears in Collections:Unicamp - Artigos e Outros Documentos

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