Three-Dimensional Quantitative Analysis of the Brainstem Safe Entry Zones Based on Internal Structures.

Autor: Serrato-Avila JL; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil., Paz Archila JA; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil., Silva da Costa MD; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil., Riechelmann GS; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil., Rocha PR; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil., Marques SR; Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil., Carvalho de Moraes LO; Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil., Cavalheiro S; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil., Yağmurlu K; Department of Neurosurgery, University of Virginia, Health System, Charlottesville, Virginia, USA; Department of Neuroscience, University of Virginia, Health System, Charlottesville, Virginia, USA., Lawton MT; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA., Chaddad-Neto F; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil. Electronic address: fereschaddad@hotmail.com.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2022 Feb; Vol. 158, pp. e64-e74. Date of Electronic Publication: 2021 Oct 27.
DOI: 10.1016/j.wneu.2021.10.100
Abstrakt: Objective: Brainstem safe entry zones (EZs) are gates to access the intrinsic pathology of the brainstem. We performed a quantitative analysis of the intrinsic surgical corridor limits of the most commonly used EZs and illustrated these through an inside perspective using 2-dimensional photographs, 3-dimensional photographs, and interactive 3-dimensional model reconstructions.
Methods: A total of 26 human brainstems (52 sides) with the cerebellum attached were prepared using the Klingler method and dissected. The safe working areas and distances for each EZ were defined according to the eloquent fiber tracts and nuclei.
Results: The largest safe distance corresponded to the depth for the lateral mesencephalic sulcus (4.8 mm), supratrigeminal (10 mm), epitrigeminal (13.2 mm), peritrigeminal (13.3 mm), lateral transpeduncular (22.3 mm), and infracollicular (4.6 mm); the rostrocaudal axis for the perioculomotor (11.7 mm), suprafacial (12.6 mm), and transolivary (12.8 mm); and the mediolateral axis for the supracollicular (9.1 mm) and infracollicular (7 mm) EZs. The safe working areas were 46.7 mm 2 for the perioculomotor, 21.3 mm 2 for the supracollicular, 14.8 mm 2 for the infracollicular, 33.1 mm 2 for the supratrigeminal, 34.3 mm 2 for the suprafacial, 21.9 mm 2 for the infrafacial, and 51.7 mm 2 for the transolivary EZs.
Conclusions: The largest safe distance in most EZs corresponded to the depth, followed by the rostrocaudal axis and, finally, the mediolateral axis. The transolivary had the largest safe working area of all EZs. The supracollicular EZ had the largest safe area to access the midbrain tectum and the suprafacial EZ for the floor of the fourth ventricle.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: