The anatomical aspects of a surgical approach through the floor of the fourth ventricle

In 1993 Kyoshima et al. introduced safe entry zones in the region of the 4th ventricle floor: infrafacial triangle and suprafacial triangle. Is it possible to demarcate these zones precisely in every case intra-operatively? A postmortem study of 40 brainstems of patients who had died of non-brain di...

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Bibliographic Details
Published in:Acta neurochirurgica 1997-11, Vol.139 (11), p.1014-1019
Main Authors: Bogucki, J, Gielecki, J, Czernicki, Z
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Brain stem
Brain Stem - surgery
Cerebral Ventricles - anatomy & histology
Cerebral Ventricles - surgery
Colliculus
Female
Humans
Male
Middle Aged
Models, Neurological
Neurosurgery
Vagus nerve
Ventricles (cerebral)
Vestibular system
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Summary:In 1993 Kyoshima et al. introduced safe entry zones in the region of the 4th ventricle floor: infrafacial triangle and suprafacial triangle. Is it possible to demarcate these zones precisely in every case intra-operatively? A postmortem study of 40 brainstems of patients who had died of non-brain disease was performed to evaluate the degree of individual morphological and morphometrical variability of the 4th ventricle floor. The purpose of this study was to find constant landmarks and distances within the rhomboid fossa region which would help a neurosurgeon to determine safe approach zones through the 4th ventricle floor to brainstem lesions. Several anatomical landmarks-median sulcus, obex, vestibular area, vagal triangle, hypoglossal triangle-were found to be sufficiently visible in all examined brainstems. However, the facial colliculus which is a border structure between the infrafacial and suprafacial safe approach zone was poorly visible in about 37% of the analyzed material. The striae medullares were not found to be good orientation structures as they were not visible in 30% of the material and exhibited individual variability of a high degree in relation to their number and arrangement. In the morphometrical study analyzed measurements were taken by utilizing the digital image analyzer MULTISCAN. Based on the results obtained the authors suggest new borders of the infrafacial safe approach zone and morphometrical directions to determine the suprafacial safe approach zone in cases when the facial colliculus is not clearly visible or invisible intra-operatively.
ISSN:0001-6268
0942-0940
DOI:10.1007/bf01411553