Endoscopic anatomy of the fourth ventricle

Longatti, Pierluigi; Fiorindi, Alessandro; Feletti, Alberto; D’Avella, Domenico; Martinuzzi, Andrea

doi:10.3171/jns/2008/109/9/0530

Cited by 32 publications

(22 citation statements)

References 23 publications

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“…Subsequently, other surgical or anatomical reports were published detailing the anatomy of the fourth ventricle as visualized by the endoscope using a transaqueductal approach [10,13,22,23,38,41].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic telovelar approach to the fourth ventricle: anatomic study

Ieva

Komatsu

et al. 2011

Neurosurg Rev

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The telovelar approach allows reliable access to the fourth ventricle and avoids the splitting of the vermis and its associated "posterior vermal split syndrome." Our objective was to describe the endoscopic topographical anatomy of the telovelum approach to the fourth ventricle as accessed by the cerebellomedullary corridor. A series of 20 fresh and fixed injected anatomical specimens were used. The endoscopic equipment consisted of rigid endoscopes with different lens angles, while the extradural step required the use of the microscope and/or the exoscope. All the anatomical landmarks and relationships within the fourth ventricle and the cerebellomedullary fissure were identified by means of the endoscopic microscope/exoscope-assisted telovelar approach. In conclusion, we showed that the endoscope is a valid tool to gain an anatomic understanding of the fourth ventricle reached by means of the telovelar approach.

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Section: Discussionmentioning

confidence: 99%

Endoscopic telovelar approach to the fourth ventricle: anatomic study

Ieva

Komatsu

et al. 2011

Neurosurg Rev

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“…Conversely, during transaqueductal neuroendoscopic navigation, the calamus scriptorius can be approached from the top downward, similar to a quill pen that is directed into the inkwell. 9,12 For this reason, neuroendoscopy allows a clear and close visualization of the AP and central medullary canal, achieving a better definition of the position of the solitary tract nucleus, which lies below the AP, with clear advantages in terms of safety of the surgical procedure in the fourth ventricle. This newly reported observation was possible because the AP lacks a BBB.…”

Section: Discussionmentioning

confidence: 99%

“…10 Transaqueductal navigation of the fourth ventricle with a flexible scope for diagnostic and treatment purposes gave us the opportunity to observe the fluorescent AP after intravenous injection of fluorescein sodium. 9,12 An anatomical paradigm of a normal AP was created by obtaining 3D reconstructions using slices from cadaveric brainstems. Three-dimensional reconstructions allow a comprehensive view of the AP, showing its relationship to other structures of the fourth ventricle and indirectly marking its boundaries.…”

mentioning

confidence: 99%

The human area postrema: clear-cut silhouette and variations shown in vivo

Longatti

Porzionato²,

Basaldella

et al. 2015

JNS

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OBJECT The human area postrema (AP) is a circumventricular organ that has only been described in cadaveric specimens and animals. Because of its position in the calamus scriptorius and the absence of surface markers on the floor of the fourth ventricle, the AP cannot be clearly localized during surgical procedures. METHODS The authors intravenously administered 500 mg fluorescein sodium to 25 patients during neuroendoscopic procedures; in 12 of these patients they explored the fourth ventricle. A flexible endoscope equipped with dual observation modes for both white light and fluorescence was used. The intraoperative fluorescent images were reviewed and compared with anatomical specimens and 3D reconstructions. RESULTS Because the blood-brain barrier does not cover the AP, it was visualized in all cases after fluorescein sodium injection. The AP is seen as 2 coupled leaves on the floor of the fourth ventricle, diverging from the canalis centralis medullaris upward. Although the leaves normally appear short and thick, there can be different morphological patterns. Exploration using the endoscope's fluorescent mode allowed precise localization of the AP in all cases. CONCLUSIONS Fluorescence-enhanced inspection of the fourth ventricle accurately identifies the position of the AP, which is an important landmark during surgical procedures on the brainstem. A better understanding of the AP can also be valuable for neurologists, considering its functional role in the regulation of homeostasis, emesis, and cardiovascular and electrolyte balance. Despite the limited number of cases in this report, evidence indicates that the normal anatomical appearance of the AP is that of 2 short and thick leaves that are joined at the midline. However, there can be great variability in terms of the structure's shape and size.

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“…Transaqueductal navigation of the 4th ventricles were also safely and successfully carried out by Longatti et al [7] with 'small flexible endoscopes' , which was however carried out through a frontal burr hole.…”

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confidence: 99%

Exploring the brain and spinal cord by a fine flexible fiberscope

Shimoji¹

2017

Phys Med Rehabil Res

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Endoscopic anatomy of the fourth ventricle

Cited by 32 publications

References 23 publications

Endoscopic telovelar approach to the fourth ventricle: anatomic study

Endoscopic telovelar approach to the fourth ventricle: anatomic study

The human area postrema: clear-cut silhouette and variations shown in vivo

Exploring the brain and spinal cord by a fine flexible fiberscope

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