Three-dimensional microsurgical anatomy of cerebellar peduncles

Perrini, Paolo; Tiezzi, Giacomo; Castagna, Maura; Vannozzi, Riccardo

doi:10.1007/s10143-012-0417-y

Cited by 37 publications

(31 citation statements)

References 19 publications

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“…16,22,24,25,31 The middle cerebellar peduncle is located on the cisternal surface of the large peduncular mass, and if injured during surgery can result in ipsilateral ataxia, hypotonia, and dysmetria and cause a clinical scenario much like that seen in AICA stroke. 51 These clinical features are most often encountered after aggressive surgical manipulation of the cerebellomesencephalic and pontocerebellar fissures, and are likely explained by our findings where a great number of the perforating arteries of the distal portion of the AICA supply the middle cerebellar peduncle through the parafloccular perforating space. However, complete AICA strokes are very rare after the resection of CPA tumors.…”

Section: Cerebellar and Brainstem Infarctssupporting

confidence: 50%

Microvascular anatomy of the cerebellar parafloccular perforating space

Sosa

Dujovny

Onyekachi

et al. 2016

JNS

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T he surgical anatomy of the cerebellopontine angle (CPA) is complex and challenging. The cerebellopontine cistern (CPC) lies in the CPA between the brainstem, cerebellum, and petrous portion of the temporal bone and is crossed by multiple delicate nerves and small vessels directed toward the cerebellum and highly eloquent portions of the brainstem. This region often witnesses vascular pathology and tumors, leading to lengthy cerebellar retraction, dissection, and the use of bipolar coagulation that jeopardizes the integrity of cranial nerves (CNs) and cerebellar and brainstem perfusion. The cisternal surface of the middle cerebellar peduncle lateral to the cerebellar flocculus-namely, the paraflocculus or parafloccular perforating space-is particularly susceptible to the abovementioned surgical manipulation from a retrosigmoid approach, which is the workhorse approach for CPA lesions. The importance of this small but key area in the cerebellopontine interface was recognized in a classic article by David and Askenasy in the 1930s, 14 and previously published articles have described its topographic relationship to the major branches of the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar abbreviatioNs AICA = anterior inferior cerebellar artery; CN = cranial nerve; CPA = cerebellopontine angle; CPC = cerebellopontine cistern; PICA = posterior inferior cerebellar artery; SCA = superior cerebellar artery. obJective The cerebellopontine angle is a common site for tumor growth and vascular pathologies requiring surgical manipulations that jeopardize cranial nerve integrity and cerebellar and brainstem perfusion. To date, a detailed study of vessels perforating the cisternal surface of the middle cerebellar peduncle-namely, the paraflocculus or parafloccular perforating space-has yet to be published. In this report, the perforating vessels of the anterior inferior cerebellar artery (AICA) in the parafloccular space, or on the cisternal surface of the middle cerebellar peduncle, are described to elucidate their relevance pertaining to microsurgery and the different pathologies that occur at the cerebellopontine angle. methods Fourteen cadaveric cerebellopontine cisterns (CPCs) were studied. Anatomical dissections and analysis of the perforating arteries of the AICA and posterior inferior cerebellar artery at the parafloccular space were recorded using direct visualization by surgical microscope, optical histology, and scanning electron microscope. A comprehensive review of the English-language and Spanish-language literature was also performed, and findings related to anatomy, histology, physiology, neurology, neuroradiology, microsurgery, and endovascular surgery pertaining to the cerebellar flocculus or parafloccular spaces are summarized. results A total of 298 perforating arteries were found in the dissected specimens, with a minimum of 15 to a maximum of 26 vessels per parafloccular perforating space. The average outer diameter of the cisternal portion of the perforating arteries was 0.1...

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Section: Cerebellar and Brainstem Infarctssupporting

confidence: 50%

Microvascular anatomy of the cerebellar parafloccular perforating space

Sosa

Dujovny

Onyekachi

et al. 2016

JNS

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“…The medial and basal surfaces of the cerebral hemispheres were subsequently dissected using the same methodology and instruments (for a detailed explanation of the method see Türe et al, 2000;Yasargil et al, 2005;Choi et al, 2011;Kucukyuruk et al, 2014). Superior and lateral aspects of the cerebellum were dissected allowing the observation of cerebellar peduncles, their course in the cerebellum white core and their relationship with the dentate nucleus (Perrini et al, 2013).…”

Section: Dissection Techniquementioning

confidence: 99%

Neuroanatomy: The added value of the Klingler method

Silva

Andrade

2016

Annals of Anatomy - Anatomischer Anzeiger

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“…Анатомiя людини впродовж багатьох рокiв, навiть столiть, використовувала тi ж методи дослiдження та пiдходи, якi використовували її за-сновники. Наприкiнцi 20-го столiття з появою циф-рових обчислювальних машин i автоматизованих систем управлiння iнформацiєю анатоми отримали можливiсть зробити видатний внесок у розвиток морфологiї i медичної освiти [3,9]. Використання 3D-технологiй -iстотний прорив у галузi медицини, що має великi перспективи у вдосконаленнi та мо-дернiзацiї медичних технологiй [4,10].…”

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