Prenatal Development Timeline
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The Interpeduncular Fossa Approach for Resection of Ventromedial Midbrain Lesions
TECHNICAL NOTE J Neurosurg 128:834–839, 2018 The interpeduncular fossa approach for resection of ventromedial midbrain lesions *M. Yashar S. Kalani, MD, PhD, Kaan Yağmurlu, MD, and Robert F. Spetzler, MD Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona The authors describe the interpeduncular fossa safe entry zone as a route for resection of ventromedial midbrain le- sions. To illustrate the utility of this novel safe entry zone, the authors provide clinical data from 2 patients who under- went contralateral orbitozygomatic transinterpeduncular fossa approaches to deep cavernous malformations located medial to the oculomotor nerve (cranial nerve [CN] III). These cases are supplemented by anatomical information from 6 formalin-fixed adult human brainstems and 4 silicone-injected adult human cadaveric heads on which the fiber dissection technique was used. The interpeduncular fossa may be incised to resect anteriorly located lesions that are medial to the oculomotor nerve and can serve as an alternative to the anterior mesencephalic safe entry zone (i.e., perioculomotor safe entry zone) for resection of ventromedial midbrain lesions. The interpeduncular fossa safe entry zone is best approached using a modi- fied orbitozygomatic craniotomy and uses the space between the mammillary bodies and the top of the basilar artery to gain access to ventromedial lesions located in the ventral mesencephalon and medial to the oculomotor nerve. https://thejns.org/doi/abs/10.3171/2016.9.JNS161680 KEY WORDS brainstem surgery; interpeduncular fossa; mesencephalon; safe entry zone; surgical technique; ventromedial midbrain HE human brainstem serves as a relay center for the pyramidal tract, which is located in the middle three- ascending and descending fiber tracts that are es- fifths of the cerebral peduncle, to remove ventral lesions sential for motor and sensory control. -
A Suprasellar Subarachnoid Pouch; Aetiological Considerations
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.47.10.1066 on 1 October 1984. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry 1984;47:1066-1074 A suprasellar subarachnoid pouch; aetiological considerations O BINITIE, BERNARD WILLIAMS, CP CASE From the Midland Centre for Neurosurgery and Neurology, Smethwick, Warley, West Midlands, UK SUMMARY A child with hydrocephalus treated by a valved shunt was reinvestigated after develop- ing a shunt infection. A pouch was discovered invaginating the floor of the third ventricle and filling slowly with CSF from the region of the interpeduncular cistern. Histology and mechanisms of this pouch formation are discussed. Arachnoid lined cysts in the subarachnoid space There was a family history of one sibling with spina form about one percent of space occupying intra- bifida and two normal siblings aged four and six cranial lesions in several series.'- These cysts may years. He was admitted to the Midland Centre for be separate from the normal subarachnoid space or Neurosurgery and Neurology (MCNN) at the age of may communicate with it. The term cyst" may be one and a half years because his head had been guest. Protected by copyright. applied to a fluid collection which has no macro- increasing in size over the previous six months. It scopic connection with other fluid containing space was also noted that his arms and legs were stiff, that and pouch" to a fluid collection with one entrance he did not attempt to crawl and his vocabulary was or exit.4 Cavities containing cerebrospinal fluid limited to basic words only. -
Susceptibility Weighted Imaging: a Novel Method to Determine the Etiology of Aqueduct Stenosis
THIEME 44 Techniques in Neurosurgery Susceptibility Weighted Imaging: A Novel Method to Determine the Etiology of Aqueduct Stenosis Chanabasappa Chavadi1 Keerthiraj Bele1 Anand Venugopal1 Santosh Rai1 1 Department of Radiodiagnosis, Kasturba Medical College, Manipal Address for correspondence Chanabasappa Chavadi, DNB, Flat No. C- University, Mangalore, India 1-13, 3rd Floor, K.M.C Staff Quarters, Light House Hill Road, Mangalore 575001, India (e-mail: [email protected]). Indian Journal of Neurosurgery 2016;5:44–46. Abstract The stenosis of aqueduct of Sylvius (AS) is a very common cause of obstruction to cerebrospinal fluid. Multiple etiologies are proposed for this condition. Because treatment is specific for correctable disorder, assessment of etiology gains importance. A case of pediatric hydrocephalus was diagnosed with stenosis of AS on magnetic resonance imaging (MRI). Susceptibility-weighted imaging (SWI) demonstrated blooming in the distal aqueduct and lateral ventricle, which was not Keywords seen on routine MRI sequences. The findings suggest that old hemorrhage is a cause ► susceptibility of chemical arachnoiditis and adhesions causing aqueduct stenosis and weighted imaging hydrocephalus. To our knowledge literature is very scarce, wherein SWI is being ► aqueductal stenosis used to confirm blood products as a cause of aqueduct stenosis; hence SWI should be ► magnetic resonance routine protocol in imaging of pediatric hydrocephalus. Etiology, clinical presentation, imaging role of imaging, and, in particular, SWI in evaluation of aqueductal stenosis is ► hydrocephalus discussed. Introduction Case Report Aqueduct of Sylvius (AS) is the narrowest segment of the An 8-month-old child presented with increased head size, cerebrospinal fluid (CSF) pathway and is the most common site developmental delay, and an episode of seizure. -
Brainstem and Its Associated Cranial Nerves
Brainstem and its Associated Cranial Nerves Anatomical and Physiological Review By Sara Alenezy With appreciation to Noura AlTawil’s significant efforts Midbrain (Mesencephalon) External Anatomy of Midbrain 1. Crus Cerebri (Also known as Basis Pedunculi or Cerebral Peduncles): Large column of descending “Upper Motor Neuron” fibers that is responsible for movement coordination, which are: a. Frontopontine fibers b. Corticospinal fibers Ventral Surface c. Corticobulbar fibers d. Temporo-pontine fibers 2. Interpeduncular Fossa: Separates the Crus Cerebri from the middle. 3. Nerve: 3rd Cranial Nerve (Oculomotor) emerges from the Interpeduncular fossa. 1. Superior Colliculus: Involved with visual reflexes. Dorsal Surface 2. Inferior Colliculus: Involved with auditory reflexes. 3. Nerve: 4th Cranial Nerve (Trochlear) emerges caudally to the Inferior Colliculus after decussating in the superior medullary velum. Internal Anatomy of Midbrain 1. Superior Colliculus: Nucleus of grey matter that is associated with the Tectospinal Tract (descending) and the Spinotectal Tract (ascending). a. Tectospinal Pathway: turning the head, neck and eyeballs in response to a visual stimuli.1 Level of b. Spinotectal Pathway: turning the head, neck and eyeballs in response to a cutaneous stimuli.2 Superior 2. Oculomotor Nucleus: Situated in the periaqueductal grey matter. Colliculus 3. Red Nucleus: Red mass3 of grey matter situated centrally in the Tegmentum. Involved in motor control (Rubrospinal Tract). 1. Inferior Colliculus: Nucleus of grey matter that is associated with the Tectospinal Tract (descending) and the Spinotectal Tract (ascending). Tectospinal Pathway: turning the head, neck and eyeballs in response to a auditory stimuli. 2. Trochlear Nucleus: Situated in the periaqueductal grey matter. Level of Inferior 3. -
The Oculomotor Cistern: Anatomy and High- ORIGINAL RESEARCH Resolution Imaging
The Oculomotor Cistern: Anatomy and High- ORIGINAL RESEARCH Resolution Imaging K.L. Everton BACKGROUND AND PURPOSE: The oculomotor cistern (OMC) is a small CSF-filled dural cuff that U.A. Rassner invaginates into the cavernous sinus, surrounding the third cranial nerve (CNIII). It is used by neuro- surgeons to mobilize CNIII during cavernous sinus surgery. In this article, we present the OMC imaging A.G. Osborn spectrum as delineated on 1.5T and 3T MR images and demonstrate its involvement in cavernous H.R. Harnsberger sinus pathology. MATERIALS AND METHODS: We examined 78 high-resolution screening MR images of the internal auditory canals (IAC) obtained for sensorineural hearing loss. Cistern length and diameter were measured. Fifty randomly selected whole-brain MR images were evaluated to determine how often the OMC can be visualized on routine scans. Three volunteers underwent dedicated noncontrast high-resolution MR imaging for optimal OMC visualization. RESULTS: One or both OMCs were visualized on 75% of IAC screening studies. The right cistern length averaged 4.2 Ϯ 3.2 mm; the opening diameter (the porus) averaged 2.2 Ϯ 0.8 mm. The maximal length observed was 13.1 mm. The left cistern length averaged 3.0 Ϯ 1.7 mm; the porus diameter averaged 2.1 Ϯ1.0 mm, with a maximal length of 5.9 mm. The OMC was visualized on 64% of routine axial T2-weighted brain scans. CONCLUSION: The OMC is an important neuroradiologic and surgical landmark, which can be routinely identified on dedicated thin-section high-resolution MR images. It can also be identified on nearly two thirds of standard whole-brain MR images. -
A Recommended Workflow Methodology in the Creation of An
Manson et al. BMC Medical Imaging (2015) 15:44 DOI 10.1186/s12880-015-0088-6 TECHNICAL ADVANCE Open Access A recommended workflow methodology in the creation of an educational and training application incorporating a digital reconstruction of the cerebral ventricular system and cerebrospinal fluid circulation to aid anatomical understanding Amy Manson1,2, Matthieu Poyade2 and Paul Rea1* Abstract Background: The use of computer-aided learning in education can be advantageous, especially when interactive three-dimensional (3D) models are used to aid learning of complex 3D structures. The anatomy of the ventricular system of the brain is difficult to fully understand as it is seldom seen in 3D, as is the flow of cerebrospinal fluid (CSF). This article outlines a workflow for the creation of an interactive training tool for the cerebral ventricular system, an educationally challenging area of anatomy. This outline is based on the use of widely available computer software packages. Methods: Using MR images of the cerebral ventricular system and several widely available commercial and free software packages, the techniques of 3D modelling, texturing, sculpting, image editing and animations were combined to create a workflow in the creation of an interactive educational and training tool. This was focussed on cerebral ventricular system anatomy, and the flow of cerebrospinal fluid. Results: We have successfully created a robust methodology by using key software packages in the creation of an interactive education and training tool. This has resulted in an application being developed which details the anatomy of the ventricular system, and flow of cerebrospinal fluid using an anatomically accurate 3D model. -
Graduate Neuroanatomy GSBS GS141181
Page 1 Graduate Neuroanatomy GSBS GS141181 Laboratory Guide Offered and Coordinated by the Department of Neurobiology and Anatomy The University of Texas Health Science Center at Houston. This course guide was adatped from the Medical Neuroscience Laboratory Guide. Nachum Dafny, Ph.D., Course Director; Michael Beierlein, Ph.D., Laboratory Coordinator. Online teaching materials are available at https://oac22.hsc.uth.tmc.edu/courses/neuroanatomy/ Other course information available at http://openwetware.org/wiki/Beauchamp:GraduateNeuroanatomy Contents © 2000-Present University of Texas Health Science Center at Houston. All Rights Reserved. Unauthorized use of contents subject to civil and/or criminal prosecution. Graduate Neuroanatomy : Laboratory Guide Page 2 Table of Contents Overview of the Nervous System ................................................................................................................ 3 Laboratory Exercise #1: External Anatomy of the Brain ......................................................................... 19 Laboratory Exercise #2: Internal Organization of the Brain ..................................................................... 35 Graduate Neuroanatomy : Laboratory Guide Page 3 Overview of the Nervous System Nachum Dafny, Ph.D. The human nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS, in turn, is divided into the brain and the spinal cord, which lie in the cranial cavity of the skull and the vertebral canal, respectively. The CNS and the PNS, acting in concert, integrate sensory information and control motor and cognitive functions. The Central Nervous System (CNS) The adult human brain weighs between 1200 to 1500g and contains about one trillion cells. It occupies a volume of about 1400cc - approximately 2% of the total body weight, and receives 20% of the blood, oxygen, and calories supplied to the body. The adult spinal cord is approximately 40 to 50cm long and occupies about 150cc. -
Characterization of an Inherited Neurologic Syndrome in Toyger Cats with Forebrain Commissural Malformations, Ventriculomegaly and Interhemispheric Cysts
UC Davis UC Davis Previously Published Works Title Characterization of an Inherited Neurologic Syndrome in Toyger Cats with Forebrain Commissural Malformations, Ventriculomegaly and Interhemispheric Cysts. Permalink https://escholarship.org/uc/item/2468j30c Journal Journal of veterinary internal medicine, 30(2) ISSN 0891-6640 Authors Keating, MK Sturges, BK Sisó, S et al. Publication Date 2016-03-01 DOI 10.1111/jvim.13836 Peer reviewed eScholarship.org Powered by the California Digital Library University of California J Vet Intern Med 2016;30:617–626 Characterization of an Inherited Neurologic Syndrome in Toyger Cats with Forebrain Commissural Malformations, Ventriculomegaly and Interhemispheric Cysts M.K. Keating, B.K. Sturges, S. Siso, E.R. Wisner, E.K. Creighton, and L.A. Lyons Background: In children, frequent congenital malformations with concomitant agenesis of the corpus callosum are diag- nosed by neuroimaging in association with other cerebral malformations, including interhemispheric cysts and ventricu- lomegaly. Similar studies providing full characterization of brain defects by in vivo magnetic resonance imaging (MRI), and correlations with the pertinent anatomic pathologic examinations are absent in veterinary medicine. Hypothesis/Objectives: Congenital brain defects underlie the neurologic signs observed in Toyger cats selectively bred for a short ear phenotype. Animals: Using proper pedigree analysis and genetic evaluations, 20 related Oriental-derived crossbred Toyger cats were evaluated. Seven clinically healthy (carrier) cats and 13 clinically affected cats that had neurologic signs, short ear phenotype and concomitant complex brain anomalies were studied. Methods: Complete physical and neurologic examinations and MRI were performed in all clinically healthy and affected cats. Postmortem and histopathologic examinations were performed in 8 affected cats and 5 healthy cats. -
Lecture (6) Internal Structures of the Brainstem.Pdf
Internal structures of the Brainstem Neuroanatomy block-Anatomy-Lecture 6 Editing file Objectives At the end of the lecture, students should be able to: ● Distinguish the internal structure of the components of the brain stem in different levels and the specific criteria of each level. 1. Medulla oblongata (closed, mid and open medulla) 2. Pons (caudal and rostral). 3. Midbrain ( superior and inferior colliculi). Color guide ● Only in boys slides in Green ● Only in girls slides in Purple ● important in Red ● Notes in Grey Medulla oblongata Caudal (Closed) Medulla Traversed by the central canal Motor decussation (decussation of the pyramids) ● Formed by pyramidal fibers, (75-90%) cross to the opposite side ● They descend in the lateral white column of the spinal cord as the lateral corticospinal tract. ● The uncrossed fibers form the ventral corticospinal tract Trigeminal sensory nucleus. ● it is the larger sensory nucleus. ● The Nucleus Extends Through the whole length of the brainstem and its note :All CN V afferent sensory information enters continuation of the substantia gelatinosa of the spinal cord. the brainstem through the nerve itself located in the pons. Thus, to reach the spinal nucleus (which ● It lies in all levels of M.O, medial to the spinal tract of the trigeminal. spans the entire brain stem length) in the Caudal ● It receives pain and temperature from face, forehead. Medulla those fibers have to "descend" in what's known as the Spinal Tract of the Trigeminal ● Its tract present in all levels of M.O. is formed of descending (how its sensory and descend?see the note) fibers that terminate in the trigeminal nucleus. -
Interpeduncular Heterotopia in Joubert Syndrome: a Previously
Interpeduncular Heterotopia in Joubert Syndrome: CLINICAL REPORT A Previously Undescribed MR Finding I. Harting SUMMARY: The so-called molar tooth sign is the radiologic hallmark of JSRD. Joubert syndrome is a U. Kotzaeridou rare, most often autosomal-recessive disorder with a characteristic malformation of the midhindbrain. We describe 3 patients with JSRD and the additional MR finding of tissue resembling heterotopia in A. Poretti the interpeduncular fossa, which in one patient was combined with a more extensive intramesen- A. Seitz cephalic heterotopia. Interpeduncular heterotopia has not been reported previously, either in the J. Pietz context of JSRD or as a separate entity. This new imaging feature enlarges the spectrum of brain stem M. Bendszus abnormalities in JSRD. In view of the underlying ciliopathy, it seems likely that the interpeduncular E. Boltshauser heterotopia results from misdirected migration. ABBREVIATIONS: CNS ϭ central nervous system; GE ϭ gradient-echo; JSRD ϭ Joubert syndrome and related disorders; T1WI, T1-weighted imaging; T2WI ϭ T2-weighted imaging oubert syndrome is a rare disorder (estimated prevalence truncal control had significantly improved, and her respira- J1/100 000) with a characteristic complex malformation of tion normalized. Neurologic examination revealed persisting the midbrain-hindbrain, seen as the so-called molar tooth sign profound muscular hypotonia and lack of spontaneous move- on axial imaging. This results from vermis hypoplasia, a deep ments, horizontal nystagmus, and lack of fixation due to se- interpeduncular fossa and thickened, elongated, abnormally verely reduced visual acuity. horizontal superior cerebellar peduncles.1 Joubert syndrome In addition to the characteristic molar tooth sign, MR im- is clinically characterized by cognitive impairment, hypotonia, aging revealed a circumscribed, nodular structure within the and later evolving ataxia. -
Cribside Neurosonography: Real-Time Sonography for Intracranial Investigation of the Neonate
501 Cribside Neurosonography: Real-Time Sonography for Intracranial Investigation of the Neonate Mary K. Edwards 1 A prospective study was made of 94 real-time sonographic sector scans of 56 David L. Brown 1 neonates in a 6 month period. The examinations were performed using the anterior Jans Muller2 fontanelle as an acoustic window. In 17 cases, computed tomography (CT) head scans were available for comparison. In no case did the CT and sonographic examination Charles B. Grossman 1 disagree as to the size of the lateral ventricles. Abnormalities detected by sonography Gonzalo T. Chua 1 include ventriculomegaly, intracerebral hematomas, a congenital glioma, and several cystic lesions. Sonographic sector scanning produces excellent, detailed images of dilated lateral and third ventricles, uses no ionizing radiation, is less expensive than CT, and can be performed in the isolette, minimizing the risk of hypoxia and hypother mia. At Methodist Hospital Graduate Medical Center, sonography has replaced CT as the initial method of investigation of ventricular size. CT plays a complementary role in the evaluation of the posterior fossa, intracranial hemorrhage, and mass lesions. Since the first report of the clinical application of echoencephalography in 1956 [1], there has been much interest in the sonographic demonstration of intracranial pathology [2, 3]. Recent advances in sonographic technology have produced high resolution contact scanners and the Octason, an automated water delay scanner [1 , 4, 5]. These instruments produce images of the neonatal intracranial contents with sufficient detail to permit accurate evaluation of ventri culomegaly and certain other intracranial lesions [1 , 4-6]. The development of a compact transducer head for wide-angle real-time sector scanning (ATL real time digital scanner) has permitted the use of the anterior fontanelle as an acoustic window. -
Is Composed from Spinal Cord and Brain
doc. MUDr. Adriana Boleková, PhD. MVDr. Natália Hvizdošová, PhD. CENTRAL NERVOUS SYSTEM – is composed from spinal cord and brain SPINAL CORD cranial border: foramen magnum, pyramidal decussation, exit of first pair of spinal nerves caudal border: level of L1 – L2 vertebrae medullary cone – filum terminale (S2) – cauda equina enlargements: cervical enlargement (C5 – Th1): origin of nerves for upper extremity – brachial plexus lumbosacral enlargement (L1 – S2): origin of nerves for lower extremity – lumbosacral plexus external features: anterior median fissure anterolateral sulcus – anterior roots of spinal nn. posterolateral sulcus – posterior roots of spinal nn. posterior median sulcus posterior intermediate sulcus internal features: White matter anterior funiculus (between anterior median fissure and anterolateral sulcus) lateral funiculus (between anterolateral and posterolateral sulci) posterior funiculus (between posterolateral sulcus and posterior median sulcus) fasciculus gracilis fasciculus cuneatus Gray matter anterior (ventral) horn – motor function: Rexed laminae I – VI lateral horn – serves to visceral function: Rexed lamina VII dorsal (posterior) horn – sensory information: Rexed laminae VIII – IX central grey matter – interneurons: around central canal Rexed lamina X Central canal cranially opens into IV. ventricle caudally expands into terminal ventricle vessels of spinal cord: Arteries: spinal brr. from surrounding arteries – anterior radicular aa., posterior radicular aa.: posterior spinal aa. (in posterolateral