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Morphometric Analysis of Ventricular System of Human Brain - a Study by Dissection Method Jemds.com Original Research Article Morphometric Analysis of Ventricular System of Human Brain - A Study by Dissection Method Prabahita Baruah1, Purujit Choudhury2, Pradipta Ray Choudhury3 1Department of Anatomy, Silchar Medical College and Hospital, Silchar, Assam, India. 2Department of Surgery, Gauhati Medical College and Hospital, Guwahati, Assam, India. 3Department of Anatomy, Silchar Medical College and Hospital, Silchar, Assam, India. ABSTRACT BACKGROUND It is often a challenge to determine if the brain ventricles are within normal limits Corresponding Author: or swollen with the age of the patient. With a standardized and comparable system, Dr. Purujit Choudhury, it is therefore necessary to define normal ventricular size ranges. Cadaveric Associate Professor, dissection is always considered the gold standard of anatomical education. Present Department of Surgery, Gauhati Medical College and Hospital, work is undertaken to study morphometric analysis of lateral, third & fourth Guwahati, Assam, India. ventricles by dissection method. Morphometric assessment of the ventricular E-mail: [email protected] system is helpful in the diagnosis as well as classification of hydrocephalus and in the evaluation and monitoring of ventricular system enlargement during DOI: 10.14260/jemds/2020/121 ventricular shunt therapy. Financial or Other Competing Interests: METHODS None. Different parameters of all parts of lateral ventricle, third and fourth ventricle were How to Cite This Article: measured with digital vernier caliper in cadaveric brain specimens. The brain Baruah P, Choudhury P, Choudhury PR. specimens were obtained from dead bodies subjected to post-mortem Morphometric analysis of ventricular examinations in the Department of Forensic Medicine and from the dead bodies system of human brain- a study by voluntarily donated to the Department of Anatomy, Silchar Medical College, Silchar. dissection method. J. Evolution Med. Dent. Sci.2020;9(08):539-543, DOI: RESULTS 10.14260/jemds/2020/121 37 brain specimens were obtained, out of which 24 were male, 13 were female and Submission 26-12-2019, were of different age groups. Change in the parameters of different ventricles in Peer Review 02-02-2020, relation to gender was found to be significant. Ventricular sizes are also observed to Acceptance 05-02-2020, be more after the age of 60 years. Published 24-02-2020. CONCLUSIONS There is a positive correlation in measurements of the brain ventricles with age and variation in accordance with gender and laterality. KEY WORDS Brain Ventricles, Sexual Dimorphism, Age J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 08/ Feb. 24, 2020 Page 539 Jemds.com Original Research Article BACKGROUND Silchar. The brain specimens were obtained from dead bodies subjected for post-mortem examinations in the Department of Forensic Medicine and from the dead bodies The ventricular region filled with cerebrospinal fluid is an voluntarily donated to the Department of Anatomy, Silchar 1,2 integral part of the brain. The ventricular system comprises Medical College, Silchar. The study has been approved by the a collection of interconnecting spaces that derive from the institutional ethical committee. Brains were removed from central lumen of embryonic neural tube. The cerebral the cranial cavity & preserved in 10% formalin solutions. ventricular system consists of two lateral ventricles, midline Post-mortem brain specimens with head injury & visible third ventricle in the diencephalon and fourth ventricle mass lesions were excluded from study. Each brain is divided between the brain and the pons; connected by in the midsagittal plane and the arachnoid and pia mater are interventricular foramen of Monro and aqueduct of Sylvius removed carefully. Brains were dissected according to the respectively.3,4 The lateral ventricles, one in each cerebral Cunningham’s Manual of Practical Anatomy to expose the hemisphere, are the cavity of the telencephalon.5 The lateral ventricles. ventricles contribute approximately 82% of the overall ventricular system6. It is divided into a body (in the parietal Parameters Used for Lateral Ventricle lobe), anterior horn (in the frontal lobe), posterior horn in the Length of Frontal Horn- Measured from interventricular occipital lobe and inferior horn present in the temporal lobe.7 foramen to tip of frontal horn on both sides. The brain ventricular function is a brain development marker Length of the Body- From inter ventricular foramen to and also a predictor of the outcome of neurodevelopment.8 In collateral trigone on both sides. cases of CNS disorders, ventriculomegaly is commonly Length of the Posterior Horn- From collateral trigone to the considered the ' iceberg tip'.9 Malformations such as corpus tip of posterior horn on both sides. callosum agenesis, spina bifida, and heart defects are associated with ventriculomegaly. Fetuses with Length of the Inferior Horn- From collateral trigone to the tip ventriculomegaly with other defects have a higher risk of of inferior horn on both sides. chromosomal abnormality, like Down syndrome.10 Parameters Used for Third Ventricle Extensive ventricular size and/or asymmetry are used as Antero-Posterior Length- anterior point marked on the markers for psychiatric disorder like schizophrenia. lamina terminalis and posterior point on the posterior Ventricular enlargement is an important correlation of commissure. 11 Alzheimer's dementia. The brain undergoes several gross and histopathological changes in advanced age and also in Superior-Inferior Height- Superior point was taken at the dementias with brain tissue regression leading to ventricle highest curvature of the inferior surface of fornix and enlargement.12 Abnormal ventricular enlargement was seen inferior point marked on the superior surface of mamillary body. as an indicator of cerebral atrophy, partly due to adaptive potential of the fluid-filled ventricular system's adaptive Parameters Used for Fourth Ventricle potential or decreased nerve cell size.13 Thalamic nuclei For dissection of the fourth ventricle, the cerebellum is split regression after age of 50 describes the frequency of third into two equal parts by a median sagittal section through the ventricular enlargement.14 Neuroradiologists frequently face vermis which exposes the floor of fourth ventricle. the hassle of determining whether the ventricles are in the normal limits or they're swollen with the age of the affected Height- Measured from the upper end of superior medullary person. Consequently, a standardized technique of measuring velum to level of obex. ventricular size needs to be used to pick out normal Width- Measured at the level of lateral recesses. degrees.15 Morphometric assessment of the ventricular system is helpful in the diagnosis as well as classification of Statistical Analysis hydrocephalus and in the evaluation and monitoring of Various parameters were measured with digital Vernier ventricular system enlargement during Ventricular shunts caliper. Statistical analysis of the data was carried out by therapy.16 using SPSS version 18. For all parameters, mean, standard To the best of our knowledge, very few anatomical studies deviation were calculated for males, females and total of ventricular system in cadaveric brain has been done so far, subjects studied. Student t- test was used to compare the that too in this population of north- east region of India. The means of different parameters. For P value, level of present study aims at to examine the range in dimensions of significance was taken as 0.05. the normal lateral, third and fourth ventricles of the human brain by dissection method and also to observe if there exist any variations in the dimensions of the ventricles with RESULTS reference to gender, age and laterality (In case of right and left sided lateral ventricles) in this population. 37 brain specimens were obtained, out of which 24 are male, 13 are female. The brain specimens were found to be of age 20 to 70 years. All parts of the lateral ventricle (frontal horn, METHODS body, posterior and inferior horns), third and fourth ventricle showed gradual increase in length as the age The present Study is a cross sectional study and was carried increases. Greatest dimensions seen at older age groups. out in the Department of Anatomy, Silchar Medical College, J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 08/ Feb. 24, 2020 Page 540 Jemds.com Original Research Article Male Female (Table 1). Dimensions of all ventricles are found to be more Parameters in persons above 60 years of age in both male & female (in mm) (in mm) p=0.0097 (Table 2&3), and the differences were found to be significant Length of Frontal horn 30.26 ± 3.67 26.80 ± 3.68 (very significant) t=2.734 when compared with measurements below 60 years of age. p=0.0249, t=2.344 Length of Body 32.512 ± 3.98 29.33 ± 3.86 (p<0.05). The mean lengths of all parts of lateral ventricle (significant) p=0.0763, t=1.827 Length of Post. Horn 27.64 ± 3.80 25.17 ± 4.19 (frontal horn, body, posterior horn and inferior horn) are (not significant) 39.06 ± p=0.0580, t=1.960 more on left side than right side in both sexes, and the Length of Inf. horn 43.08 ± 6.21 17.17 (not significant) differences were significant. (Table 4) Mean Antero-posterior length 0.8149(not 26.85 ± 3.66 26.62 ± 4.36 On comparing the dimensions between male and female, of third ventricle significant) 0.4675(not Mean height of third ventricle 23.80 ± 2.97 23.13 ± 4.90 it was observed that both antero-posterior & superior- significant) 0.3382(not inferior diameter of third ventricle are more in males, (26.85 Height of fourth ventricle 27.36 ± 3.84 25.98 ± 4.62 significant) ± 3.66 mm and 23.80 ± 2.97 mm) than females (26.62 ± 4.36 0.2514(not Width of fourth ventricle 28.86 ± 3.92 27.21 ± 4.45 mm and 23.13 ± 4.90 mm) although they are statistically significant) Table 5.
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