Bogucki J, Czernicki Z, Gielecki J
Department of Neurosurgery, Polish Academy of Sciences, Warsaw, Poland.
Acta Neurochir (Wien). 2000;142(4):383-7. doi: 10.1007/s007010050446.
This work is a continuation of the anatomical study in which safe approach zones through the floor of the fourth ventricle--infrafacial and suprafacial--were morphologically and morphometrically defined (Acta Neurochir (1997) 139: 1014-1019). The purpose of cytoarchitectonic study was to analyze correlation between morphometry of the facial colliculus and hypoglossal triangle and localization of the corresponding cranial nerves nuclei in the brainstem tegmentum in order to verify morphometrical borders of the previously defined zones. Morphometrical evaluation of the fourth ventricle floor of 10 examined brainstems was initially performed. Distances from obex to the rostral portion of hypoglossal triangle and facial colliculus were determined. Then a series of axial sections of each specimen, stained for Nissl substance, were analyzed to define the distance from obex to the rostral portion of the hypoglossal and abducens nuclei. Distances of motor trigeminal and facial nuclei from the midline sagittal plane were also measured. The obtained results allowed morphometrical determination of the infra-abducental and supra-abducental region of safe entry into the brainstem tegmentum. Infra-abducental region corresponds to infrafacial safe approach zone and supra-abducental to suprafacial zone. The distance of the rostral portion of facial colliculus from obex was longer than the distance of the rostral pole of abducens nucleus from obex in every examined specimen (by 0.7 mm on average). A very similar correlation between the distance of the rostral margin of hypoglossal triangle and localization of the rostral pole of hypoglossal nucleus was found. The rostral portion of hypoglossal triangle was longer by 1.5 mm on average. The obtained results show that previously defined infrafacial and suprafacial safe approach zones via the fourth ventricle floor correspond morphometrically to tegmental regions of safe entry--infra-abducental and supra-abducental respectively. It suggests that morphometrical evaluation of the fourth ventricle floor proposed by the authors could be useful in the intra-operative determination of safe entry via the rhomboid fossa into the brainstem tegmentum.
本研究是一项解剖学研究的延续，在该解剖学研究中，从形态学和形态测量学角度定义了经第四脑室底的安全入路区域——面下和面上区域（《神经外科学文献》（1997年）139卷：1014 - 1019页）。细胞构筑学研究的目的是分析面神经丘和舌下神经三角的形态测量与脑干被盖中相应脑神经核定位之间的相关性，以验证先前定义区域的形态测量边界。最初对10个检查的脑干的第四脑室底进行了形态测量评估。确定了从闩到舌下神经三角和面神经丘头端部分的距离。然后对每个标本的一系列尼氏染色轴位切片进行分析，以确定从闩到舌下神经核和展神经核头端部分的距离。还测量了运动三叉神经核和面神经核到矢状中线平面的距离。所获得的结果使得能够从形态测量学角度确定进入脑干被盖的展神经下和展神经上安全区域。展神经下区域对应于面下安全入路区域，展神经上区域对应于面上区域。在每个检查的标本中，面神经丘头端部分到闩的距离比展神经核头端到闩的距离长（平均长0.7毫米）。在舌下神经三角头缘距离与舌下神经核头端定位之间发现了非常相似的相关性。舌下神经三角头端部分平均长1.5毫米。所获得的结果表明，先前经第四脑室底定义的面下和面上安全入路区域在形态测量学上分别对应于安全进入的被盖区域——展神经下和展神经上区域。这表明作者提出的第四脑室底形态测量评估可能有助于术中确定经菱形窝进入脑干被盖的安全入路。
