Department of Neurosurgery, Karabuk Research and Training Hospital, Health Science University, Karabuk, Turkey; Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Neurosurgery, Tepecik Research and Training Hospital, Health Science University, Izmir, Turkey.
World Neurosurg. 2021 Aug;152:e408-e428. doi: 10.1016/j.wneu.2021.05.102. Epub 2021 May 29.
Projections from the dentate nucleus (DN) follow a certain organized course to upper levels. Crossing and noncrossing fibers of the dentatorubrothalamic (DRT) tract terminate in the red nucleus and thalamus and have various connections throughout the cerebral cortex. We aimed to establish the microsurgical anatomy of the DN in relation to its efferent connections to complement the increased recognition of its surgical importance and also to provide an insight into the network-associated symptoms related to lesions and microsurgery in and around the region.
The cerebellum, DN, and superior cerebellar peduncle (SCP) en route to red nucleus were examined through fiber dissections from the anterior, posterior, and lateral sides to define the connections of the DN and its relationships with adjacent neural structures.
The DN was anatomically divided into 4 areas based on its relation to the SCP; the lateral major, lateral anterosuperior, posteromedial, and anteromedial compartments. Most of the fibers originating from the lateral compartments were involved in the decussation of the SCP. The ventral fibers originating from the lateral anterosuperior compartment were exclusively involved in the decussation. The fibers from the posteromedial compartment ascended ipsilaterally and decussated, whereas most anteromedial fibers ascended ipsilaterally and did not participate in the decussation.
Clarifying the anatomofunctional organization of the DN in relation to the SCP could improve microneurosurgical results by reducing the complication rates during infratentorial surgery in and around the nucleus. The proposed compartmentalization would be a major step forward in this effort.
齿状核（DN）的投射遵循一定的有组织的途径到达上水平。齿状红核束（DRT）的交叉和非交叉纤维终止于红核和丘脑，并在整个大脑皮层中有各种连接。我们旨在建立与 DN 传出连接有关的 DN 的显微解剖学，以补充其手术重要性的认识增加，并深入了解与该区域及其周围病变和显微手术相关的网络相关症状。
通过从前、后和侧方对小脑、DN 和通往红核的上小脑脚（SCP）进行纤维解剖，检查 DN 的连接及其与相邻神经结构的关系。
根据与 SCP 的关系，DN 在解剖上分为 4 个区域；外侧大、外侧前上、后内侧和前内侧隔室。来自外侧隔室的大多数纤维参与 SCP 的交叉。来自外侧前上隔室的腹侧纤维专门参与交叉。来自后内侧隔室的纤维向同侧上升并交叉，而大多数前内侧纤维向同侧上升且不参与交叉。
阐明与 SCP 有关的 DN 的解剖功能组织，可以通过降低核内和周围的幕下手术的并发症发生率来提高显微神经外科手术的结果。所提出的分区将是朝着这一方向迈出的重要一步。
