Department of Neuroscience, University of Padova, Padova, Italy.
Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Verona, Italy.
Oper Neurosurg (Hagerstown). 2023 Jul 1;25(1):11-19. doi: 10.1227/ons.0000000000000669. Epub 2023 Mar 3.
The anatomy of the roof of the fourth ventricle has been illustrated in many laboratory investigations, but in vivo reports of the roof anatomy and its variants are still lacking.
To describe the topographical anatomy of the roof of the fourth ventricle explored through a transaqueductal approach that overcomes cerebrospinal fluid depletion, displaying in vivo anatomic images possibly quite close to normal physiological conditions.
We critically reviewed the intraoperative video recordings of our 838 neuroendoscopic procedures, selecting 27 cases of transaqueductal navigation that provided good quality image details of the anatomy of the roof of the fourth ventricle. Twenty-six patients affected by different forms of hydrocephalus were therefore categorized into three groups: Group A: blockage of the aqueduct-aqueductoplasty, Group B: communicating hydrocephalus, and Group C: tetraventricular obstructive hydrocephalus.
Group A has shown what the roof of a normal fourth ventricle really looks like albeit the structures seemed overcrowded because of the narrow space. Images from groups B and C paradoxically allowed a more distinct identification of the roof structures flattened by ventricular dilation, making them more comparable with the topography traced on the laboratory microsurgical studies.
Endoscopic in vivo videos and images provided a novel anatomic view and an in vivo redefinition of the real topography of the roof of the fourth ventricle. The relevant role of cerebrospinal fluid was defined and outlined, as well as the effects of hydrocephalic dilation on some structures on the roof of the fourth ventricle.
第四脑室外侧隐窝的解剖结构已在许多实验室研究中得到阐明，但有关其解剖结构及其变异的活体报告仍然缺乏。
通过经导水管入路来描述第四脑室外侧隐窝的表面解剖结构，该入路克服了脑脊液耗竭的问题，可在活体上显示出与正常生理状态非常接近的解剖图像。
我们对 838 例神经内镜手术的术中录像进行了仔细审查，选择了 27 例经导水管导航的病例，这些病例提供了第四脑室外侧隐窝解剖结构的高质量图像细节。因此，26 例患有不同类型脑积水的患者被分为 3 组：A 组：导水管阻塞-导水管成形术；B 组：交通性脑积水；C 组：四脑室梗阻性脑积水。
A 组显示了正常第四脑室外侧隐窝的真实外观，尽管由于空间狭窄，结构显得拥挤。B 组和 C 组的图像反而允许更清晰地识别因脑室扩张而变平的屋顶结构，使它们与在实验室显微镜下研究中所追踪的地形更相似。
内镜下的活体视频和图像提供了一种新的解剖视角，并对第四脑室外侧隐窝的真实地形进行了活体重新定义。明确了脑脊液的相关作用，并概述了脑积水扩张对第四脑室外侧隐窝某些结构的影响。
