Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
World Neurosurg. 2024 May;185:171-180. doi: 10.1016/j.wneu.2024.02.088. Epub 2024 Feb 23.
Brainstem surgery is more difficult and riskier than surgeries in other parts of the brain due to the high density of critical tracts and cranial nerves nuclei in this region. For this reason, some safe entry zones into the brainstem have been described. The main purpose of this article is to bring on the agenda the significance of the intrinsic structures of the safe entry zones to the brainstem. Having detailed information about anatomic localization of these sensitive structures is important to predict and avoid possible surgical complications. In order to better understand this complex anatomy, we schematically drew the axial sections of the brainstem showing the intrinsic structures at the level of 9 safe entry zones that we used, taking into account basic neuroanatomy books and atlases. Some illustrations are also supported with intraoperative pictures to provide better surgical orientation. The second purpose is to remind surgeons of clinical syndromes that may occur in case of surgical injury to these delicate structures. Advanced techniques such as tractography, neuronavigation, and neuromonitorization should be used in brainstem surgery, but detailed neuroanatomic knowledge about safe entry zones and a meticulous surgery are more important. The axial brainstem sections we have drawn can help young neurosurgeons better understand this complex anatomy.
由于脑干区域内存在大量密集的关键束和颅神经核，因此脑干手术比大脑其他部位的手术更困难和更具风险。出于这个原因，已经描述了一些进入脑干的安全进入区。本文的主要目的是提出安全进入区的固有结构对脑干的重要性。详细了解这些敏感结构的解剖定位对于预测和避免可能的手术并发症很重要。为了更好地理解这种复杂的解剖结构，我们示意性地绘制了脑干的轴位切片，显示了我们使用的 9 个安全进入区的固有结构，同时考虑了基本神经解剖学书籍和图谱。一些插图还得到了术中图片的支持，以提供更好的手术定位。第二个目的是提醒外科医生，如果这些精细结构在手术中受到损伤，可能会出现哪些临床综合征。脑干手术中应使用神经束追踪、神经导航和神经监测等先进技术，但关于安全进入区的详细神经解剖学知识和精细手术更为重要。我们绘制的脑干轴位切片可以帮助年轻的神经外科医生更好地理解这种复杂的解剖结构。
