Commenced in January 2007
Paper Count: 30124
The Relationship of the Dentate Nucleus with the Pyramid of Vermis: A Microneurosurgical Anatomical Study
Abstract:The region of dentate nucleus is a common site for various pathologies like hematomas, tumours, etc. We aimed to study in detail the relationship of this region with the vermis, especially the pyramid using microscopic fibre dissection technique. To achieve this aim, 20 cerebellar hemispheres were studied from the 11 cerebellums. Dissection was performed using wooden spatulas and micro dissectors under a microscope following Klingler’s preservation technique. The relationship between the pyramid of vermis and the dentate nucleus was studied in detail. A similar relationship was studied on the MRI of randomly selected trigeminal neuralgia patients and correlated with anatomical findings. Results show the mean distance of the lateral margin of the dentate nucleus from the midline on anatomic specimens was 21.4 ± 1.8 mm (19-25 mm) and 23.4 ± 3.4 mm (15-29 mm) on right and left side, respectively. Similar measurements made on the MRI were 22.97 ± 2.0 mm (20.03-26.15 mm) on the right side and 23.98 ± 2.1 mm (21.47-27.67 mm) on the left side. The amount of white matter dissection required to reach the dentate nucleus at the pyramidal attachment area was 7.3 ± 1.0 mm (6-9 mm) on the right side and 6.8 ± 1.4 mm (5-10 mm) on the left side. It was concluded that the pyramid of vermis has a constant relationship with the dentate nucleus and can be used as an excellent landmark during surgery to localise the dentate nucleus on the suboccipital surface.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.3461926Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 320
 Werner H. Hermann Neugebauer, Eric Juttler, Patrick Mitchell, “Decompressive craniectomy for infarction and hemorrhage,” in Stroke: E-Book: pathophysiology, Diagnosis, and Management., 6th ed., L. K. S. W. James C. Grotta, Gregory W. Albers, Joseph P. Broderick, Scott E. Kasner, Eng H. Lo, A. David Mendelow, Ralph L. Sacco, Ed. elsevier, 2015, pp. 1200–1217.
 A. L. D. Vikram V. Nayar, “Surgical Management of cerebellar Stroke- Hemorhhage and Infarction,” in Scmidek and sweet operative neurosurgical techniques. indications, methods and results., 6th ed., B. L. H. Christopher S. Ogilvy, Ed. Elsevier, 2012, pp. 837–844.
 S. Khadilkar, S. Jaggi, B. Patel, R. Yadav, P. Hanagandi, and L. L. Faria Do Amaral, “A practical approach to diseases affecting dentate nuclei,” Clin. Radiol., vol. 71, no. 1, pp. 107–119, 2016.
 J. B. Paul w. Brazis, Joseph C. Masdeu, Ed., “The cerebellum,” in localization in clinical neurology, 6th ed., Lippioncott Williams and Wilkins, 2001, pp. 403–418.
 C. J. O’Halloran, G. J. Kinsella, and E. Storey, “The cerebellum and neuropsychological functioning: A critical review,” J. Clin. Exp. Neuropsychol., vol. 34, no. 1, pp. 35–56, Jan. 2012.
 J. D. Schmahmann, “Disorders of the Cerebellum: Ataxia, Dysmetria of Thought, and the Cerebellar Cognitive Affective Syndrome,” J. Neuropsychiatry Clin. Neurosci., vol. 16, no. 3, pp. 367–378, Aug. 2004.
 R. P. Dum, “An Unfolded Map of the Cerebellar Dentate Nucleus and its Projections to the Cerebral Cortex,” J. Neurophysiol., vol. 89, no. 1, pp. 634–639, Oct. 2002.
 F. A. Middleton, “Basal-ganglia ‘Projections’ to the Prefrontal Cortex of the Primate,” Cereb. Cortex, vol. 12, no. 9, pp. 926–935, 2002.
 J. D. Schmahmann and J. C. Sherman, “The cerebellar cognitive affective syndrome,” Brain, vol. 121, no. 4, pp. 561–579, 1998.
 A. Ramos, F. Chaddad-Neto, H. L. Dória-Netto, J. M. de Campos-Filho, and E. Oliveira, “Cerebellar anatomy as applied to cerebellar microsurgical resections,” Arq. Neuropsiquiatr., vol. 70, no. 6, pp. 441–446, Jun. 2012.
 A. Akakin, M. Peris-Celda, T. Kilic, A. Seker, A. Gutierrez-Martin, and A. Rhoton, “The Dentate Nucleus and Its Projection System in the Human Cerebellum,” Neurosurgery, vol. 74, no. 4, pp. 401–425, Apr. 2014.
 K. J., “Erleichterung der makroskopischen praeparation des gehirnsdurch den gefrierprozess.,” schweiz Arch Neurolpsychiatr, vol. 36, pp. 247–256, 1935.
 E. Ludwig and J. Klingler, “Atlas Cerebri Humani.” 1956.
 J. Klingler and P. Gloor, “The connections of the amygdala and of the anterior temporal cortex in the human brain,” J. Comp. Neurol., vol. 115, no. 3, pp. 333–369, Dec. 1960.
 A.-M. O. Ture U, Yasargil MG, Friedman AH, “Fiber Dissection Technique : Lateral Aspect of the Brain . Fiber Dissection Technique : Lateral Aspect of the Brain Ovid : Fiber Dissection Technique : Lateral Aspect of the Brain .,” Neurosurgery, vol. 47, no. August, pp. 417–427, 2000.
 J. Voogd and T. J. H. Ruigrok, “The organization of the corticonuclear and olivocerebellar climbing fiber projections to the rat cerebellar vermis: The congruence of projection zones and the zebrin pattern,” J. Neurocytol., vol. 33, no. 1, pp. 5–21, Jan. 2004.
 P. R. Brazis PW, Biller J, Fine M, Palacios E, “Cerebellar degeneration with Hodgkin’s disease: computed tomographic correlation and literature review,” Arch Neurol., vol. 38, no. 4, pp. 253–256, 1981.
 M. Pitsika and V. Tsitouras, “Cerebellar mutism,” J. Neurosurg. Pediatr., vol. 12, no. 6, pp. 604–614, Dec. 2013.
 S. K. Gudrunardottir T, Sehested A, Juhler M, “Cerebellar mutism: incidence, risk factors and prognosis.,” Childs Nerv Syst, vol. 27, pp. 513–515, 2011.
 H. J. Asamoto M, Ito H, Suzuki N, Oiwa Y, Saito K, “Transient mutism after posterior fossa surgery.,” Childs Nerv Syst, vol. 10, pp. 275–278, 1994.
 K. Kusano Y, Tanaka Y, Takasuna H, Wada N, Tada T and Y, “Transient cerebellar mutism caused by bilateral damage to the dentate nuclei after the second posterior fossa surgery. Case report.,” J Neurosurg., pp. 329–331, 25512BC.
 A. C. M. Mussi and A. L. Rhoton, “Telovelar approach to the fourth ventricle: microsurgical anatomy,” J. Neurosurg., vol. 92, no. 5, pp. 812–823, May 2000.
 T. Matsushima, M. Fukui, T. Inoue, Y. Natori, T. Baba, and K. Fujii, “Microsurgical and Magnetic Resonance Imaging Anatomy of the Cerebellomedullary Fissure and Its Application during Fourth Ventricle Surgery,” Neurosurgery, vol. 30, no. 3, pp. 325–330, Mar. 1992.
 V. Cerebelar and T. y Variaciones, “Cerebellar Vermis: Topography and Variations,” Int. J. Morphol, vol. 28, no. 2, pp. 439–443, 2010.
 M. D. Albert L. Rhoton, Jr., “cerebellum and fourth ventricle,” Neurosurgery, vol. 47, no. 3, pp. S7–S27, 2000.
 E. M. Jan Voogd, “gross anatomy of the cerbellum,” in Essentials of Cerebellum and Cerebellar Disorders: A Primer For Graduate, 1st ed., Y. S. Donna L. Gruol, Noriyuki Koibuchi, Mario Manto, Marco Molinari, Jeremy D. Schmahmann, Ed. Springer, 2013, pp. 33–38.
 J. H. P. Jordi X. Kellogg, “resection of fourth ventricle tumours without splitting of vermis: The cerebellomedullary fissure approach,” pediatr Neurosurg, vol. 27, pp. 28–33, 1997.
 W. C. Jean et al., “Subtonsillar approach to the foramen of Luschka: An anatomic and clinical study,” Neurosurgery, vol. 52, no. 4, pp. 860–866, 2003.
 B. Drayer, R. Darwin, S. Riederer, R. Herfkens, and G. A. Johnson, “Magnetic Resonance Imaging of Brain Iron,” AJNR, vol. 7, no. June, pp. 373–380, 1986.
 C. W. Tjoa, R. H. B. Benedict, B. Weinstock-Guttman, A. J. Fabiano, and R. Bakshi, “MRI T2 hypointensity of the dentate nucleus is related to ambulatory impairment in multiple sclerosis,” J. Neurol. Sci., vol. 234, no. 1–2, pp. 17–24, 2005.
 J. Diedrichsen et al., “Imaging the deep cerebellar nuclei: A probabilistic atlas and normalization procedure,” Neuroimage, vol. 54, no. 3, pp. 1786–1794, Feb. 2011.
 D. N. shigeki Aoki, Yoshitaka Okada, Kazumasa Nishimura, A. James Barkovich, Bent O. Kjos, Robert C. Brasch, “normal deposition of brain iron in childhood and Adolescence: MR imaging at 1.5 T,” Radiology, vol. 172, pp. 381–385, 1981.
 R. Telford and S. Vattoth, “MR Anatomy of Deep Brain Nuclei with Special Reference to Specific Diseases and Deep Brain Stimulation Localization,” Neuroradiol. J., vol. 27, no. 1, pp. 29–43, Feb. 2014.
 Burton P. Drayer, “Basal Ganglia : Significance of Signal hypointensity on T2- weighted MR images,” Radiology, vol. 173, pp. 311–312, 1989.
 A. Dimitrova et al., “Probabilistic 3D MRI atlas of the human cerebellar dentate/interposed nuclei,” Neuroimage, vol. 30, no. 1, pp. 12–25, Mar. 2006.
 N. Gelman et al., “MR Imaging of Human Brain at 3 . 0 T : Preliminary Report on Transverse Relaxation Rates and Relation to Estimated Iron Content 1,” Neuroradiology, no. 3, pp. 759–767, 1999.
 A. Dimitrova et al., “MRI Atlas of the Human Cerebellar Nuclei,” Neuroimage, vol. 17, no. 1, pp. 240–255, Sep. 2002.
 A. McNeill et al., “T2* and FSE MRI distinguishes four subtypes of neurodegeneration with brain iron accumulation,” Neurology, vol. 70, no. 18, pp. 1614–1619, Apr. 2008.
 S.-Q. Yan, J. Sun, Y. Yan, H. Wang, and M. Lou, “Evaluation of Brain Iron Content Based on Magnetic Resonance Imaging (MRI): Comparison among Phase Value, R2* and Magnitude Signal Intensity,” PLoS One, vol. 7, no. 2, p. e31748, Feb. 2012.
 H. J. Brittenham GM, Farrell DE, “Magnetic susceptibility measurements of human iron stores.,” N Engl J Med, vol. 307, pp. 1671–1675, 1982.
 M. Maschke et al., “Age-related changes of the dentate nuclei in normal adults as revealed by 3D fast low angle shot (FLASH) echo sequence magnetic resonance imaging.,” J. Neurol., vol. 251, no. 6, pp. 740–6, 2004.
 J. D. Schmahmann et al., “Three-Dimensional MRI Atlas of the Human Cerebellum in Proportional Stereotaxic Space,” Neuroimage, vol. 10, no. 3, pp. 233–260, 1999.
 C. C. W. R.F. Heimburger, “stereotactic localisation of the human dentate nucleus,” Neurology, vol. 26, pp. 346–358, 1965.
 P. Gortvai and S. Teruchkin, “The Position and Extent of the Human Dentate Nucleus,” Acta Neurochir. (Wien)., vol. 121, pp. 101–110, 1974.
 U. T. Cristina Goga, “The anatomy of Meyer’s loop revisited: changing the anatomical paradigm of the temporal loop based on evidence from fiber microdissection,” J. Neurosurg., vol. 122, no. June, pp. 1253–1262, 2015.
 N. Salamon et al., “White matter fiber tractography and color mapping of the normal human cerebellum with diffusion tensor imaging,” J. Neuroradiol., vol. 34, no. 2, pp. 115–128, 2007.
 S. C. L. Deoni and M. Catani, “Visualization of the deep cerebellar nuclei using quantitative T1 and rho magnetic resonance imaging at 3 Tesla.,” Neuroimage, vol. 37, no. 2007, pp. 1260–6, 2007.
 B. G. B.Fraioli, “effects of sterotactic lesions of the dentate nucleus of the cerebellum in man,” appl. neurophysiol, vol. 38, pp. 81–90, 1975.
 S. Ishizaka et al., “161 Optogenetic Stimulation of Cerebellar Dentate Nucleus Promotes Persistent Functional Recovery After Stroke,” Neurosurgery, vol. 62, pp. 218–219, Aug. 2015.
 M. J. Teixeira et al., “Deep brain stimulation of the dentate nucleus improves cerebellar ataxia after cerebellar stroke,” Neurology, vol. 85, no. 23, pp. 2075–2076, Dec. 2015.
 H. Ma et al., “Resting-state functional connectivity of dentate nucleus is associated with tremor in Parkinson’s disease,” J. Neurol., vol. 262, no. 10, pp. 2247–2256, 2015.
 D. C. de A. Manoel J. Teixeira, Rubens Gisbert Cury, Ricardo Galhardoni, Victor Rossetto Barboza, André R. Brunoni, Eduardo Alho, Guilherme Lepski, “Deep Brain Stimulation Of The Dentate Nucleus Improves Cerebellar Ataxia After Cerebellar Stroke,” Neurology, vol. 85, pp. 2075–2076, 2015.