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Microsurgical anatomy and surgical exposure of the cerebellar peduncles

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Abstract

A better understanding of the surgical anatomy of the cerebellar peduncles in different surgical approaches and their relationship with other neural structures are delineated through cadaveric dissections. We aimed to revisit the surgical anatomy of the cerebellar peduncles to describe their courses along the brain stem and the cerebellum and revise their segmental classification in surgical areas exposed through different approaches. Stepwise fiber microdissection was performed along the cerebellar tentorial and suboccipital surfaces. Multiple surgical approaches in each of the cerebellar peduncles were compared in eight silicone-injected cadaveric whole heads to evaluate the peduncular exposure areas. From a neurosurgical point of view, the middle cerebellar peduncle (MCP) was divided into a proximal cisternal and a distal intracerebellar segments; the inferior cerebellar peduncle (ICP) into a ventricular segment followed by a posterior curve and a subsequent intracerebellar segment; the superior cerebellar peduncle (SCP) into an initial congregated, an intermediate intraventricular, and a distal intramesencephalic segment. Retrosigmoid and anterior petrosectomy approaches exposed the junction of the MCP segments; telovelar, supratonsillar, and lateral ICP approaches each reached different segments of ICP; paramedian supracerebellar infratentorial, suboccipital transtentorial, and combined posterior transpetrosal approaches displayed the predecussation SCP within the cerbellomesencephalic fissure, whereas the telovelar approach revealed the intraventricular SCP within the superolateral recess of the fourth ventricle. Better understanding of the microsurgical anatomy of the cerebellar peduncles in various surgical approaches and their exposure limits constitute the most critical aspect for the prevention of surgical morbidity during surgery in and around the pons and the upper medulla. Our findings help in evaluating radiological data and planning an operative procedure for cerebellar peduncles.

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Acknowledgements

We thank Stryker Medical Technology Co and company’s country representation in Turkey, for providing the electrically powered instruments, including the drills, to the Microsurgical Neuroanatomy Laboratory in Istanbul University—Cerrahpasa, Department of Neurosurgery.

We also thank Ufuk Köse for providing artwork.

Data were provided in part by the Human Connectome Project, WU-Minn Consortium (Principal Investigators: David Van Essen and Kamil Ugurbil; 1U54MH091657) funded by the 16 NIH Institutes and Centers that support the NIH Blueprint for Neuroscience Research; and by the McDonnell Center for Systems Neuroscience at Washington University.

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Authors and Affiliations

  1. Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University—Cerrahpasa, Fatih, 34098, Istanbul, Turkey

    Oguz Baran, Serhat Baydin, Muyassar Mirkhasilova, Nicat Bayramli, Berra Bilgin & Necmettin Tanriover

  2. Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey

    Oguz Baran

  3. Department of Radiology, Mayo Clinic, Jacksonville, FL, USA

    Erik Middlebrooks

  4. Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University—Cerrahpasa, Istanbul, Turkey

    Fatma Ozlen & Necmettin Tanriover

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  1. Oguz Baran
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  2. Serhat Baydin
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Contributions

OB: cadaver dissections, conducted study method, literature search, collected data, writing of the manuscript, revised the manuscript and final approval; SB: cadaver dissections, literature search, revised the manuscript and final approval; MM: some cadaveric dissections, revised the manuscript and final approval; NB: some cadaveric dissections, revised the manuscript and final approval; BB: some cadaveric dissections, revised the manuscript and final approval; EM: 3D radiologic figures, revised the manuscript and final approval; FO: study supervision, revised the manuscript and final approval; NT: conceived the idea, study supervision, revised the manuscript and final approval.

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Correspondence to Necmettin Tanriover.

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Baran, O., Baydin, S., Mirkhasilova, M. et al. Microsurgical anatomy and surgical exposure of the cerebellar peduncles. Neurosurg Rev 45, 2095–2117 (2022). https://doi.org/10.1007/s10143-021-01701-3

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