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Vol. 28. Num. 3.May - June 2017Pages 103-158
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Vol. 28. Num. 3.May - June 2017Pages 103-158
Clinical Research
DOI: 10.1016/j.neucie.2017.02.002
3D anatomy of cerebellar peduncles based on fibre microdissection and a demonstration with tractography
Anatomía de los pedúnculos cerebelosos en 3D basada en microdisección de fibras y demostración a través de tractografía
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Ruben Rodríguez-Menaa,b,
Corresponding author
, José Piquer-Bellocha,b, José Luis Llácer-Ortegaa,b, Pedro Riesgo-Suáreza,b, Vicente Rovira-Lilloa,b
a Hospital Universitario de la Ribera, Alzira, Valencia, Spain
b Cátedra de Neurociencias – Fundación NISA-CEU, Valencia, Spain
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Abstract
Objective

To perform an anatomical and radiological study, using fibre microdissection and diffusion tensor tractography (DTT), to demonstrate the three-dimensionality of the superior, middle and inferior cerebellar peduncles.

Material and methods

A total of 15 brain-stem, 15 cerebellar hemispheres, and 5 brain hemispheres were dissected in the laboratory under the operating microscope with microsurgical instruments between July 2014 and July 2015. Brain magnetic resonance imaging was obtained from 15 healthy subjects between July and December of 2015, using diffusion-weighted images, in order to reproduce the cerebellar peduncles on DTT.

Results

The main bundles of the cerebellar peduncles were demonstrated and delineated along most of their trajectory in the cerebellum and brain-stem, noticing their overall anatomical relationship to one another and with other white matter tracts and the grey matter nuclei the surround them, with their corresponding representations on DTT.

Conclusions

The arrangement, architecture, and general topography of the cerebellar peduncles were able to be distinguished using the fibre microdissection technique. This knowledge has given a unique and profound anatomical perspective, supporting the correct representation and interpretation of DTT images. This information should be incorporated in the clinical scenario in order to assist surgeons in the detailed and critical analysis of lesions that may be located near these main bundles in the cerebellum and/or brain-stem, and therefore, improve the surgical planning and achieve a safer and more precise microsurgical technique.

Keywords:
Cerebellum
Inferior cerebellar peduncle
Middle cerebellar peduncle
Superior cerebellar peduncle
Fibre microdissection technique
Tractography
Resumen
Objetivo

Realizar un estudio anatómico de microdisección de fibras y radiológico mediante tractografía basada en tensor de difusión (DTT) para demostrar tridimensionalmente los pedúnculos cerebelosos superiores, medios e inferiores.

Material y métodos

Bajo visión microscópica y con el uso de instrumental microquirúrgico en el laboratorio, se disecaron 15 troncoencéfalos, 15 hemisferios cerebelosos y 5 hemisferios cerebrales humanos, entre julio de 2014 y julio de 2015. Se obtuvieron imágenes de resonancia magnética cerebrales realizas a 15 sujetos sanos entre julio y diciembre de 2015, empleando secuencias potenciadas en difusión para el trazado de los pedúnculos cerebelosos y su reproducción mediante DTT.

Resultados

Se demostraron y describieron anatómicamente las principales fibras de los pedúnculos cerebelosos a lo largo de gran parte de su trayectoria en el cerebelo y troncoencéfalo, identificando las relaciones entre sí y con otros haces de sustancia blanca y núcleos de sustancia gris que los rodean, con la correspondiente representación mediante DTT.

Conclusiones

Mediante la técnica de microdisección se apreció la disposición, arquitectura y organización topográfica general de los pedúnculos cerebelosos. Este conocimiento ha aportado una perspectiva anatómica única y profunda que ha favorecido la representación y correcta interpretación de las imágenes de DTT. Esta información debe ser trasladada a la práctica clínica para favorecer el análisis crítico y exhaustivo por parte del cirujano ante la presencia de lesiones que puedan localizarse cercanas a este grupo de haces en el cerebelo y/o troncoencéfalo, y, en consecuencia, mejorar la planificación quirúrgica y alcanzar una técnica microquirúrgica más segura y precisa.

Palabras clave:
Cerebelo
Pedúnculo cerebeloso inferior
Pedúnculo cerebeloso medio
Pedúnculo cerebeloso superior
Técnica de microdisección de fibras
Tractografía

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