The double massa intermedia
Serhat Baydin1, Abuzer Gungor1, Oguz Baran1
1Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, Florida, USA.
Background:
To describe the rare finding of a double massa intermedia (MI). Typically, the MI (interthalamic adhesion) is a single bridge of gray matter connecting the medial surfaces of the thalami.
Methods:
Twelve formalin- and alcohol-fixed human third ventricles were examined from superior to inferior by fiber dissection technique under ×6 to ×40 magnifications and with the endoscope.
Results:
In all hemispheres, the anterior and posterior commissure were defined. The MI, which bridges the medial surfaces of the thalami, was defined in all hemispheres. In one hemisphere, there was a second bridge between the thalami, located posteroinferior to the common MI. Endoscopic view confirmed that there was a second MI in this specimen. The MI usually traverses the third ventricle posterior to the foramen of Monro and connects the paired thalami. The MI is an important landmark during endoscopic and microscopic surgeries of the third ventricle. Although a double MI is very rare, surgeons should be aware of the possibility in their surgical planning.
Conclusion:
The surgeon should be aware of the possibility of a double MI to avoid confusion during third ventricle surgery.
Insights
A rare double massa intermedia (interthalamic adhesion) was found, presenting as a second bridge connecting the thalami. This anatomical variation is crucial for surgeons to recognize during third ventricle procedures.
Area of Science:
- Neuroanatomy
- Surgical Anatomy
Background:
- The massa intermedia (MI), or interthalamic adhesion, is typically a single midline bridge of gray matter connecting the thalami.
- Variations in brain anatomy can impact surgical approaches and outcomes.
Purpose of the Study:
- To document and describe the rare occurrence of a double massa intermedia.
- To highlight the anatomical significance of this variation in the context of third ventricle surgery.
Main Methods:
- Examination of twelve human third ventricles using fiber dissection microscopy (×6–×40 magnification).
- Endoscopic visualization was employed to confirm anatomical findings.
- Systematic dissection from superior to inferior to identify key structures like the anterior and posterior commissures.
Main Results:
- The massa intermedia was identified in all examined hemispheres.
- A rare instance of a double massa intermedia was observed in one hemisphere, located posteroinferior to the typical MI.
- Endoscopic examination confirmed the presence of the second MI, adding a crucial layer of verification.
Conclusions:
- The massa intermedia serves as a vital landmark in endoscopic and microscopic surgeries of the third ventricle.
- Awareness of the potential for a double massa intermedia is essential for surgical planning and to prevent intraoperative confusion.
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