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Anatomy of the Brain: Ventricles01:18

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Related Experiment Video

Updated: Oct 15, 2025

Stereotaxic Surgical Approach to Microinject the Caudal Brainstem and Upper Cervical Spinal Cord via the Cisterna Magna in Mice
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Three-Dimensional Quantitative Analysis of the Brainstem Safe Entry Zones Based on Internal Structures.

Juan Leonardo Serrato-Avila1, Juan Alberto Paz Archila1, Marcos Devanir Silva da Costa1

  • 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil.

World Neurosurgery
|October 29, 2021
PubMed
Summary

This study quantifies brainstem safe entry zones (EZs), revealing optimal surgical corridors. The transolivary EZ offers the largest safe working area for accessing brainstem pathologies.

Keywords:
BrainstemFiber tractsMicrosurgical anatomySafe entry zones

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Area of Science:

  • Neurosurgery
  • Neuroanatomy
  • Surgical Neurology

Background:

  • Brainstem safe entry zones (EZs) are critical for accessing intrinsic brainstem pathologies.
  • Understanding the limits of these EZs is essential for minimizing surgical damage.

Purpose of the Study:

  • To quantitatively analyze the intrinsic surgical corridor limits of commonly used brainstem entry zones.
  • To illustrate these limits using advanced imaging and 3D reconstructions.

Main Methods:

  • Dissection of 26 human brainstems (52 sides) using the Klingler method.
  • Definition of safe working areas and distances based on eloquent fiber tracts and nuclei.
  • Quantitative analysis of depth, rostrocaudal, and mediolateral axes for each EZ.

Main Results:

  • The transolivary EZ demonstrated the largest safe working area (51.7 mm²).
  • Specific EZs provided maximal safe distances along different axes: depth (lateral transpeduncular, 22.3 mm), rostrocaudal (transolivary, 12.8 mm), and mediolateral (supracollicular, 9.1 mm).
  • The supracollicular EZ is optimal for midbrain tectum access, and the suprafacial EZ for the fourth ventricle floor.

Conclusions:

  • Safe distances vary across EZs and axes, with depth often being the largest.
  • The transolivary EZ offers the most extensive safe working area.
  • Specific EZs are best suited for targeting distinct brainstem regions.