Neural Circuits and Systems Neuroscience
Author: Julian Leonardo Cicler | Email: juliancicler@icloud.com
Julian Cicler1°, Axel Colombo1°, Camila Migliardo1°, Valentina Duzer Salvador1°, Valeria Trofa1°, Juan Navarro1°, Julieta Laura Rodríguez Valdivia1°, Facundo Villamil1°2°, Gonzalo Bonilla1°
1° Laboratorio de Neuroanatomía, III Cátedra de Anatomía, Facultad de medicina, Universidad De Buenos Aires
2° Laboratorio de Neuroanatomía Quirúrgica, Departamento de Neurocirugía, FLENI, Montañeses 2325, CP1428 Buenos Aires. Argentina
Introduction: Surgical resection of pontine cavernomas presents unique challenges due to the variety of critical neural structures in that region, such as the corticospinal tract (CST). Given the important role of the CST in voluntary movements of most of our body, this study focuses on the anatomy and CST relationships at the level of the pons with nearby structures, aiming to reduce tract injuries in different approaches and thereby improve postoperative outcomes.
Materials and Methods: Five brainstems and two hemi-brainstems with cerebellum were dissected using the Kingler technique and fixed with formaldehyde and alcohol. The approach started from the ventral side of the brainstem and was completed on the dorsal one. Wooden spatulas were used, beginning with the larger diameter and then progressing to smaller ones, as well as microdissection tools.
Results: The CST fibers in the pons disperse into small fascicles, circumscribed ventrally and dorsally by the transverse pontine fibers (TPF) and the pontine nuclei. Additionally, their dorsal relationship with the medial lemniscus is remarcable, this last one being separated from the CST by the TPF.
Conclusions: This study highlights the importance of the CST, including its anatomy and immediate relationships, for its preservation during the resection of pontine cavernomas. Its intraoperative location is crucial for preserving its fibers, significantly improving motor outcomes and reducing the risk of neurological deficits