RESUMEN
PURPOSE: The dentate nucleus (DN) is the largest, most lateral, and phylogenetically most recent of the deep cerebellar nuclei. Its pivotal role encompasses the planning, initiation, and modification of voluntary movement but also spans non-motor functions like executive functioning, visuospatial processing, and linguistic abilities. This review aims to offer a comprehensive description of the DN, detailing its embryology, anatomy, physiology, and clinical relevance, alongside an analysis of dentatotomy. METHODS AND RESULTS: We delve into the history, embryology, anatomy, vascular supply, imaging characteristics, and clinical significance of the DN. Furthermore, we thoroughly review the dentatotomy, emphasizing its role in treating spasticity. CONCLUSIONS: Understanding the intricacies of the anatomy, physiology, vasculature, and projections of the DN has taken on increased importance in current neurosurgical practice. Advances in technology have unveiled previously unknown functions of the deep cerebellar nuclei, predominantly related to non-motor domains. Such discoveries are revitalizing older techniques, like dentatotomy, and applying them to newer, more localized targets.
Asunto(s)
Núcleos Cerebelosos , Humanos , Núcleos Cerebelosos/cirugía , Núcleos Cerebelosos/anatomía & histología , Procedimientos Neuroquirúrgicos/métodos , Espasticidad Muscular/cirugíaRESUMEN
OBJECTIVE: To define the anatomy of dentate nucleus and cerebellar peduncles, demonstrating the surgical application of anatomic landmarks in cerebellar resections. METHODS: Twenty cerebellar hemispheres were studied. RESULTS: The majority of dentate nucleus and cerebellar peduncles had demonstrated constant relationship to other cerebellar structures, which provided landmarks for surgical approaching. The lateral border is separated from the midline by 19.5 mm in both hemispheres. The posterior border of the cortex is separated 23.3 mm from the posterior segment of the dentate nucleus; the lateral one is separated 26 mm from the lateral border of the nucleus; and the posterior segment of the dentate nucleus is separated 25.4 mm from the posterolateral angle formed by the junction of lateral and posterior borders of cerebellar hemisphere. CONCLUSIONS: Microsurgical anatomy has provided important landmarks that could be applied to cerebellar surgical resections.
Asunto(s)
Cerebelo/anatomía & histología , Cerebelo/cirugía , Microcirugia , Cadáver , Núcleos Cerebelosos/anatomía & histología , Núcleos Cerebelosos/cirugía , Corteza Cerebral/anatomía & histología , Corteza Cerebral/cirugía , Femenino , Humanos , Masculino , Ilustración MédicaRESUMEN
OBJECTIVE: To define the anatomy of dentate nucleus and cerebellar peduncles, demonstrating the surgical application of anatomic landmarks in cerebellar resections. METHODS: Twenty cerebellar hemispheres were studied. RESULTS: The majority of dentate nucleus and cerebellar peduncles had demonstrated constant relationship to other cerebellar structures, which provided landmarks for surgical approaching. The lateral border is separated from the midline by 19.5 mm in both hemispheres. The posterior border of the cortex is separated 23.3 mm from the posterior segment of the dentate nucleus; the lateral one is separated 26 mm from the lateral border of the nucleus; and the posterior segment of the dentate nucleus is separated 25.4 mm from the posterolateral angle formed by the junction of lateral and posterior borders of cerebellar hemisphere. CONCLUSIONS: Microsurgical anatomy has provided important landmarks that could be applied to cerebellar surgical resections.
OBJETIVO: Definir a anatomia do núcleo denteado e dos pedúnculos cerebelares, demonstrando a aplicação dos marcos anatômicos em cirurgias cerebelares. MÉTODOS: Foram estudados 20 hemisférios cerebelares. RESULTADOS: A maioria dos núcleos denteados e pedúnculos cerebelares demonstraram relação anatômica constante com outras estruturas cerebelares, fato que proporcionou o estabelecimento de marcos anatômicos específicos a serem utilizados em acessos cirúrgicos. O bordo lateral do núcleo denteado é separado da linha média em 19,5 mm em ambos os hemisférios cerebelares. O bordo posterior do córtex é separado do segmento posterior do núcleo denteado por 23,3 mm. O bordo lateral do córtex é separado do bordo lateral do núcleo por 26 mm e o segmento posterior do núcleo denteado é separado por 25,4 mm do ângulo posterolateral, que é formado pela junção dos bordos lateral e posterior do hemisfério cerebelar. CONCLUSÕES: O estudo da anatomia microcirúrgica proporcionou o estabelecimento de marcos anatômicos importantes que podem ser utilizados durante cirurgias cerebelares ablativas.
Asunto(s)
Femenino , Humanos , Cerebelo/anatomía & histología , Cerebelo/cirugía , Microcirugia , Cadáver , Núcleos Cerebelosos/anatomía & histología , Núcleos Cerebelosos/cirugía , Corteza Cerebral/anatomía & histología , Corteza Cerebral/cirugía , Ilustración MédicaRESUMEN
Neurogenic neuroprotection is a promising approach for treating patients with ischemic brain lesions. In rats, stimulation of the deep brain nuclei has been shown to reduce the volume of focal infarction. In this context, protection of neural tissue can be a rapid intervention that has a relatively long-lasting effect, making fastigial nucleus stimulation (FNS) a potentially valuable method for clinical application. Although the mechanisms of neuroprotection induced by FNS remain partially unclear, important data have been presented in the last two decades. A 1-h electrical FNS reduced, by 59%, infarctions triggered by permanent occlusion of the middle cerebral artery in Fisher rats. The acute effect of electrical FNS is likely mediated by a prolonged opening of potassium channels, and the sustained effect appears to be linked to inhibition of the apoptotic cascade. A better understanding of the neuronal circuitry underlying neurogenic neuroprotection may contribute to improving neurological outcomes in ischemic brain insults.
Asunto(s)
Infarto Encefálico/prevención & control , Núcleos Cerebelosos/fisiología , Estimulación Encefálica Profunda/métodos , Animales , Infarto Encefálico/etiología , Núcleos Cerebelosos/anatomía & histología , Núcleos Cerebelosos/metabolismo , Circulación Cerebrovascular/fisiología , Modelos Animales de Enfermedad , Encefalitis/etiología , Encefalitis/prevención & control , Humanos , Infarto de la Arteria Cerebral Media/complicaciones , Vías Nerviosas/fisiología , Lóbulo Parietal/fisiologíaAsunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Sistema Nervioso/anatomía & histología , Sistema Nervioso/fisiopatología , Neuronas/fisiología , Neuroglía/fisiología , Tejido Nervioso/anatomía & histología , Tejido Nervioso/fisiología , Médula Espinal/anatomía & histología , Médula Espinal/fisiología , Cerebelo/anatomía & histología , Cerebelo/fisiología , Corteza Cerebelosa/anatomía & histología , Corteza Cerebelosa/fisiología , Núcleos Cerebelosos/anatomía & histología , Núcleos Cerebelosos/fisiología , Sistema Nervioso Periférico/anatomía & histología , Sistema Nervioso Periférico/fisiología , Circulación Sanguínea/fisiología , Atención/fisiología , Memoria/fisiología , LenguajeRESUMEN
The ventricular sulcal pattern and the cellular structure of the brain stem of the axolotl Ambystoma mexicanum have been studied in transversely cut Nissl and Bodian stained serial sections. Six longitudinal sulci, the sulcus medianus inferior, the sulcus intermedius ventralis, the sulcus limitans, the sulcus intermedius dorsalis, the sulcus medianus superior and the sulcus lateralis mesencephali could be distinguished. A seventh groove, the sulcus isthmi, clearly deviates from the overall longitudinal pattern of the other sulci. Although most neuronal perikarya are contained within a diffuse periventricular gray, 19 cell masses could be delineated; seven of these are primary efferent or motor nuclei, four are primary afferent or sensory centers, four nuclei are considered as components of the reticular formation, and the remaining four cell masses can be interpreted as "relay" nuclei. In order to study the zonal pattern of the brain stem, this structure was subjected to a topological analysis (cf, Nieuwenhuys, '74 and fig. 13). This analysis yielded the following results. In the rhombencephalon the grisea are arranged in four longitudinal zones which, following Kuhlenbeck, have been termed area ventralis, area intermedioventralis, area intermediodorsalis and area dorsalis. Where present the sulcus intermedius ventralis, the sulcus limitans and the sulcus intermedius dorsalis mark the boundaries between these four morphological entities. The zonal areas in question coincide largely, but not entirely, with the so-called functional columns of Herrick and Johnston. The most obvious incongruity is that the area intermediodorsalis contains, in addition to the nucleus fasciculi solitarii and the nucleus visceralis secundarius, two non-visceral sensory cell masses, namely the nucleus vestibularis magnocellularis and the nucleus cerebelli. The four morphological zones delineated in the rhombencephalon cannot be distinguished in the mesencephalon and it is of particular importance that the sulcus limitans does not extend into this part of the brain. Functionally, however, the medial part of the tegmentum mesencephali may be considered the rostral extreme of the somatic motor column, whereas the tectum primarily represents a somatic sensory correlation area.