Longitudinal Reference Values for Cerebral Ventricular Size in Preterm Infants Born at 23-27 Weeks of Gestation.

OBJECTIVE: To establish longitudinal reference values for cerebral ventricular size in the most vulnerable patients at risk for intraventricular hemorrhage (IVH) and posthemorrhagic ventricular dilatation (PHVD). STUDY DESIGN: This retrospective study included neurologically healthy preterm neonates born at 230/7-266/7 weeks of gestational age between September 2011 and April 2019. Patients were treated at 2 Austrian tertiary centers, Medical University of Vienna and Medical University of Innsbruck. All available cerebral ultrasound scans until 30 weeks corrected age were analyzed. Ventricular measurements included ventricular index, anterior horn width (AHW), and thalamo-occipital distance (TOD) and longitudinal percentiles were created. RESULTS: The study cohort consisted of 244 preterm neonates, with a median gestational age of 253/7 weeks (IQR, 244/7-260/7 weeks) and a median birth weight of 735 g (IQR, 644-849 g). A total of 993 ultrasound scans were available for analysis, resulting in >1800 measurements of ventricular index, AHW, and TOD. Special attention was given to the 97th percentile as well as 2 mm and 4 mm above the 97th percentile, which are used internationally as cutoffs for intervention in the presence of PHVD. CONCLUSIONS: We present percentile charts based on a cohort of extremely premature infants including neonates born at the border of viability suited to follow-up the most vulnerable patients at risk for IVH and PHVD. Furthermore, we provide an extensive literature research and comparison of all available reference values, focusing on ventricular index, AHW, and TOD.

Morphometric MRI study of the brain ventricles in healthy Turkish subjects / Estudio morfométrico de resonancia magnética de los ventrículos cerebrales en sujetos turcos sanos

The aim of this study was to determine the normal values of brain ventricles and indices in healthy subjects in our population using magnetic resonance imaging (MRI) and to reveal sex and age related differences. The MRI of two hundred-sixty-five healthy individuals aged between eighteen and eighty-seven years were examined and the midsagittal and axial images were used for measurements. The measurements were performed from MRI on a Workstation. The following mean values of brain ventricles and indices were observed; frontal horn width (FHW) (33.14 mm); third (3rd) ventricle width (TVW) (3.37 mm); fourth ventricle anteroposterior width (FVWAP) (9.93 mm); fourth ventricle transverse width (FVWT) (12.40 mm); and the maximum transverse inner diameter of the skull (TIDS) (128.75 mm) in females. The same dimensions were 34.85 mm, 3.91 mm, 10.26 mm, 12.81 mm, and 134.68 mm in males, respectively. There were statistically significantly differences in the frontal horn width, third (3rd) ventricle width, and the maximum transverse inner diameter of the skull values in between sexes. The mean values of Evans' index which obtanied with maximum width between the frontal horns of the lateral ventricles divided by the maximum transverse inner diameter of the skull were found as 0.280 ±0.172 in females; whereas the same dimensions were calculated 0.276±0.161 in males. These values were lower in healthy male subjects than females, however; there were no found significantly difference between groups. Present findings obtained from MRI are necessary anatomical baseline data for interpreting pathological changes, planning surgery, and determining presence and progress of some neurological diseases.

El objetivo de este estudio fue determinar los valores normales de los ventrículos e índices cerebrales en sujetos sanos en nuestra población mediante el uso de imágenes de resonancia magnética (RM) y revelar las diferencias relacionadas con el sexo y la edad. Se examinó la resonancia magnética de 265 individuos sanos de entre 18 y 87 años, y se utilizaron las imágenes en sentido medio y sagital para las mediciones. Las mediciones se realizaron a partir de IRM en una estación de trabajo. Se observaron los siguientes valores medios de ventrículos e índices cerebrales: longitud del asta frontal (FHW) (33,14 mm); longitud del tercer ventrículo (TVW) (3,37 mm); longitud anteroposterior del cuarto ventrículo (FVWAP) (9,93 mm); longitud transversal del cuarto ventrículo (FVWT) (12,40 mm); y el diámetro transversal máximo del cráneo (SID) (128,75 mm) en las hembras. Las mismas dimensiones fueron 34,85 mm, 3,91 mm, 10,26 mm, 12,81 mm y 134,68 mm en machos, respectivamente. Hubo diferencias estadísticamente significativas en el ancho del asta frontal, el ancho del tercer ventrículo y el diámetro interno transversal máximo de los valores del cráneo entre los sexos. Los valores medios del índice de Evans que obtuvieron el ancho máximo entre los cuernos frontales de los ventrículos laterales dividido por el diámetro interno transversal máximo del cráneo se encontraron en 0,280 ± 0,172 en las mujeres; mientras que las mismas dimensiones se calcularon en hombres (0,276 ± 0,161). Sin embargo, estos valores fueron más bajos en hombres sanos que en mujeres; no se encontraron diferencias significativas entre los grupos. Los hallazgos actuales obtenidos de IRM son datos anatómicos de referencia necesarios para interpretar los cambios patológicos, planificar la cirugía y determinar la presencia y el progreso de algunas enfermedades neurológicas.

Age-related changes of the cerebral ventricles of healthy domestic cats / Alterações senis dos ventrículos cerebrais de gatos domésticos hígidos

This study aimed to determine age-related changes of the cerebral ventricles of healthy non-brachycephalic domestic cats by the acquisition of brain MRI images of 12 adult (1 to 6 years), 11 mature (7 to11 years) and 10 geriatric (12 years or more) cats. Our hypothesis is that the cerebral ventricular system of cats expands with increasing age. The possibility of the evidence of the olfactory bulb cavities and temporal horns of the lateral ventricles were evaluated in this study. Volumes of the olfactory bulb cavities, lateral ventricles (including the temporal horns), third ventricle, mesencephalic aqueduct and fourth ventricle were measured and corrected for the intracranial volume. Significant differences were found between the adult and mature groups in relation to the geriatric one for the variable related to the evidence of the temporal ventricular horns, which were most frequently visualized in geriatric cats. Percentage of the right lateral and third ventricles volume by intracranial volume were significantly higher in geriatric cats compared to the adults. The results of this study demonstrate that ventricular dilation tends to occur with advancing age in cats, as well as the increase in the frequency of the temporal ventricular horn evidence, as had been indicated in the hypothesis of the study.(AU)

O estudo objetivou a determinação das alterações senis dos ventrículos cerebrais de gatos domésticos hígidos não braquicefálicos pela aquisição de imagens encefálicas de 12 indivíduos adultos (1 a 6 anos), 11 maduros (7 a 11 anos) e 10 geriátricos (12 anos de idade ou mais) por ressonância magnética. Nossa hipótese é de que o sistema ventricular dos gatos se expande com o avanço da idade. A possibilidade de evidenciação das cavidades do bulbo olfatório e dos cornos temporais dos ventrículos laterais foi avaliada nesse estudo. Os volumes das cavidades do bulbo olfatório, ventrículos laterais (incluindo os cornos temporais), terceiro ventrículo, aqueduto mesencefálico e quarto ventrículo foram mensurados e corrigidos de acordo com o volume intracraniano. Diferenças significativas foram encontradas entre os grupos dos adultos e maduros em relação aos geriátricos para a variável referente à evidenciação dos cornos temporais, que foram visualizados de forma mais frequente nos gatos geriátricos. A porcentagem do volume do ventrículo lateral direito e do terceiro ventrículo em relação ao volume intracraniano foi significativamente maior nos animais geriátricos em comparação aos adultos. Os resultados desse estudo demonstram que a dilatação ventricular tende a ocorrer com o avanço da idade nos gatos, assim como o aumento na frequência da evidenciação dos cornos temporais, como havia sido indicado na hipótese do estudo.(AU)

Age-related changes of the cerebral ventricles of healthy domestic cats / Alterações senis dos ventrículos cerebrais de gatos domésticos hígidos

This study aimed to determine age-related changes of the cerebral ventricles of healthy non-brachycephalic domestic cats by the acquisition of brain MRI images of 12 adult (1 to 6 years), 11 mature (7 to11 years) and 10 geriatric (12 years or more) cats. Our hypothesis is that the cerebral ventricular system of cats expands with increasing age. The possibility of the evidence of the olfactory bulb cavities and temporal horns of the lateral ventricles were evaluated in this study. Volumes of the olfactory bulb cavities, lateral ventricles (including the temporal horns), third ventricle, mesencephalic aqueduct and fourth ventricle were measured and corrected for the intracranial volume. Significant differences were found between the adult and mature groups in relation to the geriatric one for the variable related to the evidence of the temporal ventricular horns, which were most frequently visualized in geriatric cats. Percentage of the right lateral and third ventricles volume by intracranial volume were significantly higher in geriatric cats compared to the adults. The results of this study demonstrate that ventricular dilation tends to occur with advancing age in cats, as well as the increase in the frequency of the temporal ventricular horn evidence, as had been indicated in the hypothesis of the study.(AU)

O estudo objetivou a determinação das alterações senis dos ventrículos cerebrais de gatos domésticos hígidos não braquicefálicos pela aquisição de imagens encefálicas de 12 indivíduos adultos (1 a 6 anos), 11 maduros (7 a 11 anos) e 10 geriátricos (12 anos de idade ou mais) por ressonância magnética. Nossa hipótese é de que o sistema ventricular dos gatos se expande com o avanço da idade. A possibilidade de evidenciação das cavidades do bulbo olfatório e dos cornos temporais dos ventrículos laterais foi avaliada nesse estudo. Os volumes das cavidades do bulbo olfatório, ventrículos laterais (incluindo os cornos temporais), terceiro ventrículo, aqueduto mesencefálico e quarto ventrículo foram mensurados e corrigidos de acordo com o volume intracraniano. Diferenças significativas foram encontradas entre os grupos dos adultos e maduros em relação aos geriátricos para a variável referente à evidenciação dos cornos temporais, que foram visualizados de forma mais frequente nos gatos geriátricos. A porcentagem do volume do ventrículo lateral direito e do terceiro ventrículo em relação ao volume intracraniano foi significativamente maior nos animais geriátricos em comparação aos adultos. Os resultados desse estudo demonstram que a dilatação ventricular tende a ocorrer com o avanço da idade nos gatos, assim como o aumento na frequência da evidenciação dos cornos temporais, como havia sido indicado na hipótese do estudo.(AU)

The Ventricular System of the Brain: Anatomy and Normal Variations.

The cerebral ventricular system is intimately associated with the forebrain and brainstem. The ventricular system functions to produce and circulate cerebrospinal fluid, which plays an important role in mechanical protection and regulation of homeostasis in the central nervous system. This article discusses anatomy and neuroimaging of the ventricular system and highlights normal anatomical variations that may be mistaken for pathology. Applied surgical anatomy is reviewed with emphasis on operative approach and potential risk to adjacent central nervous system structures.

Estudo dos ventrículos cerebrais por ultrassonografia, na criança normal, nascida a termo, de 1 a 6 meses / Sonographic evaluation of cerebral ventricular system in healthy, full term infants aged 1-6 months

OBJETIVO: Estudo dos ventrículos cerebrais por ultrassonografia, com o objetivo de estabelecer de forma simplificada parâmetros para diagnóstico das dilatações ventriculares leves. MATERIAIS E MÉTODOS: Foram estudadas, prospectivamente, 105 crianças, normais, nascidas a termo, com um total de 181 exames realizados, mensalmente até os 6 meses, através da observação de dados morfológicos e medidas. As medidas efetuadas foram: índice ventrículo/hemisfério, diâmetro anteroposterior do corno anterior e do quarto ventrículo. RESULTADOS: Obtiveram-se média, desviopadrão e percentis de normalidade das medidas estabelecidas, em cada faixa etária. A pesquisa de halo anecoico nos dois terços posteriores do plexo coroide em plano coronal VI, para avaliação dos cornos temporal/posterior, foi ausente, e o terceiro ventrículo mostrou-se como uma fenda anecoica, menor que 1 mm, em plano coronal V em todas as crianças do estudo. CONCLUSÃO: Os achados morfológicos relacionados aos cornos temporal/posterior e ao terceiro ventrículo, associados ao percentil 95 das medidas como limite superior da normalidade, podem ser utilizados para diagnóstico simplificado de dilatações ventriculares leves.

OBJECTIVE: Study of the cerebral ventricular system by ultrasonography with the objective of establishing parameters for the diagnosis of mild ventricular dilatation. MATERIALS AND METHODS: Prospective study of 105 healthy, full term infants aged 1-6 months, submitted to monthly scans for morphological data evaluation and measurements of ventricle/ hemisphere ratio, and anteroposterior diameter of frontal horn and fourth ventricle. RESULTS: Normality mean, standard deviation and percentile were obtained for each age range. Negative results were observed in the search for anechoic halo surrounding the posterior two thirds of the choroid plexus on coronal section VI for evaluation of temporal/posterior horns, and the third ventricle was seen as an anechoic cleft < 1 mm on coronal section V in all of the evaluated infants. CONCLUSION: Sonographic findings related to temporal/posterior horns and third ventricle associated with the 95th percentile as upper limit of normality can be utilized as parameters for a simplified diagnosis of mild ventricular dilatation.

Choroid plexus cysts and their anatomical correlations: importance in fetal prognosis. A critical literature review

The objective of this investigation was to carry out a literature review on the choroid plexus cysts and theirimportance in fetal prognosis with search on PubMed, Web of Science, LILACS and MEDLINE databases usingkeywords in English without time restrictions. Choroid plexus cysts, which are also termed intraventricularneuroepithelial cysts, choroid epithelial cysts or ependimary cysts, are structures localized within the interiorof the lateral ventricles, comprising secretory epithelium, the principal function of which is the production ofcerebrospinal fluid. Ultrasound images of the choroid plexuses within the lateral ventricles consist of hyperechogenicstructures at the level of the body, trigon and inferior horn of the ventricles. Between the 16th andthe 20th week of gestation, cystic structures in the interior of the ventricular plexuses may be observed at arate of 0.3-1.0% in an ultrasound examination of the fetal head, as is shown. Most choroid plexus cysts regressspontaneously without after effects, although there is a possible association with chromosomal abnormalities,notably trisomy 18 (Edwards’ syndrome) and less frequently cited, trisomy 21 (Down syndrome). The presenceof this kind of cyst is considered to be a lesser marker for them, except when combined with other morefrequently used and accepted ecographic markers, such as nuchal translucency, intracardiac echogenic focusand others. Its isolated presence as the sole characteristic of this aneuploidy is rare. The majority of choroidcysts are transitory and of little clinical significance, and may be identified through a computerized tomographyexamination. As such, the existence of isolated choroid cysts does not indicate the confirmation of chromosomalaneuploidies so much as an alarm that should trigger an investigation in greater depth in search ofother more important markers, emphasizing the importance of pre-natal monitoring.

Dissection technique for the study of the cerebral sulci, gyri and ventricles.

Neuroanatomy in addition to neurophysiology, are the basic areas for the proper formation from health students to specialized professionals in neuroscience. A step by step guide for practical studies of neuroanatomy is required for this kind of knowledge to become more acceptable among medical students, neurosurgeons, neurologists, neuropediatricians and psychiatric physicians. Based on the well known courses of sulci, gyri and ventricles offered by Beneficência Portuguesa Hospital in São Paulo, Brazil, two times a year, since 1994, totalizing more than 20 complete courses, and answering the request of many neuroscience students and professionals whose asked for a practical guide to the neuroanatomy study, the authors suggest a protocol for the study of superficial and deep brain structures showing how to approach the more structures as possible with minimum damage to the anatomic piece and with the smaller number of brains.

Dissection technique for the study of the cerebral sulci, gyri and ventricles / Técnica de dissecação para o estudo dos sulcos, giros e ventriculos cerebrais

Neuroanatomy in addition to neurophysiology, are the basic areas for the proper formation from health students to specialized professionals in neuroscience. A step by step guide for practical studies of neuroanatomy is required for this kind of knowledge to become more acceptable among medical students, neurosurgeons, neurologists, neuropediatricians and psychiatric physicians. Based on the well known courses of sulci, gyri and ventricles offered by Beneficência Portuguesa Hospital in São Paulo, Brazil, two times a year, since 1994, totalizing more than 20 complete courses, and answering the request of many neuroscience students and professionals whose asked for a practical guide to the neuroanatomy study, the authors suggest a protocol for the study of superficial and deep brain structures showing how to approach the more structures as possible with minimum damage to the anatomic piece and with the smaller number of brains.

Neuroanatomia e a neurofisiologia são as áreas básicas para a adequada formação desde estudantes na área da saúde a profissionais especializados em neurociências. Um guia prático, passo a passo, para o estudo de neuroanatomia é necessário para tornar esse conhecimento mais acessível entre estudantes de medicina, neurologistas, neurofisiologistas, neurocirurgiões, neuropediatras e psiquiatras. Baseados em cursos reconhecidos nacional e internacionalmente a respeito dos sulcos, giros e ventrículos cerebrais elaborados e realizados pelo Instituto de Ciências Neurológicas (ICNE) no Hospital de Beneficência Portuguesa de São Paulo, Brasil, duas vezes ao ano, totalizando mais de 20 cursos já realizados, os autores apresentam um protocolo de dissecação para o estudo das estruturas superficiais e profundas do encéfalo, mostrando como expor o máximo de estruturas com um mínimo de manipulação e dano à peça anatômica e utilizando o menor número de encéfalos possíveis.

Estudio de los ventrículos cerebrales mediante inyección de resinas poliéster / Brain ventricles study by polyester resins injection

Introducción: El manejo de resinas poliéster para obtener moldes de órganos huecos tiene un claro fin didáctico, ya que permitoe comprender la morfologías tridimensional del órgano y sus relaciones. Material y métodos: Mediante el uso de resinas poliéster, los autores obtuvieron tres moldes de las cavidades ventriculares del encéfalo y tres moldes unilaterales aislados de los ventrículos laterales. Una vez seleccionada la pieza a inyectar, se hace un lavado de las cavidades ventriculares con agua corriente y luego con alcohol para deshidratar la superficie y minimizar el conflicta agua - resina. Posteriormente se inyecta la resina en los ventrículos bajo presión manual, se deja fraguar y se hace corrosión del órgano con ácido sulfítico al noventa y ocho por ciento. Discusión y conclusiones: Todas las piezas obtenidas fueron de buena calidad, permitiendo una mejor comprensión tridimensional de las cavidades ventriculares. (AU)

Estudio de los ventrículos cerebrales mediante inyección de resinas poliéster / Brain ventricles study by polyester resins injection

Introducción: El manejo de resinas poliéster para obtener moldes de órganos huecos tiene un claro fin didáctico, ya que permitoe comprender la morfologías tridimensional del órgano y sus relaciones. Material y métodos: Mediante el uso de resinas poliéster, los autores obtuvieron tres moldes de las cavidades ventriculares del encéfalo y tres moldes unilaterales aislados de los ventrículos laterales. Una vez seleccionada la pieza a inyectar, se hace un lavado de las cavidades ventriculares con agua corriente y luego con alcohol para deshidratar la superficie y minimizar el conflicta agua - resina. Posteriormente se inyecta la resina en los ventrículos bajo presión manual, se deja fraguar y se hace corrosión del órgano con ácido sulfítico al noventa y ocho por ciento. Discusión y conclusiones: Todas las piezas obtenidas fueron de buena calidad, permitiendo una mejor comprensión tridimensional de las cavidades ventriculares.

Pressor effects of the injection of noradrenaline into different cerebroventricular spaces in unanesthetized rats.

Injection of noradrenaline (NA) into the lateral cerebral ventricle (i.c.v.) was reported to cause blood pressure increase in unanesthetized rats, blocked by i.v. injection of vasopressin antagonists. We report similar responses to NA injection into the III or IV ventricles, suggesting multiple sites of action for i.c.v. NA. These responses were blocked by i.v. pretreatment with vasopressin antagonist, suggesting a common mediation by vasopressin release into circulation. Selected ventricular spaces were occluded with Nivea cream plugs to identify ventricular areas responding to i.c.v. NA. III ventricle or aqueduct occlusions markedly reduced pressor responses to i.c.v. NA. Microinjection of NA into the periaqueductal gray matter (PAG) caused pressor responses that were similar to those of i.c.v. NA, reinforcing the idea of a site of action in the aqueduct. IV ventricle occlusion only partially blocked the response to i.c.v. NA. The results suggest at least two sites of action for i.c.v. NA in unanesthetized rats. A primary site located in the PAG and another on the IV ventricle wall.

Ependymal cell differentiation and GLUT1 expression is a synchronous process in the ventricular wall.

Ependymal cells appear to be totally differentiated during the first 3 weeks in the mouse brain. Early during postnatal development ependymal cells differentiate and undergo metabolic activation, which is accompanied by increased glucose uptake. We propose that ependymal cells induce an overexpression of the glucose transporter, GLUT1, during the first 2 weeks after delivery in order to maintain the early metabolic activation. During the first postnatal day, GLUT1 is strongly induced in the upper region of the third ventricle and in the ventral area of the rostral cerebral aqueduct. During the next 4 days, GLUT1 is expressed in all differentiated ependymal cells of the third ventricle and in hypothalamic tanycytes. At the end of the first week, ependymal cell differentiation and GLUT1 overexpression is concentrated in the latero-ventral area of the aqueduct. We propose that ependymal cell differentiation and GLUT1 overexpression is a synchronous process in the ventricular wall.

[Microanatomical study of the choroidal fissure in ventricular and cisternal approaches]. / Estudo microanatômico da fissura coroidéia na abordagem dos ventrículos e cisternas cerebrais.

The choroidal fissure is a narrow cleft in the medial part of the lateral ventricle, in a C-shaped arc, between the fornix and the thalamus, where the choroidal plexus join. Due to absence nervous tissue between ependyma and pia-mater along this invagination, it is an important route in brain ventricles and cisterns. Five brains were studied by injecting colored silicone arteries and veins and five brains without colored silicone, in a total number of 20 brain hemispheres. It was analyzed and revised the neural, arterial and venous relationships and surgical approaches in all parts of the choroidal fissure. In conclusion, the previous knowledge detailed this microanatomy is primordial for neurosurgeons that will approach brain ventricular and cisternal lesions because the neurosurgeons gain a tridimensional notion that will be indispensable during surgery.

Estudo microanatômico da fissura coroidéia na abordagem dos ventrículos e cisternas cerebrais / Microanatomical study of the choroidal fissure in ventricular and cisternal approaches

The choroidal fissure is a narrow cleft in the medial part of the lateral ventricle, in a C-shaped arc, between the fornix and the thalamus, where the choroidal plexus join. Due to absence nervous tissue between ependyma and pia-mater along this invagination, it is an important route in brain ventricles and cisterns. Five brains were studied by injecting colored silicone arteries and veins and five brains without colored silicone, in a total number of 20 brain hemispheres. It was analyzed and revised the neural, arterial and venous relationships and surgical approaches in all parts of the choroidal fissure. In conclusion, the previous knowledge detailed this microanatomy is primordial for neurosurgeons that will approach brain ventricular and cisternal lesions because the neurosurgeons gain a tridimensional notion that will be indispensable during surgery.

A fissura coroidéia é uma estreita fenda situada na parte medial dos ventrículos laterais, em formato de "C", entre o fórnix e o tálamo e onde o plexo coróide se adere. O fato de não haver tecido nervoso entre o epêndima e a pia-máter ao longo deste acidente anatômico torna-o uma importante via no acesso aos ventrículos e cisternas cerebrais. Foram estudados cinco cérebros, injetando-se artérias e veias com material siliconado colorido e cinco cérebros sem realce colorido dos vasos, num total de 20 hemisférios cerebrais. Foram analisadas e revisadas as relações neurais, arteriais e venosas, bem como as abordagens cirúrgicas em cada parte da fissura coroidéia. Concluiu-se que o conhecimento prévio detalhado desta microanatomia é fundamental para os neurocirurgiões que vão abordar lesões nos ventrículos e cisternas cerebrais, pois se obtém uma noção tridimensional que será indispensável durante o ato cirúrgico.

[Observation of the ventricular system and subarachnoid space in the skull base by flexible neuroendoscopy: normal structures]. / Observación del sistema ventricular y espacio subaracnoideo de la base del cráneo por neuroendoscopia flexible: Estructuras normales.

Worldwide in the last two decades, in Latin America in the last decade, and Mexico in particular cerebral endoscopy as part of the minimally invasive neurological surgery, has constituted a significant advance for the treatment of neurological diseases such as congenital or acquired hydrocephalus, Chiari malformation, neurocysticercosis, stroke, ventricular and paraventricular tumors and cysts, arachnoidal cyst and hydrocephalus secondary to shunt malfunction. The lateral ventricles, the third ventricle, the cerebral aqueduct, the fourth ventricle, and the subarachnoid basal cisterns are among the most non-accessible regions of the central nervous system. Due to light-rand fiber optic-systems in combination with the experiences of nine consecutive year's and more than 600 endoscopies, most of them flexible neuroendoscopies, we present the neuroendoscopic approach with flexible cerebral endoscope to the anatomy and its normal variants of the whole ventricle system and the subarachnoid basal cisterns including the subarachnoid space of the cervical spine. We also describe their site related structures including veins, arteries, cranial nerves, pituitary gland, choroidal plexus and their normal anatomic variants.

Observación del sistema ventricular y espacio subaracnoideo de la base del cráneo por neuroendoscopia flexible: Estructuras normales / Observation of the ventricular system and subarachnoid space in the skull base by flexible neuroendoscopy: normal structures

En las últimas dos décadas a nivel mundial y en la última década en Latinoamérica, especialmente en México, la endoscopia cerebral como parte de la cirugía neurológica de mínima invasión ha sido un paso de gran importancia para el tratamiento de enfermedades neurológicas T4 como hidrocefalia congénita o adquirida, malformaciones Chiari, neurocisticercosis, enfermedad vascular cerebral, tumores o quistes ventriculares y paraventriculares, quistes aracnoideos e hidrocefalias secundarias a disfunciones valvulares. Entre las regiones más inaccesibles al sistema nervioso central se encuentran los ventrículos laterales, el tercer ventrículo, el acueducto cerebral, el cuarto ventrículo y el espacio subaracnoideo de la base del cráneo. Gracias a los sistemas de fibra óptica y luz en combinación con la experiencia de nueve años consecutivos y más de 600 endoscopias realizadas, en su mayoría endoscopias cerebrales flexibles, presentarnos el abordaje por medio de neuronavegación con endoscopía cerebral flexible de la anatomía normal y sus variantes de todo el sistema ventricular y el espacio subaracnoideo de la base del cráneo, incluyendo el espacio subaracnoideo de la médula cervical. También presentamos las estructuras relacionadas a estos sitios como: venas, arterias, nervios craneales, glándula pituitaria y plexos coroideos.

Worldwide in the last two decades, in Latin America in the last decade, and Mexico in particular cerebral endoscopy as part of the minimally invasive neurological surgery, has constituted a significant advance for the treatment of neurological diseases such as congenital or acquired hydrocephalus, Chiari malformation, neurocysticercosis, stroke, ventricular and paraventricular tumors and cysts, arachnoidal cyst and hydrocephalus secondary to shunt malfunction. The lateral ventricles, the third ventricle, the cerebral aqueduct, the fourth ventricle, and the subarachnoid basal cisterns are among the most non accessible regions of the central nervous system. Due to light rand fiber optic systems in combination with the experiences of nine consecutive year's and more than 600 endoscopies, most of them flexible neuroendoscopies, we present the neuroendoscopic approach with flexible cerebral endoscope to the anatomy and its normal variants of the whole ventricle system and the subarachnoid basal cisterns including the subarachnoid space of the cervical spine. We also describe their site related structures including veins, arteries, cranial nerves, pituitary gland, choroidal plexus and their normal anatomic variants.

Sistema ventricular: anatomia e patologia aplicadas ao diagnóstico por imagem / Ventricular system: anatomy and pathological diseases related to the diagnostic imaging

O sistema ventricular encefálico (SV) é composto por câmaraspreenchidas por líquido cefalorraquidiano (LCR), localizadasno interior do encéfalo e revestidas por epêndima.Vários fenômenos patológicos comprometem a morfologia econteúdo dos ventrículos, tais como: malformações congênitas,neoplasias, neurofacomatoses, lesões inflamatórias,hemorragias e processos obstrutivos da circulação liquórica.O objetivo do presente estudo é fazer uma revisão da anatomiae patologia do SV com ênfase para o diagnóstico por imagem

Evaluation of location of mandibular and mental foramina in dry, young, adult human male, dentulous mandibles

The present study was undertaken to determine the precise location of the mental and mandibular foramina and the surrounding anatomic landmarks. Measurements were made on both right and left sides of each of 34 dried young Turkish adult (30-40 years old) human male mandibles. The mandibles were moderately robust and were from dentulous subjects. The results obtained in the study showed that the distance of the mandible foramen to the angle of the anterior ramus were 16.9 mm on the right and 16.78 mm on the left. The distance to the posterior side of the ramus was 14.09 mm on the right, and 14.37 mm on the left. The narrowest anteroposterior diameters were 32.8 mm on the right and 32.05 on the left. The mandibular foramen is 0.5 mm posterior to the centre of the ramus on the right and 0.75 mm on the left. The distance of the lowest point of mandibular notch to the foramen was 22.37 mm on the right and 22.17 mm on the left. The distance from the mandibular foramen to the inferior border of the ramus in the mid position of the ramus was 30.97 mm on the right and 29.75 mm on the left. The average angle of the mandible (gonial angle) was 120.17 on both sides. The distance of the mental foramen to inferior border of the mandible was 14.61 mm and 14.29 mm on the right and left, respectively. Its distance to the superior border was 13.62 mm on the right and 14.62 mm on the left. The horizontal dimensions of the mental foramen was 2.93 mm on the right, 3.14 mm on the left and its vertical dimension was 2.38 mm on the right and 2.64 mm on the left. The mental foramen was located below the root of the second premolar in 21 bones (61.76 percent) on the right and 17 bones (50 percent) on the left while in the remaning mandibles, the foramen was present between the roots of the first and second premolars in 13 bones (38.2 percent) on the right and 17 (50 percent) on the left. The average angle of the mental foramen was 96.82 degrees. (AU)

Utilizaçäo de peças anatômicas de cadáver e o ensino médico / Anatomical preparations from human cadavers and medical education

Este trabalho teve como objetivo avaliar, pelo estudo da anatomia das estrias medulares no assoalho do IV ventrículo (fossa rombóide), como exemplo, a importância e necessidade de peças anatômicas, obtidas de cadáveres humanos, no ensino e aprendizagem de alunos em secolas médicas. Foram utilizados 35 troncos do encéfalo, fixados em formol 4 por cento, sendo numerados de 1 a 35, para o estudo macroscópico de cada peça anatômica, com registro do número e posição relativa das estrias medulares no assoalho do IV ventrículo, em ambos os lados do sulco mediano. Foram encontradas 11 peças (31 por cento) somente com estrias transversas e oblíquas simultaneamente, 2 (6 por cento) somente com estrias oblíquas e 6 (17 por cento) com ausência de estrias medulares em ambos os lados do sulco mediano. Pelo padrão de posição, das estrias medulares, encontrado, foi concluído que há a necessidade da utilização de peças anatômicas de cadáveres para o estudo do corpo humano normal, devido suas variações não serem observadas em peças anatômicas sintéticas e nos programas de multimídia, que devem ser utilizados apenas como complementares dos estudos anatômicos e não como substitutos do método convencional