Anatomic study of the deep structures of the cerebellum: location of the dentate nucleus and its relationship with surgical approaches to tumor lesions.

Abstract

Introduction and objectives: The cerebellum presents complex relationships, such as those with the structures of the cerebello pontine angle and a complex anatomy consisting of surfaces, lobes, lobules, peduncles, and nuclei. On this matter, the cerebellum is a challenging structure to approach which has important relationships that if not taken in account may lead to an injury and may not possibly reduce morbidity and mortality. Our objective is to present a system of anatomic and topographic landmarks to identify the dentate nucleus (DN) during the supracerebellar infratentorial approach.

Materials and methods: Postmortem dissections were performed on 10 cerebella according to the Klingler technique. Anatomy was observed and then a deep dissection was performed, identifying the peduncles and then the DN. Subsequently, the DN was delineated with four lines α, β, γ, and Ω, allowing to find the DN within 100% of cases. Finally, the number of times the nucleus was found within the quadrilateral was observed.

Results: The lobules of the vermis and hemispheres were identified on the tentorial and suboccipital surfaces, with the superior (SCP), middle (MCP), and inferior (ICP) cerebellar peduncles recognized on the tentorial surface and the MCP on the suboccipital surface. The DN was identified on both aspects.

Conclusion: There are no landmarks to locate the DN during surgery, our proposal of a quadrilateral that allows intraoperative localization of the nucleus reduce the morbidity and mortality of the surgery of the cerebellum.