title: Topographic anatomy of the cochlear nuclear region at the floor of the fourth ventricle in humans.
abstract: OBJECTIVE
  The development of appropriate methods to stimulate the dorsal and ventral cochlear nucleus by means of an auditory brainstem implant in patients with acquired bilateral anacusis requires a detailed topoanatomical knowledge both of the location and extension of the nuclear surface in the fourth ventricle and lateral recess and of its variability. The goal of this study was to provide that information. Anatomically, it is possible to use a midline surgical approach to the fourth ventricle rather than the translabyrinthine and suboccipital routes of access used hitherto. This is especially useful if severe scarring, which occurs as a result of tumor removal in the cerebellopontine angle, make the orientation and placement of an auditory brainstem implant via a lateral surgical approach difficult. There have been only a few studies, involving single cases and small series of patients, in which the focus was the exact extension of the cochlear nuclei, whose microsurgically relevant position in relation to the surface structures is not known in detail.
  
  
  METHODS
  Landmarks that are important for the placement of an auditory brainstem implant through the fourth ventricle were examined and measured in a large series of 28 formalin-fixed human brainstems. In all cases, these examinations were supplemented by addition of a histological section series. For the first time values of unfixed fresh brainstem tissue were determined. Anatomical features are discussed with regard to their possible neurosurgical relevance, taking into account inter- and intraindividual variability.
  
  
  CONCLUSIONS
  The midline approach would provide an opportunity to stimulate the whole area of the dorsal as well as the ventral cochlear nucleus with an auditory brainstem implant.
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, University of Cologne, Germany. ralf.quester@uni-koeln.de
authors.forename: R
authors.initials: R
authors.lastname: Quester
authors.forename: R
authors.initials: R
authors.lastname: Schröder
mesh_terms: D000328:Adult; D000368:Aged; D048588:Benzoxazines; D001933:Brain Stem / Q000033:anatomy & histology; D002530:Cerebellopontine Angle / Q000033:anatomy & histology; D002531:Cerebellum / Q000033:anatomy & histology; D002552:Cerebral Ventricles / Q000033:anatomy & histology* / Q000601:surgery; D017626:Cochlear Nucleus / Q000033:anatomy & histology* / Q000601:surgery; D004396:Coloring Agents; D003638:Deafness / Q000601:surgery; D004801:Eosine Yellowish-(YS); D005404:Fixatives; D005456:Fluorescent Dyes; D005557:Formaldehyde; D006416:Hematoxylin; D006801:Humans; D007211:Indoles; D008866:Microsurgery; D008875:Middle Aged; D010078:Oxazines; D016612:Paraffin Embedding; D019919:Prosthesis Implantation; D000159:Vestibulocochlear Nerve / Q000033:anatomy & histology
chemical_list: D048588:Benzoxazines; D004396:Coloring Agents; D005404:Fixatives; D005456:Fluorescent Dyes; D007211:Indoles; D010078:Oxazines; C018588:Luxol Fast Blue MBS; D005557:Formaldehyde; C028911:cresyl violet; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin