title: Mapping the Internal Anatomy of the Lateral Brainstem: Anatomical Study with Application to Far Lateral Approaches to Intrinsic Brainstem Tumors.
abstract: BACKGROUND
  Intramedullary brainstem tumors present a special challenge to the neurosurgeon. Unfortunately, there is no ideal part of the brainstem to incise for approaches to such pathology. Therefore, the present study was performed to identify what incisions on the lateral brainstem would result in the least amount of damage to eloquent tracts and nuclei. Case illustrations are also discussed.
  
  
  METHODS
  Eight human brainstems were evaluated. Based on dissections and the use of standard atlases of brainstem anatomy, the most important deeper brainstem structures were mapped to the surface of the lateral brainstem.
  
  
  RESULTS
  With these data, we defined superior acute and inferior obtuse corridors for surgical entrance into the lateral brainstem that would minimize injury to deeper tracts and nuclei, the damage to which would result in significant morbidity.
  
  
  CONCLUSIONS
  To our knowledge, a superficial map of the lateral brainstem for identifying deeper lying and clinically significant nuclei and tracts has not previously been available. Such data might decrease patient morbidity following biopsy or tumor removal or aspiration of brainstem hemorrhage. Additionally, this information can be coupled with the previous literature on approaches into the fourth ventricular floor for more complex, multidimensional lesions.
authors.affiliation: Seattle Science Foundation.
authors.forename: Joe
authors.initials: J
authors.lastname: Iwanaga
authors.affiliation: Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies.
authors.forename: Andre
authors.initials: A
authors.lastname: Granger
authors.affiliation: Neurological Surgery, Thomas Jefferson University.
authors.forename: Payman
authors.initials: P
authors.lastname: Vahedi
authors.affiliation: Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies.
authors.forename: Marios
authors.initials: M
authors.lastname: Loukas
authors.affiliation: Neurosurgery, Complex Spine, Swedish Neuroscience Institute.
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Oskouian
authors.affiliation: Saarland University Faculty of Medicine, Saarland University Medical Center.
authors.forename: Fabian N
authors.initials: FN
authors.lastname: Fries
authors.affiliation: Neurosurgery, Tabriz University of Medical Sciences.
authors.forename: Iraj
authors.initials: I
authors.lastname: Lotfinia
authors.affiliation: Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Mortazavi
authors.affiliation: Pediatric Neurosurgery, Children's of Alabama.
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
authors.affiliation: Neurosurgery, Seattle Science Foundation.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
keywords: anatomy; approaches; morbidity; neurosurgery; nuclei