Artikel
Endoscopic anatomy of the arachnoid membrane system of the human brain
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Autoren
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Peter Kurucz
- Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany; Laboratory of Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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Gabor Baksa
- Laboratory of Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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Lajos Patonay
- Laboratory of Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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Firas Thaher
- Laboratory of Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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Nikolai J. Hopf
- Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: The safe use of endoscopic techniques in skull base surgery requires a very detailed knowledge of anatomy of the basal cisterns. Not only their neurovascular contents are important but also the membranous arachnoid structures separating them from each other. The anatomy of these membranes as a whole, interconnected construct was never studied before. The aim of this work was to map and describe the endoscopic anatomy of these structures and recognize a possible higher level of systematic organization in their relations.
Methods: Anatomical dissections were done on a total of 127 fresh human cadavers. Rigid endoscopes were introduced through defined keyhole craniotomies and the anatomical relations of the arachnoid on the entire skull base was step-by-step explored and described.
Results: It was possible to recognize a complex, systematic organization in the topography of the arachnoid membranes. 43 individual arachnoid membranes were found, which are in strong connection to each other, forming a complex, three-dimensional membrane construct which we called the "arachnoid membrane System". This system can be further divided to five distinct “arachnoid membrane groups”, namely: the carotid, the Sylvian, the tentorial, the clival and the perimedullary membrane group. Each membrane group has an exact three-dimensional geometrical shape build by the interconnected individual membranes and located on certain, anatomically well-defined regions of the skull base. The neurovascular relations, common variations and endoscopically important aspects of each individual membranes were studied and described in details.
Conclusions: The appropriate use of the newest optical modalities in skull base surgery needs more finer and detailed knowledge of anatomy. These results are important not only for approach planning and intraoperative orientation with the endoscope but also essential in understanding the mechanism of CSF circulation disorders.
