Artikel
Primary obstruction of the foramen of Luschka: anatomy, histology and clinical significance
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Autoren
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Laszlo Barany
- Semmelweis University, Department of Anatomy, Histology and Embryology, Budapest, Ungarn
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Gabor Baksa
- Semmelweis University, Department of Anatomy, Histology and Embryology, Budapest, Ungarn
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Lajos Patonay
- Semmelweis University, Department of Anatomy, Histology and Embryology, Budapest, Ungarn
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Gergely Racz
- Semmelweis University, 1st Department of Pathology and Experimental Cancer Research, Budapest, Ungarn
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Oliver Ganslandt
- Klinikum Stuttgart, Neurochirurgische Klinik, Stuttgart, Deutschland
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Michael Buchfelder
- Friedrich-Alexander-University Erlangen-Nürnberg, Neurochirurgische Klinik, Erlangen, Deutschland
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Peter Kurucz
- Klinikum Stuttgart, Neurochirurgische Klinik, Stuttgart, Deutschland; Friedrich-Alexander-University Erlangen-Nürnberg, Neurochirurgische Klinik, Erlangen, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: The foramen of Luschka is a natural hole between the fourth ventricle and the subarachnoid space of the cerebellopontine angle (CPA). The obstruction of the foramen is a rare entity with primary and secondary forms. The secondary form is a result of various pathologies, while the primary form is seen as a membrane closing the foramen without any signs of underlying pathology. The available data about this variant and its role in the development of CPA cysts are contradictory in the literature.
Methods: Sixty-one formaline fixed human brains (122 foramina of Luschka) were involved in this study. The macroscopic and histologic features of the primary closure were examined. The slides were stained with hematoxylin-eosin, AZAN and Luxol fast-blue combined with cresyl-violet and impregnated with silver according to Gallyas’s method. Three different sized rhomboid lips with the lateral recess and one sample of cerebellar cortex with all leptomeningeal layers were used for the comparison. Five operated cases of Luschka diverticulum were included in this study. A selected case is presented in detail to illustrate our anatomical and histologic findings and support them with intraoperative as well as radiological observations.
Results: Primary obstruction of the foramen of Luschka was present in 11/122 cases (9.01%). It presented as pouch containing a choroid plexus and communicating with the fourth ventricle in the CPA in all the cases. In one case, we found a significantly enlarged, thick-walled and rigid pouch with a widened lateral recess and irregular over-sized and loop-shaped choroid plexus in its cavity. The wall of the membrane in primary obstruction was composed of three different layers in all cases: (1) an inner ependymal, (2) a middle glial and (3) an outer leptomeningea layerl. The histological features of the rhomboid lip were the same, irrespective of their size.
Conclusion: The rhomboid lip is a remnant of the fourth ventricle’s roof. The imperforation of the foramen of Luschka results in a choroid plexus (the so-called Bochdalek’s flower basket) containing pouch in the CPA, communicating with the fourth ventricle. This pouch has the potential of growing to a diverticulum and cause clinical symptoms. According to our clinical cases, a detailed description of radiological and surgical-anatomical criteria was presented and treatment strategies were suggested to support the differential diagnosis of a Luschka diverticulum.
