Article
Neural architecture of the septum pellucidum – an anatomical study and considerations for safe endoscopic septum pellucidotomy
Neuraler Aufbau des Septum pellucidum – eine anatomische Studie und Überlegungen zur sicheren endoskopischen Septum pellucidotomie
Search Medline for
Authors
-
Laszlo Barany
- Semmelweis Universität, Anatomisches, Histologisches und Embryologisches Institut, Budapest, Hungary
-
Cintia Meszaros
- Semmelweis Universität, Anatomisches, Histologisches und Embryologisches Institut, Budapest, Hungary
-
Oliver Ganslandt
- Klinikum Stuttgart, Neurochirurgische Klinik, Stuttgart, Deutschland
-
Michael Buchfelder
- Friedrich-Alexander-University Erlangen-Nürnberg, Neurochirurgische Klinik, Erlangen, Deutschland
-
Peter Kurucz
- Klinikum Stuttgart, Neurochirurgische Klinik, Stuttgart, Deutschland; Friedrich-Alexander-University Erlangen-Nürnberg, Neurochirurgische Klinik, Erlangen, Deutschland
| Published: | May 8, 2019 |
|---|
Outline
Text
Objective: The endoscopic septum pellucidotomy is a well-known surgical treatment method in case of unilateral and specific case of bilateral hydrocephalus. The fenestration should be performed on an avascular area of the septum to preserve the deep venous drainage and far away from the fornices to avoid injury of the limbic system. The microsurgical and endoscopic anatomy of the septal veins is well described but interestingly, no study was addressed to the neural fibres of the septum pellucidum before. The aim of our work was to identify these neural elements and examine their relations to the septal veins as well as major landmarks within the ventricular system.
Methods: According to Klinger’s fibre dissection method, 5 human brains (10 septum pellucidum) were fixed in 10% formalin solution. A central block containing the septum pellucidum was removed and freezed on -30 °C for 2 weeks. The fibres of the septum pellucidum and the adjacent areas including their venous elements, were dissected under 7-14x magnification using custom-made wooden spatulas and microsurgical instruments. In 1 case, two septum pellucidum was sliced into 5 portions and after embedding into paraffin, histological examinations were made to distinguish the neural structures and correspond them to the findings of the fibre dissections.
Results: The septum pellucidum and the subjacent septum verum form the medial wall of the anterior horn of the lateral ventricle. Both structures contain nerve fibres that were organized in 3 groups: 1) fibres originated from the fornix to the corpus callosum in the dorsal part of the septum pellucidum; 2) fibres originated from the fornix to the lower septal nuclei rostral to the columna fornicis; and 3) fibres over the rostrum corporis callosi to the genu corporis callosi. The area exactly rostral from the columna fornicis consisted of macroscopically identifiable grey matter. Their relations to the anterior commissure, the fornix, the mammillothalamic and the mammillotegmental fascicles, the stria terminalis and the stria medullaris thalami as well as to the major septal veins were described in all cases. The histological observation confirmed the results of the macroscopic fibre dissections.
Conclusion: The septum pellucidum consists of macroscopically identifiable neural components. Beside the venous anatomy, these neural elements should be also considered during endoscopic fenestration of the septum pellucidum.
