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Typical and atypical neurovascular relations of the trigeminal nerve in the cerebellopontine angle: an anatomical study.

Domenii publicaţii > Ştiinţe medicale + Tipuri publicaţii > Articol în revistã ştiinţificã

Autori: Rusu MC, Ivascu RV, Cergan R, Paduraru D, Podoleanu L.

Editorial: Springer, Surg Radiol Anat., 31(7), p.507-516, 2009.


The aim of the present study was to anatomically evaluate in adults the
neurovascular trigeminal relations in the cerebellopontine angle (CPA), from a
morphological and topographical perspective and thus to improve, detail and
debate the pre-existing information, with educational and surgical implications.
For the present anatomical study we performed bilateral dissections on 20 human
adult skull bases, in formalin-fixed cadavers, at the level of the
cerebellopontine angle, using the anatomical superior approach; we also studied
20 additional drawn specimens-cerebellum and brainstems, from autopsied cadavers,
in order to better document the vasculature at the trigeminal root entry zone
(REZ). The most constant but not exclusive neurovascular relations of the
trigeminal nerves were those with the superior cerebellar artery (SCA) and the
superior petrosal vein (the petrosal vein of Dandy). The regular possibility for
the SCA to appear divided into a medial and a lateral branch and these to
represent individual trigeminal relations at the level of the pontine cistern or
REZ must not be neglected. The petrosal vein tributaries can also represent
superior, inferior, or interradicular trigeminal relations. Arterioles emerging
from the SCA or the anterior inferior cerebellar artery (AICA) represented
trigeminal relations either at the REZ or were coursing between the trigeminal
roots. A dissected specimen presented a radicular trigeminal artery emerging from
the basilar artery and entering the trigeminal cavum inferior to the nerve.
Another specimen presented two bony lamellae superior to the trigeminal nerve at
the entrance in the trigeminal cavum-these lamellae were embedded within the
lateral border of tentorium cerebelli and the posterior petroclinoid ligament. So
we bring here an evidence-based support extremely useful not only for specialists
dealing with this area but also for educational purposes. It appears important
not only to consider the typical anatomy at this level but also to take into
account the atypical and hardly predictable morphologies that may alter the
diagnoses and the specific surgical procedures.

Cuvinte cheie: Pontine cistern, Petrosal vein, Cerebellar artery, Trigeminal artery, Cavum of Meckel