{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T09:45:27Z","timestamp":1790329527425,"version":"4.1.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2018,5,10]],"date-time":"2018-05-10T00:00:00Z","timestamp":1525910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Treatment of intrinsic lesions of the ventral brainstem is a surgical challenge that requires complex skull base antero- and posterolateral approaches. More recently, endoscopic endonasal transclival approach (EETA) has been reported in the treatment of selected ventral brainstem lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>In this study we explored the endoscopic ventral brainstem anatomy with the aim to describe the degree of exposure of the ventral safe entry zones. In addition, we used a newly developed method combining traditional white matter dissection with high-resolution 7T magnetic resonance imaging (MRI) of the same specimen coregistered using a neuronavigation system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Eight fresh-frozen latex-injected cadaver heads underwent EETA. Additional 8 formalin-fixed brainstems were dissected using Klingler technique guided by ultra-high resolution MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The EETA allows a wide exposure of different safe entry zones located on the ventral brainstem: the exposure of perioculomotor zone requires pituitary transposition and can be hindered by superior cerebellar artery. The peritrigeminal zone was barely visible and its exposure required an extradural anterior petrosectomy. The anterolateral sulcus of the medulla was visible in most of specimens, although its close relationship with the corticospinal tract makes it suboptimal as an entry point for intrinsic lesions. In all cases, the use of 7T-MRI allowed the identification of tiny fiber bundles, improving the quality of the dissection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Exposure of the ventral brainstem with EETA requires mastering surgical maneuvers, including pituitary transposition and extradural petrosectomy. The correlation of fiber dissection with 7T-MRI neuronavigation significantly improves the understanding of the brainstem anatomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opy080","type":"journal-article","created":{"date-parts":[[2018,5,9]],"date-time":"2018-05-09T23:30:30Z","timestamp":1525908630000},"page":"239-249","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":17,"title":["Endoscopic Endonasal Transclival Approach to the Ventral Brainstem: Anatomic Study of the Safe Entry Zones Combining Fiber Dissection Technique with 7 Tesla Magnetic Resonance Guided Neuronavigation"],"prefix":"10.1227","volume":"16","author":[{"given":"Alessandro","family":"Weiss","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital of Livorno, Livorno, Italy"},{"name":"Laboratory of Surgical NeuroAnatomy (LSNA), University of Barcelona, Barcelona, Spain"},{"name":"Microneurosurgical Laboratory, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Perrini","sequence":"additional","affiliation":[{"name":"Microneurosurgical Laboratory, University of Pisa, Pisa, Italy"},{"name":"Department of Neurosurgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"De Notaris","sequence":"additional","affiliation":[{"name":"Laboratory of Surgical NeuroAnatomy (LSNA), University of Barcelona, Barcelona, Spain"},{"name":"Division of Neurosurgery, \u201cG. Rummo\u201d Hospital, Benevento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guadalupe","family":"Soria","sequence":"additional","affiliation":[{"name":"Laboratory of Surgical NeuroAnatomy (LSNA), University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alarcon","family":"Carlos","sequence":"additional","affiliation":[{"name":"Laboratory of Surgical NeuroAnatomy (LSNA), University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura","family":"Castagna","sequence":"additional","affiliation":[{"name":"Microneurosurgical Laboratory, University of Pisa, Pisa, Italy"},{"name":"Department of Human Pathology, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lodovico","family":"Lutzemberger","sequence":"additional","affiliation":[{"name":"Microneurosurgical Laboratory, University of Pisa, Pisa, Italy"},{"name":"Department of Neurosurgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orazio Santo","family":"Santonocito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital of Livorno, Livorno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Catapano","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, \u201cG. Rummo\u201d Hospital, Benevento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Kassam","sequence":"additional","affiliation":[{"name":"St. Luke's Medical Center, Aurora Neuroscience Innovation Institute, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Prats-Galino","sequence":"additional","affiliation":[{"name":"Microneurosurgical Laboratory, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,2]]},"reference":[{"issue":"2","key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1227\/NEU.0b013e3181ff9cde","article-title":"Advan-ces in the treatment and outcome of brainstem cavernous malformation surgery","volume":"68","author":"Abla","year":"2011","journal-title":"Neurosurgery"},{"key":"bib2-20240909","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/978-3-7091-6898-1_5","article-title":"Surgery for gliomas and other mass lesions of the brainstem","volume":"22","author":"Bricolo","year":"1995","journal-title":"Adv Tech Stand Neurosurg"},{"issue":"1","key":"bib3-20240909","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/S0090-3019(99)00036-1","article-title":"Cavernous angiomas of the brain stem","volume":"52","author":"Cantore","year":"1999","journal-title":"Surg Neurol."},{"issue":"5","key":"bib4-20240909","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.3171\/2015.4.JNS141945","article-title":"Microsurgical anatomy of safe entry zones to the brainstem","volume":"124","author":"Cavalcanti","year":"2016","journal-title":"J Neurosurg."},{"issue":"6","key":"bib5-20240909","doi-asserted-by":"crossref","first-page":"987","DOI":"10.3171\/jns.1993.78.6.0987","article-title":"A study of safe entry zones via the floor of the fourth ventricle for brain-stem lesions","volume":"78","author":"Kyoshima","year":"1993","journal-title":"J Neurosurg"},{"issue":"3 suppl 1","key":"bib6-20240909","first-page":"9","article-title":"Microsurgical anatomy of the safe entry zones on the anterolateral brainstem related to surgical approaches to cavernous malformations","volume":"62","author":"Recalde","year":"2008","journal-title":"Neurosurgery"},{"issue":"suppl 4)","key":"bib7-20240909","first-page":"602","article-title":"Three-dimensional microsurgical anatomy and the safe entry zones of the brainstem","volume":"10","author":"Yagmurlu","year":"2014","journal-title":"Neurosurgery"},{"issue":"1-2","key":"bib8-20240909","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s101430100179","article-title":"Cerebral cavernomas in the adult. 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