{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:47:20Z","timestamp":1783774040512,"version":"3.55.0"},"reference-count":58,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>Brainstem surgery remains a challenge for the neurosurgeon despite recent improvements in neuroimaging, microsurgical techniques, and electrophysiological monitoring. A detailed knowledge of the microsurgical anatomy of the brainstem surface and its internal architecture is mandatory to plan appropriate approaches to the brainstem, to choose the safest point of entry, and to avoid potential surgical complications.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>An extensive review of the literature was performed regarding the brainstem surgical approaches, and their correlations with the pertinent anatomy were studied and illustrated through dissection of human brainstems properly fixed with 10% formalin. The specimens were dissected using the fiber dissection technique, under \u00d76 to \u00d740 magnification. 3D stereoscopic photographs were obtained (anaglyphic 3D) for better illustration of this study.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The main surgical landmarks and their relationship with the cerebellum and vascular structures were identified on the surface of the brainstem. The arrangements of the white matter (ascending and descending pathways as well as the cerebellar peduncles) were demonstrated on each part of the brainstem (midbrain, pons, and medulla oblongata), with emphasis on their relationships with the surface. The gray matter, constituted mainly by nuclei of the cranial nerves, was also studied and illustrated.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The objective of this article is to review the microsurgical anatomy and the surgical approaches pertinent to the brainstem, providing a framework of its external and internal architecture to guide the neurosurgeon during its related surgical procedures.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.4.jns132778","type":"journal-article","created":{"date-parts":[[2015,10,30]],"date-time":"2015-10-30T10:03:06Z","timestamp":1446199386000},"page":"1377-1395","source":"Crossref","is-referenced-by-count":67,"title":["Microsurgical anatomy and internal architecture of the brainstem in 3D images: surgical considerations"],"prefix":"10.3171","volume":"124","author":[{"given":"Richard Gonzalo","family":"P\u00e1rraga","sequence":"first","affiliation":[{"name":"Institute of Neurological Sciences (ICNE), S\u00e3o Paulo;"},{"name":"Microneurosurgery Laboratory, Benefic\u00eancia Portuguesa Hospital, S\u00e3o Paulo;"},{"name":"Department of Neurological Surgery, Hospital UNIVALLE, Cochabamba-Cercado, Bolivia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Loss","family":"Possatti","sequence":"additional","affiliation":[{"name":"Institute of Neurological Sciences (ICNE), S\u00e3o Paulo;"},{"name":"Microneurosurgery Laboratory, Benefic\u00eancia Portuguesa Hospital, S\u00e3o Paulo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael Vicente","family":"Alves","sequence":"additional","affiliation":[{"name":"Institute of Neurological Sciences (ICNE), S\u00e3o Paulo;"},{"name":"Microneurosurgery Laboratory, Benefic\u00eancia Portuguesa Hospital, S\u00e3o Paulo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Carvalhal","family":"Ribas","sequence":"additional","affiliation":[{"name":"Department of Surgery-LIM 02, University of S\u00e3o Paulo Medical School (FMUSP), S\u00e3o Paulo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U\u011fur","family":"T\u00fcre","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evandro","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Institute of Neurological Sciences (ICNE), S\u00e3o Paulo;"},{"name":"Microneurosurgery Laboratory, Benefic\u00eancia Portuguesa Hospital, S\u00e3o Paulo;"},{"name":"Department of Neurosurgery, State University of Campinas (UNICAMP), Campinas, S\u00e3o Paulo, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns132778","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1227\/NEU.0b013e3181ff9cde","article-title":"Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients","volume":"68","author":"Abla","year":"2011"},{"key":"b2-jns132778","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"922","DOI":"10.3171\/jns.2002.97.4.0922","article-title":"Comparison of different infratentorial-supracerebellar approaches to the posterior and middle incisural space: a cadaveric study","volume":"97","author":"Ammirati","year":"2002"},{"key":"b3-jns132778","series-title":"Op Tech Neurosurg","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1053\/oy.2000.6559","article-title":"Surgical management of intrinsic brain stem gliomas","volume":"3","author":"Bricolo","year":"2000"},{"key":"b4-jns132778","series-title":"Adv Tech Stand Neurosurg","doi-asserted-by":"publisher","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"},{"key":"b5-jns132778","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/S0090-3019(99)00036-1","article-title":"Cavernous angiomas of the brain stem. 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