Wolfgang Seeger Anatomical for Dissections Use i n Neurosurgery 1 Vol. In Collaboration with H. R. Eggert Springer-Verlag Wien NewYork Prof. Dr. med. WOLFGANG SEEGER Medical Director ofthe Department of General Neurosurgery and Chairman of Neurosurgery of the Neurosurgical Clinic PD Dr. HANS-RuDOLF EGGERT Department of General Neurosurgery, Neurosurgical Clinic University ofFreiburg i. Br., Federal Republic of Germany With 150 Figures This work is subject to copyright All rights are reserved, whether the wholeor partofthe material isconcerned, specificallythoseoftranslation,reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks © 1987 by Springer-VerlaglWien Printed in Austria Library ofCongressCataloging-in-Publication Data Seeger, Wolfgang, 1929- . Anatomical dissections for use in neurosurgery. Includes bibliographies and index. 1. Brain-Surgery. 2. Brain-Dissection. I. Eggert, H. R. (Hans-Rudolf) II. Title. [DNLM: 1. Brain-anatomy & histology. 2. Dissection. 3. Neurosurgery methods. WL 368S451a] RD594.S423 1987. 617'.48 .87-16692. ISBN 3-211-81998-3 Springer-Verlag Wien-New York ISBN 0-387-81998-3 Springer-Verlag New York-Wien Dr. Karl Vossschuite Professor emeritus of Surgery, Justus-Liebig-Universitiit Giessen to his anniversary 8()h PREFACE '-- 1VII ---1 Preface This book is published in two volumes. Velum medullare posterior in the area of the 4th In this first volume, an attempt is made to give young ventricle, including the choroid point of the PICA, neurosurgeons methodical instruction in the dissec can be studied exactly. These examples were chosen tion of formaldehyde-preserved brains. This book, because exact topographical knowledge of these ves however, is not intended to be taken as a textbook on sel-richstructuresisofteninadequate; andwhenusing anatomy. Conventional presentations ofthe anatomy modern operative techniques, increasingly more op ofthe brain must present, step by step, the individual erations are performed in just these particular areas. systems of the organ according to its developmental These dissections compose the content of the first and functional aspects, e. g. cortex, limbic system, volume. basal ganglia, brainstem, and cerebellum. Because The second volume is intended for experienced during a single operation the neurosurgeon is some neurosurgeons who performcomplexoperationsdeep times confronted with all the various systems, it is inside the brain. Some of these operations have be necessary to perform brain dissections from the view come standardized, e. g. the opening of the sylvian point of operative approaches. Therefore, in this fissure with operations in the area of the Insula and work the attempt is made to keep certain individual cranial base. Other complex operations are per surface structures, e. g. the Gyrus praecentralisintact formed seldom even today, e. g. approaches to the until the end of the dissection so that the relative 3rd ventricle, Velum interpositum, lateral ventricle, topographical positions ofsurface and deep structures Cisterna tecti, Lobulus quadrangularis cerebelli, to can be made discernable. For these reasons, it is name just a few. Before such operations, it is advis advisable to view the surface structures ofthe brain in able (the authorstilldoesso occasionally) toorientate relationship to the skull, but then to start with re oneself on a formaldehyde-preserved brain. It is movingthe bloodvessels andleptomeninges so thatin shown how on a formaldehyde-preserved brain, even this way the skeletonized organ is dissected step by though itdoes not provide the realconditionsofalive step, because in the preserved vascular system, the brain under the operative microscope, the most im structures are only partially recognizable and thus portant topographical relationships can be recog confusing. For this dissection two organs are needed. nized. In the first dissection, the cerebrum and cerebellum Both volumes are the result of a one-year dissection are studied. These the young neurosurgeon should course for colleagues meeting twice a week in our have become familiar during his initial training in the clinic. The specimens depicted originate from these surgeryofsurfacestructures. In the seconddissection, disse~tions or from the author himself. the relationship between deep-seated parts, the ven In order to achieve as true and lifelike as possible a tricular system and surface structures are of major representation, certain specimens were chosen and importance. photographed in various positions by my colleague Experience has shown that during such a dissection Priv.-Doz. Dr. H. R. Eggert. Slides of these photo for thefirst timeseveralmistakes are madesothat the graphs were projected and then the author copied specimen is rather damaged by the end of the dissec them in India ink, whereby the essential structures tion, the deeper structures should be more carefully were brought out more clearly and others were left studied during the second dissection. During the sec out. The authoralso thanks Priv.-Doz. Dr. H. R. Eg ond dissection, the vessels and the leptomeninges can gert for several suggestions on presention and dissec be preserved, not just on the outer surface of the tion techniques. ~brain but also especially in their depth so that the Special appreciation is due to Prof. Dr. anatomical structure of the Velum interpositum be J. Staubesand, Directorofthe Institute ofAnatomy I tween the Thalami and Fornices, the structure of the ofthe University ofFreiburg, and Prof. Dr. B. Volk, VIII &...1 1PREFACE ---1 Director of the Institute of Neuropathology of the sible for a portion of the translation. The manuscript University ofFreiburg, for their advice and help. For was typed by Mrs. T. Masyk and Mr. G. Forster. her help in assembling and arranging of the material Finally, I wish to express my appreciation to the and especially for her corrections of the text, special Springer Publishing Company for their invariably thanks are due to my secretary for many years, courteous cooperation over the years and for the Mrs. Ermy Hilsenbek-Hottek. Mrs. K. Weigand, of excellent layout of the books. Linden by Giessen and H. H. Gossman, M. B., B. S., F. R. C. S., Plymouth/Devonshire are respon- Freiburg, June 1987 WolfgangSeeger CONTENTS IX L-J ----11 Contents Part I Anatomical Dissection of the Brain After Removal of Leptomeninges and Vessels (Figs. 1 to 57) Chapter 1 Basic Principles (Figs. 1 to 5) 2 Chapter 2 Lateral and Medial Cortex cerebri (Figs. 6 to 22) 12 Chapter 3 Basal Ganglia, Lateral and 3rd Ventricle (Figs. 23 to 32) 46 Chapter 4 Cerebellum and 4th Ventricle (Figs. 33 to 57) 66 Part II Anatomical Dissection of the Brain. Leptomeninges and Vessels Preserved (Figs. 58 to 150) Chapter 5 Supratentorial Structures (Figs. 58 to 134) 118 Chapter 6 Infratentorial Structures (Figs. 135 to 150) 272 References 305 Subject Index 311 Part I Anatomical Dissection of the Brain After Removal of Leptomeninges and Vessels (Figs. 1 to 57) '- BASIC PRINCIPLES ....JJ 2 LI Chapter 1 Basic Principles (Figs. 1 to 5) Fig. 1 A to 8' Most important instruments for anatomical dissection D to I Special instruments ======================------ ==========================::JI FIG. 1 3 CI-I-- 1 ® see®® \-------=-- ,..---__---.J1 E e u u