Background: Neurosurgical management of cerebellar lesions remains challenging. Thus, it is important to have sound knowledge on microsurgical anatomy of the cerebellum and dentate nucleus and to define different types of exposure in a variety of surgical interventions.
Objective: To examine the anatomy of the dentate nucleus (DN) from a neurosurgical viewpoint using fiber tracking techniques.
Methods: Ten formalin-fixed human hemispheres were dissected using Klingler’s fiber-dissection technique under 6X-40X magnification. Anatomical images were created with three-dimensional Diffuse Tensor Imaging (DTI). The relationship of the DN to tentorium, suboccipital and lateral surfaces of the cerebellum, and its spatial positioning relative to different surgical approaches in the cerebellum and fourth ventricle were examined. The fiber tracts terminating at and surrounding the DN were defined.
Results: The DN is at greater risk of being injured in the transvermian and supratonsillar approaches to the cerebellum and fourth ventricle, with lesser risk in the telovelar and subtonsillar approaches. Superior approaches are safer compared to other approaches.
Conclusion: The DN represents an important anatomical structure in surgical interventions involving the posterior fossa, particularly in the elderly due to the common occurrence of atrophy-related problems in this age group. Functionally and anatomically, the DN has close relations with the superior and middle cerebellar peduncles. The inferior cerebellar peduncle poses positional risks, as it follows an anterior and superior course relative to the DN. The telovelar approach is a safer procedure for interventions involving the pathological lesions of the fourth ventricle floor.
From: The Dentate Nucleus and its Projection System in the Human Cerebellum: A Microsurgical Anatomical Study Dentate Nucleus Microsurgical Anatomical Study by Rhoton et al.