Summary
Brain stem map** (BSM) is an intraoperative neurophysiological procedure to localize cranial motor nuclei on the floor of the fourth ventricle. BSM enables neurosurgeon to understand functional anatomy on the distorted floor of the fourth ventricle, thus, it is emerging as an indispensable tool for challenging brain stem surgery. The authors described the detail of BSM with the special emphasis on its clinical application for the brain stem lesion. Surgical implications based on the result of brains stem map** would be also informative before planning a brain stem surgery through the floor of fourth ventricle.
Despite the recent advancement of MRI to depict the lesion in the brain stem, BSM remains as the only way to provide surgical anatomy in the operative field. BSM could guide a neurosurgeon to the inside of brain stem while preventing direct damage to the cranial motor nuclei on the floor of the fourth ventricle. It is expected that understanding its advantage and limitations would help neurosurgeon to perform safer surgery to the brain stem lesion.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
A Bricolo S Turazzi (1995) ArticleTitleSurgery for gliomas and other mass lesions of the brainstem Adv Tech Stand Neurosurg 22 261–341 Occurrence Handle1:STN:280:BymD2sjkvFE%3D Occurrence Handle7495420
Deletis V (1993) Intraoperative monitoring of the functional integrity of the motor pathways. In: Devinsky O, Beric A, Dogali M (eds) Electrical and magnetic stimulation of the brain and spinal cord. Raven Press, New York, pp 201–214
V Deletis F Sala N Morota (2000) ArticleTitleIntraoperative neurophysiological monitoring and map** during brainstem surgery. A modern approach Operative technique in Neurosurgery 3 109–113
CCJ Dong DB MacDonald R Akagawa B Westerberg A AlKhani I Kanaan M Hassounah (2005) ArticleTitleIntraoperative facial motor evoked potential monitoring with transcranial electrical stimulation during skull base surgery Clin Neurophysiol 116 588–596 Occurrence Handle10.1016/j.clinph.2004.09.013 Occurrence Handle15721072
W Eisner UD Schmid HJ Reulen R Oeckler V Olteanu-Nerbe C Call K Kothbauer (1995) ArticleTitleThe map** and continuous monitoring of the intrinsic motor nuclei during brain stem surgery Neurosurgery 37 255–265 Occurrence Handle1:STN:280:BymD28jptlY%3D Occurrence Handle7477777
FJ Epstein J-P Farmer (1993) ArticleTitleBrain-stem glioma growth patterns J Neurosurg 78 408–412 Occurrence Handle1:STN:280:ByyC28zovV0%3D Occurrence Handle8433142
F Epstein S Constantini (1996) ArticleTitlePractical decisions in the treatment of pediatric brain stem tumors Pediatr Neurosurg 24 24–34 Occurrence Handle1:STN:280:BymH3MvlvFU%3D Occurrence Handle8817612 Occurrence Handle10.1159/000121011
T Katsuta T Morioka K Fujii M Fukui (1993) ArticleTitlePhysiological localization of the facial colliculus during direct surgery on an intrinsic brain stem lesion Neurosurgery 32 861–863 Occurrence Handle1:STN:280:ByyB287ltVI%3D Occurrence Handle8492867
AN Konovalov A Spallone UB Makhmudov JA Kukhlajeva VI Ozerova (1990) ArticleTitleSurgical management of hematomas of the brain stem J Neurosurg 73 181–186 Occurrence Handle1:STN:280:By%2BA3cflt1I%3D Occurrence Handle2366074
K Kyoshima S Kobayashi H Gibo T Kuroyanagi (1993) ArticleTitleA study of safe entry zones via the floor of the fourth ventricle for brain-stem lesions: report of three cases J Neurosurg 78 987–993 Occurrence Handle1:STN:280:ByyB2Mzkslc%3D Occurrence Handle8487085
J Lang N Ohmachi J Lang Sen (1991) ArticleTitleAnatomical landmarks of the rhomboid fossa (floor of the 4th ventricle), its length and its width Acta Neurochir (Wien) 113 84–90 Occurrence Handle10.1007/BF01402120
N Morota V Deletis FJ Epstein M Kofler R Abbott M Lee K Ruskin (1995) ArticleTitleBrain stem map**: neurophysiological localization of motor nuclei on the floor of the fourth ventricle Neurosurgery 37 922–930 Occurrence Handle1:STN:280:BymC3s7kslc%3D Occurrence Handle8559341
N Morota V Deletis M Lee FJ Epstein (1996) ArticleTitleFunctional anatomic relationship between brain stem tumors and cranial motor nuclei Neurosurgery 39 787–794 Occurrence Handle1:STN:280:ByiD3srhtFw%3D Occurrence Handle8880774
Morota N, Deletis V, Epstein FJ (2002) Brainstem map**. In: Deletis V, Shils JL (eds) Neurophysiology in neurosurgery. Academic Press, New York, pp 319–335
A Pierre-Kahn JF Hirsh M Vinchon C Payan C Sainte-Rose D Renier A Lelouch-Tubiana J Fermanian (1993) ArticleTitleSurgical management of brain stem tumors in children: results and statistical analysis of 75 cases J Neurosurg 79 845–852 Occurrence Handle1:STN:280:ByuD28rptVY%3D Occurrence Handle8246052
IF Pollack HJ Hoffman RP Humphreys L Becker (1993) ArticleTitleThe long-term outcome after surgical treatment of dorsally exophytic brain stem gliomas J Neurosurg 78 859–863 Occurrence Handle1:STN:280:ByyB2MzksFc%3D Occurrence Handle8487066
RW Porter PW Detwiler RF Spetzleer MT Lawton JJ Baskin PT Derksen JM Zabramski (1999) ArticleTitleCavernous malformations of the brainstem: experience with 100 patients J Neurosurg 90 50–58 Occurrence Handle1:STN:280:DyaK1MzjvFGjsg%3D%3D Occurrence Handle10413155
T Sekiya T Hatayama N Shimamura S Suzuki (2000) ArticleTitleIntraoperative electrophysiological monitoring of oculomotor nuclei and their intramedullary tracts during midbrain tumor surgery Neurosurgery 47 1170–1177 Occurrence Handle1:STN:280:DC%2BD3crgvFOlsQ%3D%3D Occurrence Handle11063111
C Strauss J Romstock C Nimsky R Fahlbusch (1993) ArticleTitleIntraoperative identification of motor areas of the rhomboid fossa using direct stimulation J Neurosurg 79 393–399 Occurrence Handle1:STN:280:ByyA28jlvFI%3D Occurrence Handle8360737
C Strauss J Romstock R Fahlbusch (1999) ArticleTitlePericollicular approaches to the rhomboid fossa. Part II. Neurophysiological basis J Neurosurg 91 768–775 Occurrence Handle1:STN:280:DC%2BD3c%2FgslantA%3D%3D Occurrence Handle10541233
K Suzuki M Matsumoto M Ohta T Sasaki N Kodama (1997) ArticleTitleExperimental study for identification of the facial colliculus using electromyography and antidromic evoked potentials Neurosurgery 41 1130–1136 Occurrence Handle10.1097/00006123-199710000-00008 Occurrence Handle1:STN:280:DyaK1c%2Fis12hsA%3D%3D Occurrence Handle9361068
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Morota, N., Deletis, V. The importance of brainstem map** in brainstem surgical anatomy before the fourth ventricle and implication for intraoperative neurophysiological map**. Acta Neurochir (Wien) 148, 499–509 (2006). https://doi.org/10.1007/s00701-005-0672-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-005-0672-6