Where the central canal begins: endoscopic in vivo description

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  • 1 Department of Neurosciences, University of Padova;
  • | 2 Neurosurgical Department, Spedali Civili, University of Brescia;
  • | 3 Neurosurgical Department, Treviso Regional Hospital—University of Padova, Treviso; and
  • | 4 Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Italy
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OBJECTIVE

Although evidence and descriptions of the central canal (CC) along the medulla oblongata and the spinal cord have been provided by several anatomical and radiological studies, a clear picture and assessment of the opening of the CC, or apertura canalis centralis (ACC), into the fourth ventricle is lacking, due to its submillimetric size and hidden position in the calamus scriptorius.

METHODS

The authors reviewed all of their cases in which patients underwent ventricular transaqueductal flexible endoscopic procedures and selected 44 cases in which an inspection of the region of the calamus scriptorius had been performed and was suitable for study inclusion. Patients were divided into different groups, based on the presence or absence of a chronic pathological process involving the fourth ventricle. In each case, the visual appearance of the opening of the CC of the ACC was classified as no evidence (A0), indirect evidence (A1), or clear evidence (A2). Morphometric measurements were inferred from surrounding structures and the size of surgical tools visible in the field.

RESULTS

The opening of the CC could be clearly observed in all cases (A1 4.5%, A2 95.5%). In normal cases, a lanceolate shape along the median sulcus was most frequently found, with an average size of 600 × 250 µm that became rounded and smaller in size in cases of hydrocephalus. The distance between the caudal margin of the ACC and the obex was about 1.8 mm in normal cases, 2.1 mm in cases of obstructive hydrocephalus, and 1 mm in cases of normal pressure hydrocephalus. The two wings of the area postrema, variable in size and shape, were sited just caudal to the opening.

CONCLUSIONS

A flexible scope inserted through the cerebral aqueduct can approach the hidden calamus scriptorius like a pen fits into an inkpot. With this privileged viewpoint, the authors provide for the first time, to their knowledge, a clear and novel vision of the opening of the CC in the fourth ventricle, along with the precise location of this tiny structure compared to other anatomical landmarks in the inferior triangle.

ABBREVIATIONS

ACC = apertura canalis centralis; CC = central canal; FVOO = fourth ventricular outlet obstruction; NPH = normal pressure hydrocephalus.

Supplementary Materials

    • Supplemental Fig. 1 (PDF 422 KB)

Illustration from Hanna (pp 927–930). Copyright Barbara A. Hanna. Published with permission.

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  • 1

    Wilson JT. On the anatomy of the calamus region in the human bulb; with an account of a hitherto undescribed “Nucleus postremus.”: Part I. J Anat Physiol. 1906;40(pt 3):210241.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Wilson JT. On the anatomy on the calamus region in the human bulb; with an account of a hitherto undescribed “Nucleus postremus.”: Part II. J Anat Physiol. 1906;40(pt 4):357386.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Mussi AC, Rhoton AL Jr. Telovelar approach to the fourth ventricle: microsurgical anatomy. J Neurosurg. 2000;92(5):812823.

  • 4

    Rhoton AL Jr. Cerebellum and fourth ventricle. Neurosurgery. 2000;47 (3)(suppl):S7S27.

  • 5

    Ghali MGZ. Telovelar surgical approach. Neurosurg Rev. 2021. 44(1):6176.

  • 6

    Tanriover N, Ulm AJ, Rhoton AL Jr, Yasuda A. Comparison of the transvermian and telovelar approaches to the fourth ventricle. J Neurosurg. 2004;101(3):484498.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Tomasello F, Conti A, Angileri FF, Cardali S. Telo-velar approach to fourth-ventricle tumours: how I do it. Acta Neurochir (Wien). 2015;157(4):607610.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Duvernoy H, Koritké JG, Monnier G, Jacquet G. Vascularization of the area postrema and of the dorsal side of the medulla oblongata in the human. Article in French. Z Anat Entwicklungsgesch. 1972;138(1):4166.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Leslie RA. Comparative aspects of the area postrema: fine-structural considerations help to determine its function. Cell Mol Neurobiol. 1986;6(2):95120.

  • 10

    Longatti P, Fiorindi A, Feletti A, et al. Endoscopic anatomy of the fourth ventricle. J Neurosurg. 2008;109(3):530535.

  • 11

    Longatti P, Porzionato A, Basaldella L, et al. The human area postrema: clear-cut silhouette and variations shown in vivo. J Neurosurg. 2015;122(5):989995.

  • 12

    Longatti P, Fiorindi A, Feletti A, Baratto V. Endoscopic opening of the foramen of Magendie using transaqueductal navigation for membrane obstruction of the fourth ventricle outlets. Technical note. J Neurosurg. 2006;105(6):924927.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Longatti P, Fiorindi A, Martinuzzi A, Feletti A. Primary obstruction of the fourth ventricle outlets: neuroendoscopic approach and anatomic description. Neurosurgery. 2009;65(6):10781086.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Longatti P, Fiorindi A, Perin A, Martinuzzi A. Endoscopic anatomy of the cerebral aqueduct. Neurosurgery. 2007;61 (3)(suppl):16.

  • 15

    Kawashima M, Rhoton AL Jr, Tanriover N, et al. Microsurgical anatomy of cerebral revascularization. Part II: posterior circulation. J Neurosurg. 2005;102(1):132147.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Ciołkowski M, Sharifi M, Tarka S, Ciszek B. Median aperture of the fourth ventricle revisited. Folia Morphol (Warsz). 2011;70(2):8490.

    • Search Google Scholar
    • Export Citation
  • 17

    Petit-Lacour MC, Lasjaunias P, Iffenecker C, et al. Visibility of the central canal on MRI. Neuroradiology. 2000;42(10):756761.

  • 18

    Saker E, Henry BM, Tomaszewski KA, et al. The human central canal of the spinal cord: a comprehensive review of its anatomy, embryology, molecular development, variants, and pathology. Cureus. 2016;8(12):e927.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Markatos K, Chytas D, Korres D, et al. Charles Estienne (1504-1564): his life, work, and contribution to anatomy and the first description of the canal in the spinal cord. World Neurosurg. 2017;100:186189.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Gardner WJ. Hydrodynamic mechanism of syringomyelia: its relationship to myelocele. J Neurol Neurosurg Psychiatry. 1965;28:247259.

  • 21

    Milhorat TH, Capocelli AL Jr, Anzil AP, et al. Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases. J Neurosurg. 1995;82(5):802812.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Netsky MG. Syringomyelia; a clinicopathologic study. AMA Arch Neurol Psychiatry. 1953;70(6):741777.

  • 23

    Kasantikul V, Netsky MG, James AE Jr. Relation of age and cerebral ventricle size to central canal in man. Morphological analysis. J Neurosurg. 1979;51(1):8593.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Göritz C, Frisén J. Neural stem cells and neurogenesis in the adult. Cell Stem Cell. 2012;10(6):657659.

  • 25

    Milhorat TH, Kotzen RM, Anzil AP. Stenosis of central canal of spinal cord in man: incidence and pathological findings in 232 autopsy cases. J Neurosurg. 1994;80(4):716722.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Weiss S, Dunne C, Hewson J, et al. Multipotent CNS stem cells are present in the adult mammalian spinal cord and ventricular neuroaxis. J Neurosci. 1996;16(23):75997609.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Panayiotou E, Malas S. Adult spinal cord ependymal layer: a promising pool of quiescent stem cells to treat spinal cord injury. Front Physiol. 2013;4:340.

  • 28

    Krause W. Der Ventriculus terminalis des Rückenmarks. Archiv Mikroskop Anat. 1875;11:216230.

  • 29

    Lindstrom PA, Brizzee KR. Relief of intractable vomiting from surgical lesions in the area postrema. J Neurosurg. 1962;19:228236.

  • 30

    Di Ieva A, Komatsu M, Komatsu F, Tschabitscher M. Endoscopic telovelar approach to the fourth ventricle: anatomic study. Neurosurg Rev. 2012;35(3):341349.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31

    Matula C, Reinprecht A, Roessler K, et al. Endoscopic exploration of the IVth ventricle. Minim Invasive Neurosurg. 1996;39(3):8692.

  • 32

    Wislocki GB, Putnam TJ. Further observations on the anatomy and physiology of the areae postremae. Anat Rec. 1924;27(3):151156.

  • 33

    Milhorat TH, Miller JI. The obex is not synonymous with the upper end of the central canal. Letter. Pediatr Neurosurg. 1994;21(1):112.

  • 34

    Sarikcioglu L, Yildirim FB. Area postrema: one of the terms described by Magnus Gustaf Retzius. J Hist Neurosci. 2008;17(1):109110.

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