Abstract
Anatomical description of the fourth ventricle is essential for an accurate understanding of its related tumoral pathologies and surgical approach respecting cerebellar and brainstem structures. This study aims to demonstrate the detail of surgical anatomy and approach options for the IV ventricle. The IV ventricle is in a midline sagitsagittal midlinetent-shaped cavity. The pons and the medulla form its floor. The superior roof is formed by the superior cerebellar peduncles laterally and the superior medullary velum on the midline. The inferior roof is formed by the tela choroidea, the velum medullary inferior, and the nodule. The floor of the IV ventricle has a rhomboid shape. The rostral two-thirds are related to the pons, and the caudal one-third is posterior to the medulla. The median sulcus divides the floor into symmetrical halves. The sulcus limitans run laterally to the median sulcus, and the area between the two sulci is called the median eminence. The median eminence contains rounded prominence related to the cranial nucleus of facial, hypoglossal, and vagal nerves. The lateral recesses are extensions of the IV ventricle that open into the cerebellopontine cistern. The cerebellomedullary fissure is a space between the cerebellum and the medulla and can be used as a surgical corridor to the IV ventricle. Gently displacing the tonsils laterally exposes both the tela choroidea and the inferior medullary velum. Opening the tela provides access to the floor and body of the ventricle from the aqueduct to the obex. The additional opening of the velum provides access to the superior half of the roof of the ventricle, the fastigium, and the superolateral recess.
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Oberman, D.Z., Baldoncini, M., Campero, A., Ajler, P. (2023). Surgical Anatomy of the Fourth Ventricle . In: Figueiredo, E.G., Rabelo, N.N., Welling, L.C. (eds) Brain Anatomy and Neurosurgical Approaches . Springer, Cham. https://doi.org/10.1007/978-3-031-14820-0_20
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