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Morphometry and microsurgical anatomy of Bochdalek’s flower basket and the related structures of the cerebellopontine angle

  • Original Article - Neurosurgical Anatomy
  • Published:
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Abstract

Background

Bochdalek’s flower basket (Bfb) is the distal part of the horizontal segment of the fourth ventricle’s choroid plexus protruding through the lateral aperture (foramen of Luschka). The microsurgical anatomy of the cerebellopontine angle, fourth ventricle and its inner choroid plexus is well described in the literature, but only one radiological study has investigated the Bfb so far. The goal of the present study was to give an extensive morphometric analysis of the Bfb for the first time and discuss the surgically relevant anatomical aspects.

Method

Forty-two formalin-fixed human brains (84 cerebellopontine angles) were involved in this study. Photomicrographs with scale bars were taken in every step of dissection to perform further measurements with Fiji software. The lengths and widths of the Bfb, rhomboid lip and lateral aperture of the fourth ventricle as well as the related neurovascular and arachnoid structures were measured. The areas of two sides were compared with paired t-tests using R software. Significance level was set at p < 0.05.

Results

Protruding choroid plexus was present in 77 cases (91.66%). In 6 cases (7.14%), the Bfb was totally covered by the rhomboid lip, and in one case (1.19%), it was absent. The mean width of the Bfb was 6.618 mm (2–14 mm), the mean height 5.658 mm (1.5–14 mm) and mean area 25.80 mm2 (3.07–109.83 mm2). There was no statistically significant difference between the two sides (p = 0.1744). The Bfb was in contact with 20 AICAs (23.80%), 6 PICAs (7.14%) and 39 vestibulocochlear nerves (46.42%). Arachnoid trabecules, connecting the lower cranial nerves to the Bfb or rhomboid lip, were found in 57 cases (67.85%).

Conclusions

The Bfb is an important landmark during various surgical procedures. Detailed morphology, dimensions and relations to the surrounding neurovascular structures are described in this study. These data are essential for surgeons operating in this region.

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Authors and Affiliations

  1. Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Tuzolto u. 58, Budapest, 1094, Hungary

    Laszlo Barany, Gabor Baksa, Lajos Patonay & Peter Kurucz

  2. Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany

    Oliver Ganslandt & Peter Kurucz

  3. Department of Neurosurgery, Friedrich Alexander University Erlangen (FAU), Erlangen, Germany

    Michael Buchfelder

Authors
  1. Laszlo Barany
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  2. Gabor Baksa
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  3. Lajos Patonay
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  4. Oliver Ganslandt
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  6. Peter Kurucz
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Correspondence to Laszlo Barany.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

This article does not contain any studies with human participants performed by any of the authors.

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Comments

The authors present an anatomical cadaver study about a well-known cerebral structure. So far, Bochdalek’s flower basket has not been investigated in as much detail as in this study in human cadavers. It is surprising that the flower basket has not been described in such detail before. Thus, this detailed description provides new and useful knowledge to the field. This story is well told, and the information is new. However, there is only relative importance for surgery, because dealing with the flower basket is normally not too challenging: it is flexible and can usually be easily moved away from the surgical field. Of more relevance are the surrounding structures. The variability of the region is well described, proves to be relevant for surgery and patient safety, and is precisely photo-documented. This article bears the potential to become the standard (and also cited) description of the anatomical structure of Bochdalek’s flower basket.

Hans Clusmann, Christian Blume

Aachen, Germany

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Barany, L., Baksa, G., Patonay, L. et al. Morphometry and microsurgical anatomy of Bochdalek’s flower basket and the related structures of the cerebellopontine angle. Acta Neurochir 159, 1539–1545 (2017). https://doi.org/10.1007/s00701-017-3234-9

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  • DOI: https://doi.org/10.1007/s00701-017-3234-9

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