Microsurgical anatomy of the foramen of Luschka in the cerebellopontine angle, and its vascular supply

Surg Radiol Anat (2009) 31:431437 DOI 10.1007/s00276-009-0464-4

ORIGINAL ARTICLE

Microsurgical anatomy of the foramen of Luschka in the cerebellopontine angle, and its vascular supply

Mansoor ShariW Ewa Ungier Bogdan Ciszek Pawel Krajewski

Received: 3 July 2008 / Accepted: 8 January 2009 / Published online: 4 February 2009 Springer-Verlag 2009

Abstract Cerebellopontine angle and vascular supply of adjacent brainstem and cerebellum are susceptible to compression and eventual damage by tumors. Delicate and complicated neurosurgical operations in the cerebellopontine angles of the brainstem, where lateral recesses of fourth ventricle empty, are abundant especially operations in which foramina of Luschka are used as possible access to the Xoor of the fourth ventricle. So awareness and knowledge of the normal anatomical features of the region is valuable for neurosurgeons. Arteries of 40 human cerebella were injected with colored gelatin to investigate the micro-surgical anatomy around the foramen of Luschka in the cerebellopontine angle. Two compartments of the foramen of Luschka were distinguished, choroidal part and the patent part. Seventy-four (92.5%) of foramina were open and only 6 (7.5%) foramina were closed. The mean distance between the foramen of Luschka and the anterior inferior cerebellar artery was 3.90 mm on the left side and 3.89 on the right side. The distance from the posterior inferior cerebellar artery was 7.08 and 5.81 mm to the left and right foramina of Luschka, respectively. In ten cases, tortuous vertebral artery was occupying the left cerebellopontine angle space and the foramen of Luschka.

Keywords Anterior inferior cerebellar artery Cerebellopontine angle Foramen of Luschka Posterior inferior cerebellar artery Vasculature

Introduction

In 1902 Henneberg and Koch introduced the term cerebellopontine angle tumor, Ziehen in 1905 attempted to introduce the term angulo pontis and the French prefer the designation of tumerus cerebello-protuberantielles for the neoplasms occupying this region [3].

Cerebellopontine Wssure is a V-shaped Wssure located where the cerebellum wraps around the pons and middle cerebellar peduncle. This Wssure consists of two limbs, inferior and superior limbs (Fig. 1a) and the cerebellopontine angle is situated between the superior and inferior limbs of this Wssure [18, 21]. Cranial nerves from V to XI arise within the margins of the cerebellopontine Wssure. The

Xocculus and choroid plexus extend laterally from the foramen of Luschka above the lower limb...