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Purpose <p>The cerebral aqueduct (CA) is the narrowest part of the ventricular system, connecting the third and fourth ventricles. This structure is encircled by important neuroanatomical features, and with the increasing application of neuroendoscopic techniques, a comprehensive understanding of the anatomy of the CA is essential. This study aims to provide a comprehensive, multi-perspective anatomical analysis of the cerebral aqueduct and its surrounding structures, integrating microsurgical dissections with endoscopic anatomical correlations to support safer surgical planning.</p> Methods <p>Three formalin-fixed human brainstem specimens were prepared using the Klingler technique and microscopically dissected with a focus on the cerebral aqueduct. In addition, endoscopic exposure was simulated in two separate formalin-fixed cadaveric heads to correlate intraventricular landmarks with aqueductal anatomy.</p> Results <p>The CA is positioned ventromedially to the colliculi, which are located dorsal to the mesencephalon. The frenulum veli structure, which contains the crossing of the fourth cranial nerve, was observed inferior to the colliculi. The periaqueductal gray matter surrounds the CA dorsally and ventrolaterally on both sides. A region topographically corresponding to the oculomotor nuclear complex was approximated based on known anatomical relationships and the intramesencephalic course of cranial nerve III, without direct visualization. As the dissection progressed, the courses of the deep tracts ventral to the CA were demonstrated. The medial longitudinal fasciculus, the trigeminal mesencephalic tract, and the superior cerebellar peduncle were identified. Fibers of the central tegmental tract were observed running posterior to, and also traversing, the decussation of the superior cerebellar peduncle.</p> Conclusions <p>The relationship of the CA with adjacent anatomical structures presents challenges to micro-endoscopic interventions of this region, necessitating a thorough understanding of the related anatomy.</p>

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Microsurgical anatomy of the cerebral aqueduct and periaqueductal region: implications for microscopic and neuroendoscopic approaches

  • 期刊论文

  • 发表日期：

    2026年5月19日

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  • Berra Bilgin,
  • Mustafa Eren Yuncu,
  • Ali Karadag,
  • Erik H. Middlebrooks,
  • Necmettin Tanriover

摘要

Purpose

The cerebral aqueduct (CA) is the narrowest part of the ventricular system, connecting the third and fourth ventricles. This structure is encircled by important neuroanatomical features, and with the increasing application of neuroendoscopic techniques, a comprehensive understanding of the anatomy of the CA is essential. This study aims to provide a comprehensive, multi-perspective anatomical analysis of the cerebral aqueduct and its surrounding structures, integrating microsurgical dissections with endoscopic anatomical correlations to support safer surgical planning.

Methods

Three formalin-fixed human brainstem specimens were prepared using the Klingler technique and microscopically dissected with a focus on the cerebral aqueduct. In addition, endoscopic exposure was simulated in two separate formalin-fixed cadaveric heads to correlate intraventricular landmarks with aqueductal anatomy.

Results

The CA is positioned ventromedially to the colliculi, which are located dorsal to the mesencephalon. The frenulum veli structure, which contains the crossing of the fourth cranial nerve, was observed inferior to the colliculi. The periaqueductal gray matter surrounds the CA dorsally and ventrolaterally on both sides. A region topographically corresponding to the oculomotor nuclear complex was approximated based on known anatomical relationships and the intramesencephalic course of cranial nerve III, without direct visualization. As the dissection progressed, the courses of the deep tracts ventral to the CA were demonstrated. The medial longitudinal fasciculus, the trigeminal mesencephalic tract, and the superior cerebellar peduncle were identified. Fibers of the central tegmental tract were observed running posterior to, and also traversing, the decussation of the superior cerebellar peduncle.

Conclusions

The relationship of the CA with adjacent anatomical structures presents challenges to micro-endoscopic interventions of this region, necessitating a thorough understanding of the related anatomy.