What is the brainstem?

The brainstem is a vital part of the nervous system that not only transmits motor and sensory fiber tracts but also houses centers or ‘nuclei’ which initiate and maintain a variety of automatic functions of the brain. Functions include maintenance of consciousness, breathing, salivating, maintenance of muscle tone of the arms and legs, swallowing and phonation.

What is involved with brainstem surgery?

Functional tissue is densely represented and therefore all areas may be considered eloquent and cannot be must be dissected with great delicacy and caution. When treating lesions within the brainstem, monitoring is crucial and includes SSEP, MEP as well as a variety of other modalities. Mapping of the facial, vagal and hypoglossal nucleus are frequently performed for tumors located within the floor of the fourth ventricle. Additionally, continuous EMG recording of these nuclei are also considered. Together with the surgeon’s experience and skill, tumors may be removed if not other option exists with the least risk of injury.

Video demonstrates the technique necessary to approach the fourth ventricle and brainstem by mobilizing the cerebellar hemispheres

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