Mapping Anatomical Landmarks of the Cerebellar Central Core: Enhancing Precision in Surgical Interventions for Cerebellar Lesions

Introduction: Similar to the cerebrum, the cerebellum exhibits a central neuronal core region enveloped by a network of white fibers, identified as the central nucleus. The dentate nucleus and the extension of its fibers into the superior cerebellar peduncle play a key role. Understanding this anatomical and functional concept would improve the accuracy of surgical interventions for cerebellar infiltrative lesions.

Methods: Twenty-two formalin-fixed and frozen human cerebellar and brainstems were stored at -16º C for two weeks, according to the Klingler protocol. Dissection was performed to identify the cerebellar central nucleus and its structures. Images were captured, analyzed, and processed for the distribution of landmarks in each dissection phase.

Results: We defined the cerebellar landmarks proximal to the central nucleus. The anatomical division into planes: Superoinferior; we found the superior border of the amygdala and the MCP. Superior: the anterior portion of the horizontal fissure, the MCP, and the origin of the V cranial nerve.
Anteroposterior plane: the cerebello-mesencephalic fissure and the postclival fissure. In the mediolateral plane, we identify the cerebellar vermis's PCS and lateral border. Laterally, the fibers of the MCP and the lateral aspect of the tonsil. The biventral lobule may obscure this landmark, and we consider it an alternative landmark.

Conclusion : This study provides reliable anatomical landmarks of the cerebellum, which describe the central cerebellar nucleus. Establishing these landmarks favors three-dimensional knowledge and helps avoid associated neurological damage in this crucial structure.