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The aqueduct of Sylvius: applied 3-T magnetic resonance imaging anatomy and morphometry with neuroendoscopic relevance.
The aqueduct of Sylvius: applied 3-T magnetic resonance imaging anatomy and morphometry with neuroendoscopic relevance. Neurosurgery Matys, T., Horsburgh, A., Kirollos, R. W., Massoud, T. F. 2013; 73 (2): ons132-40Abstract
BACKGROUND:: The aqueduct of Sylvius (AsSylv) is a structure of increasing importance in neuroendoscopic procedures. However, there is currently no clear and adequate description of the normal anatomy of the AqSylv. OBJECTIVE:: To study in detail hitherto unavailable normal MRI morphometry and anatomical variants of the AqSylv. METHODS:: We retrospectively studied normal midsagittal T1-weighted 3T MR images in 100 patients. We measured widths of the AqSylv pars anterior, ampulla, pars posterior, narrowest point, and its length. We recorded angulation of the AqSylv relative to the third ventricle as multiple deviations of the long axis of the AqSylv from Talairach's bicommissural line. We statistically determined age- and gender-related changes in AqSylv morphometry using Pearson's correlation coefficient. We measured angulation of the AqSylv relative to the fourth ventricle and correlated this to the cervico-medullary angle (CMA, a surrogate for head position). RESULTS:: Patients were aged 13- 83 years (55:45, F:M). Mean morphometrics were: width of pars anterior (1.1 mm), ampulla (1.2 mm), pars posterior (1.4 mm), length (14.1 mm), narrowest point (0.9 mm), and angulation in relation to the third (26°) and fourth (18°) ventricles. Age correlated positively with width and negatively with length of the AqSylv. There was no correlation between AqSylv alignment relative to the foramen magnum, and the CMA. CONCLUSION:: Normative dimensions of the AqSylv in vivo are at variance with published cadaveric morphometrics. The AqSylv widens and shortens with cerebral involution. Awareness of these normal morphometrics is highly useful when stent placement is an option during aqueductoplasty. Reported data are valuable in guiding neuroendoscopic management of hydrocephalus and aqueductal stenosis.
View details for DOI 10.1227/01.neu.0000430286.08552.ca
View details for PubMedID 23615083