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Purpose: Microsurgical anatomy of the corticospinal tract, its functional role and crucial points in differential diagnosis were evaluated. There is no consensus about its differences and cerebral origin of the corticospinal tract. Tractography and cadaver dissection can help to investigate the characteristics of the corticospinal tract. Also, amyotrophic lateral sclerosis is hard to diagnose as it has common symptoms and signs with other disorders. Methods: Three formalin-fixed human brains (six sides) were dissected by the Klingler technique in a stepwise manner from the lateral to medial and superior to inferior under 6x–40x magnification using a surgical microscope. All stages of the dissection were photographed using three-dimensional method. Lastly, we present a patient with the sign of drop foot who underwent electromyographical and radiological examination, diagnosed as atypic amyotrophic lateral sclerosis. Results: The connections of the corticospinal tract, in particular the travel in the in trajectories of stepwise in manner cerebral origin. We demonstrated a case report with anatomic correlation to define the damage of corticospinal tract in variable levels. Crucial landmarks, connections, eloquent brain areas that related to the corticospinal tract were emphasized. Conclusion: So that pointing the importance of such disorders to keep in mind as not to move forward with incorrect operation decision. Trajectory of one of the largest desending pathway, corticospinal tract and the relationship with different diagnosis should be considered.

A better understanding of the surgical anatomy of the cerebellar peduncles in different surgical approaches and their relationship with other neural structures are delineated through cadaveric dissections. We aimed to revisit the surgical anatomy of the cerebellar peduncles to describe their courses along the brain stem and the cerebellum and revise their segmental classification in surgical areas exposed through different approaches. Stepwise fiber microdissection was performed along the cerebellar tentorial and suboccipital surfaces. Multiple surgical approaches in each of the cerebellar peduncles were compared in eight silicone-injected cadaveric whole heads to evaluate the peduncular exposure areas. From a neurosurgical point of view, the middle cerebellar peduncle (MCP) was divided into a proximal cisternal and a distal intracerebellar segments; the inferior cerebellar peduncle (ICP) into a ventricular segment followed by a posterior curve and a subsequent intracerebellar segment; the superior cerebellar peduncle (SCP) into an initial congregated, an intermediate intraventricular, and a distal intramesencephalic segment. Retrosigmoid and anterior petrosectomy approaches exposed the junction of the MCP segments; telovelar, supratonsillar, and lateral ICP approaches each reached different segments of ICP; paramedian supracerebellar infratentorial, suboccipital transtentorial, and combined posterior transpetrosal approaches displayed the predecussation SCP within the cerbellomesencephalic fissure, whereas the telovelar approach revealed the intraventricular SCP within the superolateral recess of the fourth ventricle. Better understanding of the microsurgical anatomy of the cerebellar peduncles in various surgical approaches and their exposure limits constitute the most critical aspect for the prevention of surgical morbidity during surgery in and around the pons and the upper medulla. Our findings help in evaluating radiological data and planning an operative procedure for cerebellar peduncles.

Any manipulation or resection procedures during surgery of neural system or its surrounding structures carries a high risk of causing damage to the neural tissue. Existing intraoperative imaging tools provide only information about anatomic situation. Because of this insufficiency, both physicians and patients are displeased with additional neural deficits. Using intraoperative neurophysiological monitoring (IONM) that evaluate neurological function simultaneously is very important. It is also used in other surgical operations. In our article, we report importance and advantages of IONM in neurosurgical operations.