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CC BY 4.0 · Indian Journal of Neurotrauma
DOI: 10.1055/s-0044-1801779
Original Article

Morphometric Analysis of Tentorial Orifice and its Anatomical Variations as Relevant to Transtentorial Herniation: A Preliminary Cadaveric Study

Diksha Sharma 
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Rakshay Kaul
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Deepak Agrawal 
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
› Institutsangaben Funding None.
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Abstract

Background

The tentorial orifice is a space in the tentorium cerebelli that lies toward the center and anteriorly related to the brainstem, cranial nerves, cerebrum, and cerebellum. The tentorium cerebelli is a fold of the dura mater that separates the supratentorial and infratentorial chambers. The anatomy of the tentorial orifice is complex in morphology, and it has a great significance in the neurosurgical field. Detailed understanding of the anatomical variations in the tentorial notch may help find the progression and clinical aspects of transtentorial herniation.

Objective

The aim of the study was to investigate the morphometric characteristics of the tentorial notch and its anatomical variations in human cadavers.

Materials and Methods

The study was conducted on 20 human cadavers, aged 20 to 74 years, after the conventional autopsy procedure within 24 hours after death, followed by sectioning of the midbrain at the level of the tentorial edge to note the respective observations, which were the following: (1) maximum notch length (MNL), the length between the apex of the notch and the posterosuperior edge of the dorsum sellae; (2) maximum notch width (MNW) and maximum width of the tentorial notch; (3) interpedunculoclival distance, the distance between the posterosuperior edge of the dorsum sellae and the interpeduncular fossa; (4) apicotectal distance, the distance from the apex of the notch to the tectum of midbrain; and (5) anterior notch width, the width of the tentorial notch in the axial plane through the dorsum sellae posterior aspect. The tentorial notch is classified into eight types by using two variables, which are MNL and MNW. The data obtained were analyzed.

Results

Twenty autopsy cases, comprising 18 males and 2 females, were included in the study. The groups defined by MNW (mean: 29.12 ± 1.88 mm [range: 24.4–34.3]) were labeled as narrow, midrange, and wide. Other groups defined by MNL (mean: 52.13 ± 5.01 mm [range: 44.2–59.92 mm]) were labeled as short, midrange, and long.

Conclusion

Anatomical variability in the morphology of the tentorial aperture may be associated in various clinical scenarios related to transtentorial herniation and other traumatic brain injuries. This preliminary study provides a guideline to plan the trajectory during neurosurgical procedures to be performed in the vicinity of the tentorial aperture.

Keywords

transtentorial herniation - tentorium cerebelli - brainstem herniation - notch classification - cadaveric study


Publikationsverlauf

Artikel online veröffentlicht:
25. März 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Standring S. Intracranial region. In: Standring S. ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th ed.. London: Elsevier Churchill Livingstone; 2008: 423-434
    Suche in Google Scholar
  • 2 Ono M, Ono M, Rhoton Jr AL, Barry M. Microsurgical anatomy of the region of the tentorial incisura. J Neurosurg 1984; 60 (02) 365-399
    CrossrefPubMedSuche in Google Scholar
  • 3 Meyer A. Herniation of the brain. Arch Neurol Psychiatry 1920; 4 (05) 387-400
    CrossrefPubMedSuche in Google Scholar
  • 4 Corsellis JA. Individual variation in the size of the tentorial opening. J Neurol Neurosurg Psychiatry 1958; 21 (04) 279-283
    CrossrefPubMedSuche in Google Scholar
  • 5 Sunderland S. The tentorial notch and complications produced by herniations of the brain through that aperture. Br J Surg 1958; 45 (193) 422-438
    CrossrefPubMedSuche in Google Scholar
  • 6 Rajaraajan K, Pragadhees R, Prabu SSS, Pradeep S. Morphometric analysis of tentorial incisura and its clinical implications. Int J Sci Stud 2017; 5 (07) 98-104
    PubMedSuche in Google Scholar
  • 7 Bull JW. Tentorium cerebelli. Proc R Soc Med 1969; 62 (12) 1301-1310
    PubMedSuche in Google Scholar
  • 8 Modi JP. Postmortem examination. In: Subrahmanyam BV. ed. Modi's Medical Jurisprudence and Toxicology. 22nd ed.. New Delhi: Butterworths India; 1999: 91-126
    Suche in Google Scholar
  • 9 Singh A, Ojha B, Jaiswal M, Bajaj A, Yadav A. Variations of tentorial notch anatomy in autopsy and NCCT of head injury patients to correlate its impact over brainstem: an observational study. Indian J Neurotrauma 2024; (e-pub ahead of print)
    Thieme ConnectPubMedSuche in Google Scholar
  • 10 Kaul R, Agrawal D, Sharma D. Predicting the risk of uncal herniation based on CT head in patients with traumatic brain injury: a novel ratio. Indian J Neurotrauma 2024 In press
    PubMed
  • 11 Klintworth GK. The comparative anatomy and phylogeny of the tentorium cerebelli. Anat Rec 1968; 160 (03) 635-642
    CrossrefPubMedSuche in Google Scholar
  • 12 Adler DE, Milhorat TH. The tentorial notch: anatomical variation, morphometric analysis, and classification in 100 human autopsy cases. J Neurosurg 2002; 96 (06) 1103-1112
    CrossrefPubMedSuche in Google Scholar