Primary obstruction of the foramen of Luschka: anatomy, histology and clinical significance.

Primary obstruction of the foramen of Luschka: anatomy, histology and clinical significance.

World Neurosurg. 2018 Jan 12;:

Authors: Barany L, Baksa G, Lajos P, Racz G, Ganslandt O, Buchfelder M, Kurucz P

Abstract
BACKGROUND: The foramen of Luschka is a natural aperture between the fourth ventricle and the subarachnoid space at the cerebellopontine angle (CPA). Membranous closure of this foramen is referred to as primary obstruction. The available information about this variant and its role in the development of the cysts of the posterior fossa are contradictory in the literature.
METHODS: Sixty-one formalin-fixed human brains (122 foramina) were involved in this study. Both the macroscopic and the histological features of the obstructed foramina were examined. Three rhomboid lips of various sizes with lateral recess were used for comparison. Five post-operative cases of Luschka diverticulum were included in this study. A selected case is presented in detail to illustrate our anatomical and histological findings.
RESULTS: Primary obstruction was present in 11 out of 122 cases. In one case, an enlarged rigid pouch with a thick wall was found. The wall of the membrane in primary obstruction and the rhomboid lip were composed of an inner ependymal, a middle glial and an outer leptomeningeal layer.
CONCLUSIONS: The rhomboid lip is a remnant of the fourth ventricle's roof. Imperforation of the foramen of Luschka results in a pouch in the CPA that contains the choroid plexus (Bochdalek's flower basket) and communicates with the fourth ventricle. This pouch has the potential of growing to a diverticulum and cause clinical symptoms. Based on our clinical observations, detailed radiological and surgical-anatomical criteria were proposed to support the differential diagnosis of a Luschka diverticulum. Treatment strategies were also suggested.

PMID: 29339320 [PubMed - as supplied by publisher]

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