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AIM:This study was done to study the three dimensional anatomy of internal capsule's white fibers completely by cadaveric dissection and its relation to basal ganglia and other related anatomical structures. MATERIAL and METHODS: Eight formalin fixed cerebral hemispheres were dissected for internal capsule under operating microscope. Klingler's technique of fiber dissection was adopted. The internal capsule was dissected from superiolateral, inferior and medial surface of cerebral hemisphere. During and after dissection its relation with basal ganglia and other related structures were studied. RESULTS:The internal capsule was demonstrated by dissecting fibers of all its parts. Fibers that forms the internal capsule originate from different parts of cerebral cortex and pass through corona radiata that lies in lateral periventricular area and lateral to the caudate nucleus above the upper border of lentiform nucleus. The internal capsule is situated medial to lentiform nucleus and lateral to caudate nucleus and thalamus. Caudally it continues in the midbrain as cerebral peduncle. It has an anterior limb, genu, posterior limb, retrolentiform and sublentiform part. The relation of different parts of internal capsule with surrounding structures were also shown. CONCLUSION: Knowledge of the microsurgical anatomy of the internal capsule and other white fibers tracts is essential for neurosurgeons and other neuroscientists.

In suboccipital craniectomy where the bone is not repositioned, there may be a significant cosmetic defect due to lack of skull bone in the suboccipital region. It may accompanied by sensory symptoms, including pain. To prevent any cosmetic defect and sensory symptoms we repositioned the bone chips at the craniectomy site in 42 suboccipital craniectomies before the closure of the scalp. At a mean follow-up of 22 months (range: 5-44 months), two patients complained of mild discomfort in the healed wound or of occasional local pain. One patient complained of mild itching at the site. In two patients, bone chips were accumulated at the lower part of the suboccipital craniectomy and failed to form a uniform bone cover at the operated site. In one patient, all bone chips were reabsorbed and there was no bone at the operated site. There was pseudomeningocele formation in one patient. In the rest of the cases there was satisfactory bone coverage at the operated site, both clinically and radiologically. The wound sites were aesthetically acceptable in 40 cases. Our study suggests that in the majority of cases where suboccipital craniotomy is not possible or not done, repositioning of the bone chips at the craniectomy site is associated with satisfactory aesthetic and functional outcome and formation of bone coverage at the operated site.

Abstract:Background: Endoscopic transnasal repair of CSF (Cerebro Spinal Fluid)

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