JLPascual Brainstem Version 2
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THE BRAINSTEM
J. Leonard Pascual MD FPNAAssociate Professor, Department of Anatomy, College of Medicine, UP ManilaDepartment of Neurosciences, Philippine General Hospital
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OBJECTIVES
FORM: identify the different structures in the brainstem External anatomy
Subdivisions (diencephalon, midbrain, pons, medulla) Fissures and sulci Cranial nerves Peduncles Relationships to surrounding structures and cisterns
Cross-sectional anatomy Subdivisions (tectum, tegmentum) Grey matter (cranial nerve nuclei, other nuclei) White matter (fiber tracts)
FUNCTION: know the significance of each structure of the brainstem in the normal human being
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
The diencephalon is actually the most rostral end of the brainstem
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Subdivisions of the Brainstem
DiencephalonMidbrainPonsMedulla
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Hypothalamus
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Infundibulum
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Mammillary body
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Internal capsule
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Internal capsule
Basal ganglia
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Internal capsule
Basal ganglia
Optic nerve
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Internal capsule
Basal ganglia
Optic nerve
Optic chiasm
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Internal capsule
Basal ganglia
Optic nerve
Optic chiasm
Optic tract
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Mammillary body
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Hypothalamus
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Third ventricle
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Putamen
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Putamen
Nucleus accumbens
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Putamen
Nucleus accumbens
Anterior limb, internal capsule
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Putamen
Nucleus accumbens
Anterior limb, internal capsule
Posterior limb, internal capsule
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Hypothalamus
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Thalamus
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Pineal body
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Habenula
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Third ventricle
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Internal capsule
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Internal capsule
Caudate nucleus
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Internal capsule
Caudate nucleusPutamen
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Third ventricle
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Thalamus
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Subthalamus
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Infundibulum
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Hypothalamus
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Anterior commissure Posterior commissure
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Third ventricle
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Mammillary body
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Thalamus
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Thalamus
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Hypothalamus
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Third ventricle
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Interthalamic adhesion
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Thalamus
The thalami are paired symmetrical bulb-shaped masses obliquely and lateral to the 3rd ventricle
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Thalamus
The thalami are paired symmetrical bulb-shaped masses located obliquely and lateral to the 3rd ventricle
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Thalamus
Lies medial to the posterior limb of the internal capsule
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Thalamus
Between 70-80% of humans will have an interthalamic adhesion (massa intermedia) connecting both thalami
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
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Subdivisions of the Brainstem
DiencephalonMidbrainPonsMedulla
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Subdivisions of the Brainstem
DiencephalonMidbrainPonsMedulla
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Subdivisions of the Brainstem
DiencephalonMidbrainPonsMedulla
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Subdivisions of the Brainstem (lateral view)
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Subdivisions of the Brainstem (dorsal view)
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Subdivisions of the Brainstem (ventral view)
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Midbrain (cerebral peduncles)
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Pons (basis pontis)
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Medulla oblongata
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Interpeduncular fossa
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Cerebellopontine angle
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Pontomedullary sulcus
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Anterior median sulcus
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Anterolateral sulcus
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Pyramid
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Olive
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Pontomedullary sulcus
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Anterior median sulcus
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Anteriorolateral sulcus
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Posterolateral sulcus
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Pyramid
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Pyramid
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CP angle
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Medulla
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Pons
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Midbrain
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Thalamus
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Posterior commissure
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Cerebral peduncle
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Superior cerebellar peduncle
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Superior colliculus
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Inferior colliculus
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Middle cerebellar peduncle
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Middle cerebellar peduncle
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Pons
Latin for “bridge” (ventral pons appears like a bridge between cerebellar hemispheres)Cerebellar peduncles
(brachium conjunctivum) (brachium pontis)
Superior cerebellar peduncle
Middle cerebellar peduncle
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Floor of the 4th ventricle
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*Obex
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*Obex
Open medulla
Closed medulla
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*Obex
Open medulla
Closed medulla
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*
Inferior cerebellar peduncle
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The Cranial Nerves
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Olfactory nerve
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Optic nerve, chiasm, and
tract
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Interpeduncular fossa
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Midbrain
The oculomotor nerve exits from the ventral surface of the midbrain into the space between the two cerebral peduncles (interpeduncular fossa)
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Oculomotor nerve
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Oculomotor nerve
Uncus
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Midbrain
The trochlear nerve exits dorsally at the junction between the caudal midbrain and pons
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Trochlear nerve
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Neuroanatomy at a Glance
Trochlear nerve
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Trochlear nerve
Parahippocampal gyrus
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Pons
The trigeminal nerve enters the brainstem at mid-ponsTri – Gemini (3 twins): ophthalmic, maxillary, and mandibular nerves
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Trigeminal nerve
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Trigeminal nerve Middle cerebellar peduncle
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Pons
3 other cranial nerves enter / leave along groove between pons and medulla (pontomedullary sulcus)
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Pons
The abducens nerve is the smallest and most medial of the 3 cranial nerves that enter / leave at the pontomedullary junction
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Pons
The facial nerve is further lateralConsists of a larger medial root and a smaller sensory root (nervus intermedius)
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Pons
The vestibulocochlear nerve is slightly lateral to the facial nerve
Consists of a vestibular division and a more lateral cochlear division
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Abducens nerve
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Abducens nerve
Pontomedullary sulcus
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Facial nerve
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Vestibulocochlear nerve
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Vagus nerve
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Vagus nerve
Olive
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Hypoglossal nerve
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Hypoglossal nerve
Pyramid
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Abducens nerve
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Facial nerve
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Vestibulo-cochlear nerve
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Posterolateral sulcus
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Glossopharyngeal nerve
Vagus nerve
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Anterolateral sulcus
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Hypoglossal nerve
Spinal accessory nerve
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Spinal accessory nerve
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The Brain “Stem”: Nuclei
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Organizational Set-Up of the Nervous System
ROSTRAL CAUDAL
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Organizational Set-Up of the Nervous System
DORSAL
VENTRAL
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Organizational Set-Up of the Nervous System
DORSAL
VENTRAL
Neurons specialized for receiving information (SENSORY) from the environment and their axons are located dorsally
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Organizational Set-Up of the Nervous System
DORSAL
VENTRAL
Neurons specialized for receiving information (SENSORY) from the environment and their axons are located dorsally
Neurons that control movements (MOTOR) are located ventrally
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Organizational Set-Up of the Nervous System
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Organizational Set-Up of the Nervous System
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Organizational Set-Up of the Nervous System
Curling of the neural tube results in rotation of structures in the telencephalonVentral structures come to lie anteriorly (MOTOR)Dorsal structures come to lie posteriorly (SENSORY)
anterior
posterior
ventral dorsal
dorsal
ventral
anterior posterior
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Organizational Set-Up of the Nervous System
The dorsal:sensory / ventral:motor orientation remains the same within the brainstem and spinal cord
anterior
posterior
ventral dorsal
dorsal
ventral
anterior posterior
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Embryology and the Architecture of the Brainstem
4th Ventricle
Somatic afferent column
Sensory inputsLocated dorsally and laterally
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Embryology and the Architecture of the Brainstem
4th Ventricle
Somatic afferent column
Sensory inputsLocated dorsally and laterally
Somatic efferent column
Motor output for muscles
Located ventrally and medially
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Embryology and the Architecture of the Brainstem
4th Ventricle
SENSORY
MOTOR
Sulcus limitans
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Embryology and the Architecture of the Brainstem
4th Ventricle
Somatic afferent column
Somatic afferents
Visceral afferents
Unlike the spinal cord which innervates only skeletal muscles (somites), the brainstem also innervates muscles in the face derived from the branchial arches
Somatic efferent column
Somatic efferent
Visceral efferent
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Embryology and the Architecture of the Brainstem
4th Ventricle
Somatic afferent column
Somatic afferents
GSA
SSA
Visceral afferentsGVA
SVA
Additional components in cranial nerves are innervations for special functions
Somatic efferent column
Somatic efferentGSE
Visceral efferent
GVE
SVE
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Embryology and the Architecture of the Brainstem
Somatic afferent column
Somatic afferents
GSA
SSA
Visceral afferentsGVA
SSA: afferents to the special senses
Somatic efferent column
Somatic efferentGSE
Visceral efferent
GVE
Vision
Hearing and balance
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Embryology and the Architecture of the Brainstem
Somatic afferent column
Somatic afferents
GSA
SSA
Visceral afferentsGVA
SVA
SVA's are sensory nerves that develop in association with the gastrointestinal system
Somatic efferent column
Somatic efferentGSE
Visceral efferent
GVE
Olfaction Taste
Choking
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Embryology and the Architecture of the Brainstem
Somatic afferent column
Somatic afferents
GSA
SSA
Visceral afferentsGVA
SVA
SVE's innervate muscles derived from the branchial arches (branchiomotor nerves)
Somatic efferent column
Somatic efferentGSE
Visceral efferent
GVE
SVESwallowing and digesting
Chewing
Smiling and facial movements
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Embryology and the Architecture of the Brainstem
4th Ventricle
Somatic afferent column
SSAGSA
GVA
SVA
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Embryology and the Architecture of the Brainstem
4th Ventricle
Somatic afferent column
Somatic efferent column
GVE
SVE
GSE
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Somatic afferent column
Somatic afferents
GSA
SSA
Visceral afferentsGVA
SVA
Somatic efferent column
Somatic efferentGSE
Visceral efferent
GVE
SVE
Columnar arrangement of cranial nerve nuclei
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Cranial nerve fibers will proceed to / arise from cranial nerve nuclei
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III
Cranial Nerve Nuclei in the Midbrain
Oculomotor nerve nuclei complex
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III
Cranial Nerve Nuclei in the Midbrain
Oculomotor nerve nuclei complexEdinger-Westphal nucleus
EW
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III
Cranial Nerve Nuclei in the Midbrain
Oculomotor nerve nuclei complexEdinger-Westphal nucleusTrochlear nerve nucleus
IV
EW
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III
Cranial Nerve Nuclei in the Midbrain
Oculomotor nerve nuclei complexEdinger-Westphal nucleusTrochlear nerve nucleusMesencephalic nucleus of CN V
IV
EW
V
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III
Cranial Nerve Nuclei in the Midbrain
Oculomotor nerve nuclei complexEdinger-Westphal nucleusTrochlear nerve nucleusMesencephalic nucleus of CN V
IV
EW
V
345 MB
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Cranial Nerve Nuclei in the Pons
Motor nucleus of CN V
V
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Cranial Nerve Nuclei in the Pons
Motor nucleus of CN VAbducens nucleus
V
VI
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Cranial Nerve Nuclei in the Pons
Motor nucleus of CN VAbducens nucleusFacial nucleus
V
VI
VII
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Cranial Nerve Nuclei in the Pons
Motor nucleus of CN VAbducens nucleusFacial nucleusSuperior salivatory nucleus (CN X)
V
VI
VII
X
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Cranial Nerve Nuclei in the Pons
Main sensory nucleus of CN V
V
VI
VII
X
V
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Cranial Nerve Nuclei in the Pons
Main sensory nucleus of CN VSpinal nucleus of CN V
V
VI
VII
X
V
V
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Cranial Nerve Nuclei in the Pons
Main sensory nucleus of CN VSpinal nucleus of CN VVestibular nucleus (CN VIII)
V
VI
VII
X
V
VVII
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Cranial Nerve Nuclei in the Pons
Main sensory nucleus of CN VSpinal nucleus of CN VVestibular nucleus (CN VIII)Cochlear nucleus (CN VIII)
V
VI
VII
X
V
VVIII
VIII
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Cranial Nerve Nuclei in the Pons
V
VI
VII
X
V
VVIII
VIII
Motor nuclei
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Cranial Nerve Nuclei in the Pons
V
VI
VII
X
V
VVIII
VIII
Motor nuclei
Sensory nuclei
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Cranial Nerve Nuclei in the Rostral Medulla
Hypoglossal nucleus
XII
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Cranial Nerve Nuclei in the Rostral Medulla
Hypoglossal nucleusAmbiguous nucleus (CN's IX and X)
XII X
IX
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Cranial Nerve Nuclei in the Rostral Medulla
Hypoglossal nucleusAmbiguous nucleus (CN's IX and X)Inferior salivatory nucleus (CN IX)
XII X
IX
IX
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Cranial Nerve Nuclei in the Rostral Medulla
Hypoglossal nucleusAmbiguous nucleus (CN's IX and X)Inferior salivatory nucleus (CN IX)Dorsal motor nucleus of CN X
XII X
IX
IX
X
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Cranial Nerve Nuclei in the Rostral Medulla
Solitary nucleus (CN X)
XII X
IX
IX
X
X
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Cranial Nerve Nuclei in the Rostral Medulla
Solitary nucleus (CN X)Continuation of Spinal nucleus of CN V
XII X
IX
IX
X
X V
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Cranial Nerve Nuclei in the Rostral Medulla
Solitary nucleus (CN X)Continuation of Spinal nucleus of CN VContinuation of Vestibular nucleus
XII X
IX
IX
X
X V
VIII
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Cranial Nerve Nuclei in the Caudal Medulla
Accessory nucleus
XI
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Cranial Nerve Nuclei in the Caudal Medulla
Accessory nucleusSpinal nucleus of CN V (continuation)
XI
V
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The Brain “Stem”: Long Tracts
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Organizational Set-Up of the Nervous System
DESCENDING
ASCENDING
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Organizational Set-Up of the Nervous System
DECUSSATION
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Organizational Set-Up of the Nervous System
LAMINATION
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The Brainstem and its contents
Grey matter on the insideWhite matter on the outside
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The Brainstem and its contents
Grey matter on the insideCranial nerve nucleiReticular formationPontine nuclei
White matter on the outside
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The Brainstem and its contents
Grey matter on the insideCranial nerve nucleiReticular formationPontine nuclei
White matter on the outsideAscendingDescendingMixed ascending and descending
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The Brainstem and its contents
Grey matter on the insideCranial nerve nucleiReticular formationPontine nuclei
White matter on the outsideAscending
Reticular activating system Spinothalamic tract Spinocerebellar tract Medial lemniscal – dorsal column pathway Auditory pathway Gustatory pathway
DescendingMixed ascending and descending
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ASCENDING RETICULAR ACTIVATING SYSTEM
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ASCENDING RETICULAR ACTIVATING SYSTEM
Portion of the reticular formation concerned with arousalEnsures that thalamocortical impulses are fired to “awaken” the cerebral hemispheresDamage leads to comaAffected by psychotropic drugs and anestheticsOveractivity (imbalance of norepinephrine) has been linked to ADHD (attention deficit hyperactivity disorder)
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The Brainstem and its contents
Grey matter on the insideCranial nerve nucleiReticular formationPontine nuclei
White matter on the outsideAscendingDescending
Corticospinal tract Corticobulbar tract
Mixed ascending and descending
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The Brainstem and its contents
Grey matter on the insideCranial nerve nucleiReticular formationPontine nuclei
White matter on the outsideAscendingDescendingMixed ascending and descending
Medial longitudinal fasciculus
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Corticospinal tract
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Spinothalamic tract
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Medial longitudinal fasciculus
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Cross-sectional Anatomy of the
Brainstem
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Organizational Set-Up of the Nervous System
EXTRA-AXIAL
INTRA-AXIAL
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Organizational Set-Up of the Nervous System
EXTRAMEDULLARY
MEDULLARY
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Architecture of the Brainstem
General morphology of the brainstem:
Tectum: roof of ventricular cavityTegmentum: floor of ventricular cavity:
Dorsolateral: sensory fibers / nucleiVentromedial: motor cranial nucleiIn between: reticular formation
Base: mainly motor fibers
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
Cerebral aqueduct
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Neuroanatomy at a Glance
Cerebral peduncle
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Midbrain
Large cerebral peduncles on its anterior surface
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Neuroanatomy at a Glance
Substantia nigra
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
Thalamus
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Neuroanatomy at a Glance
Thalamus
3rd ventricle
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Neuroanatomy at a Glance
Red nucleus
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Neuroanatomy at a Glance
Red nucleus
Pinkish color is attributed to iron content
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Neuroanatomy at a Glance
Red nucleus
Pinkish color is attributed to iron content
Mainly responsible for movement in animals without corticospinal tracts (controls large muscle groups)
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Neuroanatomy at a Glance
Red nucleus
Crawling of babies and arm swing is controlled by this nucleus
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Midbrain (Internal Structure)
Rostral midbrain: contains the superior colliculiExtends from the intercollicular groove to the posterior commissure
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Rostral Midbrain
Superior colliculus: paired bumps in the midbrain tectumIts neurons respond to visual, auditory, and somatosensory stimuliTogether with the inferior colliculus = corpora quadrigemina
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Rostral Midbrain
Superior colliculus: involved in saccades (fast eye movements)
Helps orient the head and the eyes towards something seen or heard
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Rostral Midbrain
Substantia nigra: pale on myelin-stained brain tissue, dark on unstained brain tissue
produces dopamineReceives and sends fibers to the putamen (striatum) and caudate nucleus
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Rostral Midbrain
Ventral tegmental area: lies close to the substantia nigra and red nucleus
Provides dopaminergic innervation to the frontal cortex and limbic systemActivities that elicit pleasure activates this area (including psychostimulants like cocaine)
Reward / addiction Fear / avoidance behavior
Ventral tegmental area of the midbrain
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Rostral Midbrain
Oculomotor nucleus: in the floor of the cerebral aqueductActually a complex of 2 groups of smaller subnuclei that innervate individual muscles
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Rostral Midbrain
Oculomotor nuclei complex: the subnucleus for the levator palpebrae superioris (upper eyelid) is shared by both oculomotor nuclei
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Rostral Midbrain
Oculomotor nuclei complex: the nucleus for the superior rectus (SR) muscle travels in the contralateral oculomotor nerve (similar to CN IV) to innervate the contralateral muscle.
SR
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Rostral Midbrain
Oculomotor nuclei complex: the nucleus for the medial rectus (MR), inferior oblique (IO), and inferior rectus (IR) muscles travel in the ipsilateral CN III to the eyeball
MR IO
IR
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Rostral Midbrain
Edinger-Westphal nucleus:Lies in close proximity to CN III nucleusSends GVE's to the ipsilateral ciliary ganglion
Ciliary ganglion innervates the sphincter pupillae (iris) and ciliary muscle
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Midbrain (Internal Structure)
Caudal midbrain: contains the inferior colliculiExtends from where the trochlear nerve emerges to the intercollicular groove
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Caudal midbrain
The 4th ventricle has narrowed into the cerebral aqueductThe periaqueductal gray matter encircles the aqueduct
Cerebral aqueduct
Periaqueductal gray
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Caudal midbrain
Periaqueductal gray:Role in defensive behavior in animals (freezing, jumping, rapid heart beat, high blood pressure)Role in female copulatory behavior (lordosis behavior) via pathway from the hypothalamusExcited by endorphins and by opiate analgesics
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Caudal midbrain
The inferior colliculus: principal nucleus of the auditory pathway in the midbrain
Relays auditory input from the contralateral ear to the thalamus (medial geniculate body)
Inferior colliculus
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Caudal midbrain
The MLF continues its course in the midline below the floor of the cerebral aqueduct
MLF
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Caudal midbrain
The tiny trochlear nucleus lies lateral to the MLF
Trochlear nucleus
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Caudal midbrain
Trochlear nucleus: fibers decussate in the superior medullary velum of the tectum and exit dorsally.
Superior medullary velum
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Caudal midbrain
Trochlear nucleus: innervates the contralateral superior oblique muscle of the eyeball
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Neuroanatomy at a Glance
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Pons (Internal Structure)
Rostral pons: from the point of attachment of the trigeminal nerve to the beginning of the cerebral aqueduct / at the point of emergence of the trochlear nerve
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Rostral Pons
The median longitudinal fasciculus (MLF) lies near the midline beneath the 4th ventricle
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Rostral Pons
The superior cerebellar peduncle appears in the lateral walls of the 4th ventricle
Major outflow from the cerebellum (efferent) to the thalamus
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Rostral Pons
Locus ceruleus: contains norepinephrine, innervates virtually the entire CNS, from spinal cord to cerebral cortex
Increased firing rate of neurons during arousal, decreases with drowsiness, and abolished during sleepReceives afferents from hypothalamus, cingulate cortex, and amygdalaActivated during stress, neurons seen to be depleted in posttraumatic stress disorder patients
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Pons (Internal Structure)
Caudal pons: bottom half of the pons from the point of attachment of CN V to the lateral wall of the 4th ventricle
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Caudal Pons
Caudal pons: bottom half of the pons from the point of attachment of CN V to the lateral wall of the 4th ventricle
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Caudal Pons
The pyramidal tract is broken up by pontine nuclei and their decussating fibers, which form the middle cerebellar peduncle
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Cranial Nerve Nuclei in the Pons
Motor nucleus of CN VAbducens nucleusFacial nucleusSuperior salivatory nucleus (CN X)
V
VI
VII
X
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Cranial Nerve Nuclei in the Pons
Main sensory nucleus of CN VSpinal nucleus of CN VVestibular nucleus (CN VIII)Cochlear nucleus (CN VIII)
V
VI
VII
X
V
VVIII
VIII
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Caudal Pons
The facial colliculus is formed by fascicles from the facial nucleus which loop around the abducens nucleus which lies on the floor of the 4th ventricle
CN VI
CN VII
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Caudal Pons
CN VI
CN VII
The facial colliculus is formed by fascicles from the facial nucleus which loop around the abducens nucleus which lies on the floor of the 4th ventricle
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Caudal Pons
The abducens innervates the lateral rectus muscle of the eyeball (GSE)
Due to the long distance it travels en route to the eyeball, it is most frequently compressed / stretched by space-occupying lesions in the cranial cavityUsually stretched / compressed against the clivus
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Caudal Pons
The abducens lies in close proximity to the parapontine reticular formation (PPRF) which is the horizontal gaze center in the pons
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Caudal Pons
The MLF is nearby (yokes / synchronizes the movements of the eyeballs)
Connects the abducens to the contralateral oculomotor nucleus in the midbrain
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
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Neuroanatomy at a Glance
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Medulla (Internal Structure)
Rostral medulla: from the obex to the lateral recess where the inferior cerebellar peduncle enters the cerebellum
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Rostral Medulla
The rostral medulla no longer looks like the spinal cord due to the presence of the 4th ventricle dorsally
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Rostral Medulla
The inferior olivary nucleus is a prominent feature of the rostral medulla, forms the swelling called the olive.
Fibers from each nucleus arch across the midline to enter the contralateral inferior cerebellar peduncle
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Cranial Nerve Nuclei in the Rostral Medulla
Hypoglossal nucleusAmbiguous nucleus (CN's IX and X)Inferior salivatory nucleus (CN IX)Dorsal motor nucleus of CN X
XII X
IX
IX
X
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Cranial Nerve Nuclei in the Rostral Medulla
Solitary nucleus (CN X)Continuation of Spinal nucleus of CN VContinuation of Vestibular nucleus
XII X
IX
IX
X
X V
VIII
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Rostral Medulla
Fascicles of the hypoglossal nerve exit between the pyramid and the inferior olivary nucleus
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Rostral Medulla
Fascicles of the hypoglossal nerve exit between the pyramid and the inferior olivary nucleus
Innervates the muscles of the tongue (general visceral efferent)
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Rostral Medulla
A pair of medial longitudinal fasciculi (MLF) lie beneath the floor of the 4th ventricle posterior to the medial lemniscus, can be traced all the way to the midbrain
involved in yoking eye movements as well as vestibular functions
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Rostral Medulla
The dorsal motor nucleus of the vagus lies in the floor of the 4th ventricle, dorsolateral to the hypoglossal nucleus
Main parasympathetic nucleusSends GVE to the thoracic and abdominal viscera
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Rostral Medulla
The solitary tract and nucleus of the vagus lies in the floor of the 4th ventricle, lateral to the dorsal nucleus of X
Taste impulses from the CN VII, IX, X, and XI (gustatory / rostral half of the solitary nucleus)
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Rostral Medulla
The solitary tract and nucleus of the vagus:The caudal half of the solitary nucleus receives cranial afferent inputs related to cardiovascular, respiratory, and gastrointestinal receptors
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Rostral Medulla
The solitary tract and nucleus of the vagus:Mediates the cough reflex, baroceptor reflex, gag reflex, baroceptor and chemoreceptor reflexes, among others
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Rostral Medulla
The solitary tract and nucleus of the vagus:Projects efferent output to the hypothalamus, cingulate gyrus, and other brainstem nuclei (heart beat, breathing)
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Rostral Medulla
The ambiguous nucleus:Cannot be distinguished in myelin stained brain tissueLocated dorsal to the inferior olivary nucleus, within the ventrolateral tegmentum, embedded within the reticular formation
Nucleus ambiguus
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Rostral Medulla
The ambiguous nucleus:Gives rise to SVE's that travel within the glossopharyngeal nerve to innervate the stylopharyngeus muscle, and within the vagus nerve to innervate the rest of the pharyngeal muscles (swallowing)
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Rostral Medulla
The vestibular and cochlear nuclei are found dorsolaterally
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The Pontomedullary Junction
Lateral recess of the 4th ventricle
The vestibular and cochlear nuclei occupy the ventricular floor at the pontomedullary junction
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Neuroanatomy at a Glance
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Medulla (Ventral aspect)
Pyramids contain the descending fibers of the corticospinal tract
Crossing over of the fibers to the other side (decussation)
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Medulla (Dorsal aspect)
The dorsal columns of the spinal cord continue into the medulla
The cuneate fasciculus ends in a swelling called the cuneate tubercle (overlying the nucleus cuneatus)
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Medulla (Dorsal aspect)
The dorsal columns of the spinal cord continue into the medulla
The fasciculus gracilis near the midline ends in a similar small bump called the gracile tubercle (or clava) overlying the nucleus gracilis.
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Medulla (Internal Structure)
Caudal medulla: from pyramidal decussation to the obexSimilar appearance to the spinal cord
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Caudal Medulla
The pyramids of the corticospinal tract lie most anteriorly
Fibers will decussate and travel to the contralateral anterior horn of the spinal cord
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External Relationships of the Brainstem
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External Anatomical Relationships of the Brainstem
The ventral brainstem is bathed in cerebrospinal fluid within the subarachnoid space
Contains blood vessels and cranial nerves
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External Anatomical Relationships of the Brainstem
Interpeduncular cistern = the space between (and around) the two cerebral peduncles in the midbrain
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External Anatomical Relationships of the Brainstem
Interpeduncular cistern = the space between (and around) the two cerebral peduncles in the midbrain
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External Anatomical Relationships of the Brainstem
The basilar artery runs across the midline of the pons within the pontine cistern
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External Anatomical Relationships of the Brainstem
Medullary cistern
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External Anatomical Relationships of the Brainstem
The cerebral peduncles of the midbrain must pass through the incisura of the tentorium cerebelli
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External Anatomical Relationships of the Brainstem
Clivus is a sloping shallow depression of the sphenoid bone of the base of the skull which supports the pons
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External Anatomical Relationships of the Brainstem
The sphenoid sinus is one of the paranasal sinuses that lies beneath the sella turcica (where the pituitary gland sits) and anterior to the clivus
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External Anatomical Relationships of the Brainstem
Pontocerebellar cistern over the cerebellopontine angleThe facial and vestibulocochlear nerves as well as the trigeminal nerve lie close to the cerebellum
CN V
CN VII
CN VIII
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External Anatomical Relationships of the Brainstem
Foramen magnum is the largest opening of the skull through which the medulla passes to become the spinal cord
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Pons (Dorsal Aspect)
Cerebellar peduncles The superior cerebellar peduncles form the roof of diamond-shaped cavity of the 4th ventricle
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