The Brainstem pdf - Neuroanatomy

Lecture

The BRAINSTEM

Medulla Oblongata

Introduction to brainstem

1- Medulla oblongata

2- Pons

3- Midbrain

occupies the posterior cranial fossa of the skull.

connects the narrow spinal cord with the expanded forebrain.

Function of Brainstem

(1) it serves as a conduit for the ascending tracts and descending tracts
connecting the spinal cord to the different parts of the higher centers in the
forebrain

(2) it contains important reflex centers associated with the control of
respiration and the cardiovascular system and with the control of
consciousness

(3) it contains the important nuclei of cranial nerves III through XII.

Medulla
oblongata

A- ant view

B- post view

Medulla Oblongata

Gross appearnse:
- Connect the pons sup to spinal cord inf
- About 2.5 cm in length
- The junction of the medulla and spinal cord is at the origin of the anterior and

posterior roots of the first cervical spinal nerve at level of foramen magnum

- It is conical in shape

- central canal

- cavity of fourth ventricle

Anteriorly:

- ant median fissure

- pyramid

- decussation of the pyramids

- Posterolateral to the pyramids are the olives

Posteriorly:

- sup is the floor 4

ventricle

- inf the median sulcus

- gracile tubercle and lat to it the cuneate tubercle

The internal structure of the medulla oblongata is considered at four levels:

level of decussation of pyramids

level of decussation of lemnisci

level of the olives

level just inferior to the pons.

level of decussation of pyramids
A transverse section through the inferior half of the medulla oblongata

passes through the decussation of the pyramids, the great motor
decussation.

It contain the following nuclei:
Nucleus gracilis, nucleus cuneatus, spinal nucleus of cranial nerve V,

accessory nucleus

level of decussation of lemnisci
A transverse section through the inferior half of the medulla oblongata, a

short distance above the level of the decussation of the pyramids, passes
through the decussation of lemnisci, the great sensory decussation The
decussation of the lemnisci takes place anterior to the central gray matter
and posterior to the pyramids.

It contain the following nuclei:
Nucleus gracilis, nucleus cuneatus, spinal nucleus of cranial nerve V,

accessory nucleus, hypoglossal nucleus

level of the olives
A transverse section through the olives passes across the inferior part of the

fourth ventricle

The amount of gray matter has increased at this level owing to the presence of

the many nuclei

It contain the following nuclei:
Inferior olivary nucleus, spinal nucleus of cranial nerve V, vestibular nucleus,

glossopharyngeal nucleus, vagal nucleus, hypoglossal nucleus, nucleus
ambiguus, nucleus of tractus solitarius

level just inferior to the pons.
There are no major changes, in comparison to the previous level, in the

distribution of the gray and white matter

It contain the following nuclei:
Lateral vestibular nucleus, cochlear nuclei

Transverse section of the medulla oblongata
at the level of decussation of the pyramids

Transverse section of the medulla oblongata at
the level of decussation of the medial lemnisci

Transverse section of the medulla oblongata at the level of the middle of the olivary
nuclei

Blood supply of Medulla oblongata:

1) ventrally: branches from vertibral and basilar arteries, Also branches from
ant spinal artery

artery

2) dorsolaterally: by post inf cerebellar artery

Venous drainage:

1)ventrally: basilar venous plexus

and inf petrosal sinus

2) Dorsally and dorsolaterally to occipital sinus

3) Medullary veins communicate with sinuses and spinal veins

Olivary Nuclear Complex

- The largest nucleus of this
complex is the inferior olivary
nucleus

- Smaller dorsal and medial
accessory olivary nuclei also
are present

- The function of the olivary
nuclei is associated with
voluntary muscle movement.

Vestibulocochlear Nuclei

Vestibular comples:

(1) medial vestibular nucleus

(2) inferior vestibular nucleus

(3) lateral vestibular nucleus

(4) superior vestibular nucleus

Cochlear nuclei:

(1) anterior cochlear nucleus

(2) posterior cochlear nucleus

The Nucleus Ambiguus

The nucleus ambiguus
consists of large motor
neurons and is situated
deep within the reticular
formation

The emerging nerve fibers join
the glossopharyngeal,
vagus, and cranial part of
the accessory nerve and
are distributed to voluntary
skeletal muscle

The medial lemniscus

forms a flattened tract on each side of the midline posterior

to the pyramid, These fibers emerge from the decussation of the lemnisci and
convey sensory information to the thalamus.

The medial longitudinal fasciculus

forms a small tract of nerve fibers situated on

each side of the midline posterior to the medial lemniscus and anterior to the
hypoglossal nucleus It consists of ascending and descending fibers

The inferior cerebellar peduncle

is situated in the posterolateral corner of the

section on the lateral side of the fourth ventricle

The spinal tract of the trigeminal nerve

and its nucleus are situated on the

anteromedial aspect of the inferior cerebellar peduncle

The reticular formation

, consisting of a diffuse mixture of nerve fibers and small

groups of nerve cells, is deeply placed posterior to the olivary nucleus The
reticular formation represents, at this level, only a small part of this system

the reticular formation is present at all levels of Medulla oblongata, it also

present in the pons and midbrain

Lecture

The BRAINSTEM

Pons and Midbrain

PONS (GROSS APPEARANCE)

Anterior surface of the brainstem showing the pons

Pons connect the medulla oblongata to midbrain and lie ant to cerebellum

It is about 1 inch (2.5 cm) long and owes its name to the appearance presented on
the anterior surface, which is that of a bridge connecting the right and left
cerebellar hemispheres

Ant it is convex with multiple transverse fibers that converge on each side to form
the middle cerebellar peduncle

a shallow groove in the midline, the basilar groove, which lodges the basilar artery

anterolateral surface of the pons, the trigeminal nerve emerges on each side. Each
nerve consists of a smaller, medial part, known as the motor root, and a larger,
lateral part, known as the sensory root

the groove between the pons and the medulla oblongata, there emerge, from
medial to lateral, the abducent, facial, and vestibulocochlear nerves

Pos. surface of the brainstem showing the pons. The cerebellum has been removed

Post it is triangular in shape forming the upper half of the floor of the fourth

ventricle, it is hidden by the cerebellum

posterior surface is limited laterally by the

superior

cerebellar peduncles

and is

divided into symmetrical halves by a median sulcus

Lateral to this sulcus is an elongated elevation, the

medial eminence

, which is

bounded laterally by the

sulcus limitans

Facial colliculus:

is produced by the root of the facial nerve winding around the

nucleus of the abducent nerve

The floor of the superior part of the sulcus limitans is bluish-gray in color and is

called the

substantia ferruginea

area vestibuli :

Lateral to the sulcus limitans, produced by the underlying vestibular

nuclei

Internal structure of the pons

pons is commonly divided into a posterior part, the tegmentum, and an anterior
basal part by the transversely running fibers of the trapezoid body

The structure of the pons may be studied at two levels: (1) transverse section
through the caudal part, passing through the facial colliculus, and (2) transverse
section through the cranial part, passing through the trigeminal nuclei

Transverse section through the caudal part of the pons at the level of the facial
colliculus

Transverse section through the pons at the level of the trigeminal nuclei

Comparison of the Different Levels of the Pons

Showing the Major Structures at Each Level

Level

Cavity

Nuclei

Motor Tracts

Sensory Tracts

Facial
colliculus

Fourth ventricle

Facial nucleus, abducent
nucleus, medial
vestibular nucleus, spinal
nucleus of cranial nerve
V, pontine nuclei,
trapezoid nuclei

Corticospinal and
corticonuclear tracts,
transverse pontine fibers,
medial longitudinal
fasciculus

Spinal tract of cranial
nerve V; lateral, spinal,
and medial lemnisci

Trigemin
al nuclei

Fourth ventricle

Main sensory and motor
nucleus of cranial nerve
V, pontine nuclei,
trapezoid nuclei

Corticospinal and
corticonuclear tracts,
transverse pontine fibers,
medial longitudinal
fasciculus

Lateral, spinal, and
medial lemnisci

Note that the reticular formation is present at all levels.

Photomicrograph of a transverse section of the pons at
the level of the trigeminal nuclei

MIDBRAIN

The midbrain measures about 0.8 inch (2 cm) in length and connects the pons

and cerebellum with the forebrain

The midbrain is traversed by a narrow channel, the cerebral aqueduct, which is

filled with cerebrospinal fluid which connects the third and fourth ventricles

The midbrain comprises two lateral halves, called the cerebral peduncles;

The midbrain is devided by the cerebral aquiduct into ventral and dorsal part

Ventrally:

divided into an anterior part, the crus cerebri, and a posterior part, the

tegmentum, by a pigmented band of gray matter, the substantia nigra.,.

Dorsally:
The tectum consist of four small surface swellings, two superior and two
Inferior colliculi

For description, two levels are studied for the internal structure of midbrain

- Transverse Section of the Midbrain at the Level of the Inferior Colliculi
- Transverse Section of the Midbrain at the Level of the superior Colliculi

Transverse section of the midbrain through the inferior colliculi shows the division

of the midbrain into the tectum and the cerebral peduncles. Note that the
cerebral peduncles are subdivided by the substantia nigra into the tegmentum
and the crus cerebri

The

Interpeduncular fossa

, is a deep depression in the midline on the anterior

aspect of the midbrain it is bounded on either side by the

crus cerebri

Many small blood vessels perforate the floor of the interpeduncular fossa, and this

region is termed the

posterior perforated substance

The oculomotor nerve emerges from a groove on the medial side of the crus cerebri

and passes forward in the lateral wall of the cavernous sinus.

Comparison of Two Levels of the Midbrain

Showing the Major Structures at Each Level

Level

Cavity

Nuclei

Motor Tract

Sensory Tracts

Inferior
colliculi

Cerebral aqueduct

Inferior colliculus,
substantia nigra, trochlear
nucleus, mesencephalic
nuclei of cranial nerve V

Corticospinal and
corticonuclear tracts,
temporopontine,
frontopontine, medial
longitudinal fasciculus

Lateral, trigeminal,
spinal, and medial
lemnisci; decussation
of superior cerebellar
peduncles

Superior
colliculi

Cerebral aqueduct

Superior colliculus,
substantia nigra,
oculomotor nucleus,
Edinger-Westphal nucleus,
red nucleus, mesencephalic
nucleus of cranial nerve V

Corticospinal and
corticonuclear tracts,
temporopontine,
frontopontine, medial
longitudinal fasciculus,
decussation of
rubrospinal tract

Trigeminal, spinal, and
medial lemnisci

Note that the reticular formation is present at all levels.

Transverse
sections of the
midbrain. A: At
the level of the
inferior
colliculus. B:
At the level of
the superior
colliculus.
Note that
trochlear
nerves
completely
decussate
within the
superior
medullary
velum

Position of some of
the cranial nerve
nuclei in the
brainstem. A:
Surface projection
on the posterior
aspect of the
brainstem. B:
Cross sections.
The motor nuclei
are in red and the
sensory nuclei in
blue

MCQ Question (sample)
base of skull

The interior of the base of the skull is divided into two cranial fossae:
anterior, and posterior

anterior cranial fossa lodges the frontal lobes of the cerebral hemispheres

optic nerve pass through optic canal

occipital bones make a major part of middle cranial fossa