Ainstem I
Ainstem I
Ainstem I
Lecture 2
The Brainstem – Part I
Lecture Overview
• Embryology
• Features and Organization
• Specific features of each Subdivision
• Key Structures
• Cranial Nerves
Lecture Overview
• The brainstem is important enough to deserve two
lectures!
– First lecture involves general description, classification of
the brainstem as well as the cross sectional and anatomical
construction of the brainstem
– Second lecture involves detailed review of cranial nerves
and their relationship to the brainstem
The Brainstem
• The Brainstem is the part of the brain that:
1. Forms the zone of transition between the brain and the spinal cord
2. From which most (but not all!) cranial nerves originate
3. Within which are contained centers which are crucial for:
• Awakeness and arousal
• Respiration
• Balance
• Conjugate gaze
4. Is associated with important CSF collections including the:
• Cerebral aqueduct
• 4th ventricle
• CSF cisterns
5. Below which is located the foramen magnum, which forms the
confines of the skull
Embryological Derivation
Organization
Evaginations and Protuberances
• Evaginations: outpouching of a local part of the neural tube
wall
• Protuberances: Proliferation of cells into masses in particular
sites:
– There is no extension of lumen of the neural tube
• Cerebellum
• Mammillary bodies
• Brainstem protuberances:
– Quadrigeminal plate
– Nuclei of the basis pontis
– Inferior olivary eminence
• Most protuberances relate to the brainstem!
Features of the Brainstem
• Essentially the brainstem has the same somite plan
as the spinal cord
• It delineates a transition zone from the diencephalon
to the spinal cord
The Brainstem as a Transition zone
• Given that it is a transition zone, additional features
are present:
– Special motor neurons (cranial nerves)
– Special nuclei and pathways that mediate the special
senses of taste, hearing, equilibrium
– Pathways that control eye movements
– Reticular formation
– Associated nuclei with the above
– Quadrigeminal plate of the midbrain
– The cerebellum: Closely associated with the brainstem
• Cerebellum is “protruding from the dorsum of the pons”
Functional Subdivisions of the
Brainstem
• The brainstem can be divided into:
– Midbrain (mesencephalon)
• Most rostral
– Pons (metencephalon)
• Middle
– Medulla (myelencephalon)
• Most caudal
• On the axial plane, the brainstem is
subdivided into three laminae:
– Tectum (most dorsal)
– Tegmentum (middle)
– Basis (most rostral)
Brainstem Organization
• Multiple manners of classification:
– According to cross sectional subdivisions:
tectum/tegmentum/basis
– According to contents of midbrain/pons/medulla
– According to nuclei and cranial nerves
– Functional classification
Cross-sectional Organization
• Tectum:
– Defined as lamina of the brainstem with tissue
dorsal to the plane of the cerebral aqueduct
– Tectum = roof
– Contents:
• Quadrigeminal plate in the midbrain (roofs over the
aqueduct)
• Superior medullary velum over the pons
• Inferior medullary velum over the medulla
Cross-sectional Organization
• Tegmentum:
– Plate of neurons and tracts between basis and tectum
– Complex relationship of gray and white matter
• General somatomotor and general sensory cranial nerve nuclei
– These are strictly located in the tegmentum: no cranial nerve nuclei are
located in the basis or tectum
• Special visceral efferent nuclei
• Supplementary motor nuclei
– In the medulla: inferior olivary nuclei
– In the pons: Nuclei of the basis pontis
– In the midbrain: Red nucleus and substantia nigra
• Sensory tracts to the thalamus: Lemnisci
• Reticular formation fills the space in the tegmentum that is not occupied
by the above
Cross-sectional Organization
• Basis:
– Transmits descending cortical efferent motor
tracts
• Corticopontine tracts
• Pyramidal tracts
– Corticobulbar
– Corticospinal
• In the medulla, the basis has an oval or “pyramidal”
shape, hence the name medullary pyramids. The name
of pyramidal tracts derives from this.
Ventral View of the Brainstem
Sagittal View of the Brainstem
Dorsal View of the Brainstem
Midbrain General Organization
• Midbrain tegmentum:
– Two cranial nerve nuclei: III, IV
– Two supplementary motor nuclei:
• Red nucleus
• Substantia nigra
• Midbrain tectum:
– Quadrigeminal plate:
• Paired colliculi: two superior, two inferior
Midbrain General Organization
• Midbrain basis:
– Corticopontine tracts
– Pyramidal tracts
• Decussations:
– Superior cerebellar peduncle fibers
– Corticobulbar pathway for volitional horizontal eye
movements
• Contains the aqueduct within the tegmentum
Tracts within the Midbrain
• We will follow the course of several major
tracts within the brainstem:
– Medial longitudinal fasciculus (MLF)
– Medial lemniscus (ML)
– Spinal lemniscus (SL)
– Corticospinal tract (CST)
Tracts within the Midbrain
• MLF: Ventral tegmentum, anterior to
periaqueductal gray
• SL: Lateral tegmentum, dorsal to ML
• ML: Together with SL form a crescent dorsal to
SN
• CST: Midbrain basis
Tectum and Tegmentum
Midbrain (Mesencephalon)
Midbrain (Mesencephalon)
Pons (Myelencephalon)
The Pons
• Pons (Lt. Bridge)
• External anatomy:
– Characteristic protuberance ventrally (“belly” of
the pons)
– Midportion of the brainstem
– Ventral and opposite to the position of the
cerebellum on sagittal views
General Structure
• Cross section: Triad 1
– Tectum: Superior medullary velum
– Tegmentum: Thin plate of gray matter
– Basis: Largest portion of the pons
• Contains longitudinally coursing cortical efferent fibers
and nuclear masses
• Corticopontocerebellar pathway
General Structure
• Pontine peduncles: Triad 2
– Three paired peduncles: afferent and efferent
cerebellar tracts; pure white matter tracts
– Cerebellar peduncles
• Superior (brachium conjuctivum), rostral, cerebellar
afferents and efferents
• Middle, cerebellar afferents only, largest
• Inferior (restiform body), caudal - afferents and
efferents
General Structure
• Pontine cranial nerves:
• Motor cranial nerve nuclei: Triad 3
– V, VI, VII
– Internal loop of VII over VI
• Sensory cranial nerve nuclei: Triad 4
– Rostral part of cochlear VIII
– Rostral part of vestibular VIII
– Sensory nucleus of V
General Structure
• Sensory nucleus of V has 3 subdivisions:
– Mesencephalic nucleus (propioception)
– Main sensory nucleus (touch)
– Spinal nucleus (medulla and rostral spinal cord
(pain/temp)
General Structure
• Decussations in the pons: Triad 5
– Auditory pathways:
• Trapezoid body and superior olive
– Pontocerebellar pathways:
• Decussation from basis pontis to MCP
– Cerebellovestibular pathways:
• Partially decussate across the roof of 4th ventricle
Tracts in the Pons
• MLF:
– Caudal pons: dorsal tegmentum, medial
– Ventral pons: further dorsal, just ventral to 4th
ventricle
• SL/ML: Move dorsally, become horizontal
fibers in midpons. Lat/medial arrangement
• CST: Within the nuclei of the basis pontis
Tractography allows for the study of the brain with imaging rather than dissection
Medulla (myelencephalon)
• External anatomy:
– Bulbous expansion of the spinal cord
– Ventral protuberance of the olive
– Transition zone to the cord
– Open and closed medulla:
• Open medulla: 4th ventricle, rostral
• Closed medulla: caudal to the 4th ventricle
Medulla (myelencephalon)
http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/atlas/i
mages/n2a5p1.gif http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=frso
l&part=ch1
Medulla
• Tegmentum thickens:
– Primarily due to nuclei of the reticular formation
– Long tracts assemble as a shell around the gray
matter
– Area postrema, only paired circumventricular
organ – located at the caudal end of the 4th
ventricle
Comparison between Medulla and Spinal
Cord
Spinal Cord Medulla
• Central canal • Fourth ventricle
• Reticular nucleus • Reticular formation
• Substantial gelatinosa • Spinal nucleus and tract of V
• Nucleus dorsalis of Clarke • Lateral cuneate nucleus
• Intersegmental ground • Medial longitudinal
bundles fasciculus
• Spinal lemniscus • Continues to medial
lemniscus
Transition from Medulla to Cord
• External features:
– The medulla is larger, the spinal cord is smaller
– Presence of the 4th ventricle in the medulla
– Presence of the external olivary eminence
– Anterior median fissure is obliterated
– Presence of spinal nerves
• Internal features:
– Decussation of the pyramids in the medulla
– Termination of the fasciculi gracilis and cuneatus
– Replacement of Lissauer’s fibers by spinal
trigeminal tract
– Development of CN nuclei
• Most caudal end of the
4th ventricle = obex
• 4th ventricle has the
shape of a writing pen
(=calamus scriptorius)!
• Cranial nerves associated with the medulla:
– Vestibulocochlear (VIII)
– Glossopharyngeal (IX)
– Vagus (X)
– Accessory (XI)
– Hypoglossal (XII)
Medullary Decussations
• 5 important decussations:
• Reticulospinal respiratory pathways
– Just ventral to the obex
• Pyramidal tract
• Internal arcuate fibers: formed by 3 decussations:
– Trigeminal lemniscus: From spinal nucleus of V
– Medial lemniscus: From nuclei gracilis and cuneatus
– Olivocerebellar tracts: From inferior olive
Medullary Tracts
• MLF: Very medial and dorsal, just ventral to the 4th ventricle
• SL: Very lateral, and now quite separate from the medial
lemniscus