brain stem external features

Dr. Ahmed Fathalla Ibrahim

BRAINPROSENCEPHALON (FOREBRAIN):1. TELENCEPHALON: Cerebral hemispheres (cavities:

2 lateral ventricles)2. DIENCEPHALON: thalamus, hypothalamus,

epithalamus & subthalamus (cavity: 3rd ventricle)MESENCEPHALON (MIDBRAIN)• Cavity: cerebral aqueductRHOMBENCEPHALON (HINDBRAIN)1. METENCEPHALON: Pons & cerebellum2. MYELENCEPHALON: Medulla• Cavity: 4th ventricle

BRAIN STEMCOMPONENTS: 1. Midbrain: most rostal part2. Pons3. Medulla oblongata: most caudal partEMBRYOLOGICAL ORIGIN:• Midbrain: arises from mesencephalon• Pons & medulla: arise from

rhombencephalon or hindbrain (together with cerebellum)

BRAIN STEMSITE: • It lies on the basilar part of occipital bone

(clivus)• The midbrain is continuous rostrally with

diencephalon of forebrain• The pons is continous rostrally with

midbrain & caudally with medulla• The medulla is continuous caudally with

spinal cord at the margin of foramen magnum

BRAIN STEM

CONNECTION TO CEREBELLUM:1. Midbrain: by superior cerebellar

peduncle2. Pons: by middle cerebellar peduncle3. Medulla oblongata: by inferior

cerebellar peduncle

BRAIN STEMIMPORTANCE:1. Pathway of tracts between cerebral cortex &

spinal cord2. Site of origin of nuclei of cranial nerves

(from 3rd to 12th)3. Site of emergence of cranial nerves (from 3rd

to 12th)4. Contains groups of nuclei & related fibers

known as reticular formation responsible for: control of level of consciousness, perception of pain, regulation of cardiovascular & respiratory systems

BRAIN STEMVENTRAL SURFACE

BRAIN STEMVENTRAL SURFACE

BRAIN STEMVENTRAL SURFACE

MEDULLA:• Ventral median fissure: 1. It divides the medulla into 2 halves 2. Its lower part is masked by decussation of

pyramidal (corticospinal) fibers• Pyramid: 1. It lies on either side of ventral median

fissure 2. It is an elevation produced by corticospinal

tract

BRAIN STEMVENTRAL SURFACE

MEDULLA:• Olive: 1. It lies lateral to the pyramid & separated from it

by the ventrolateral sulcus2. It is an elevation produced by inferior olivary

nucleusNerves emerging from Medulla (4 nerves):1. Hypoglossal (12th): between pyramid & olive2. Glossopharyngeal (9th), vagus (10th) & cranial

part of accessory (11th): dorsolateral to olive (from above downwards)

BRAIN STEMVENTRAL SURFACE

BRAIN STEMVENTRAL SURFACE

PONS:• Basilar sulcus:1. It divides the pons into 2 halves2. It is occupied by basilar artery• Transverse pontine (pontocerebellar)

fibers:1. Originate from pontine nuclei2. Cross midline & pass through contralateral

middle cerebellar peduncle to enter the opposite cerebellar hemisphere

BRAIN STEMVENTRAL SURFACE

PONS:Nerves emerging from Pons (4 nerves):1. Trigeminal (5th): from the middle of ventrolateral

aspect of pons, as 2 roots: a small medial motor root & a large lateral sensory root

2. Abducent (6th): at junction between pons & pyramid

3. Facial (7th) & vestibulocochlear (8th): at cerebellopontine angle (junction between medulla, pons & cerebellum). Both nerves emerge as 2 roots: from medial to lateral: motor root of 7th , sensory root of 7th , vestibular part of 8th & cochlear part of 8th

BRAIN STEMVENTRAL SURFACE

BRAIN STEMVENTRAL SURFACE

MIDBRAIN:• It is formed of a large column of

descending fibers (crus cerebri or basis pedunculi), on either side

• The 2 crura cerebri are separated by a depression (interpeduncular fossa)

Nerve emerging from Midbrain (one):• Occulomotor (3rd): from medial aspect

of crus cerebri

BRAIN STEMDORSAL SURFACE

BRAIN STEMDORSAL SURFACE

MEDULLA• Divided into 2 portions:1. Caudal 2/3: Closed Medulla:2. Rostral 1/3: Open Medulla

BRAIN STEMDORSAL SURFACE

CLOSED MEDULLA• Contains the rostral continuation of central canal• Composed of:1. Dorsal median sulcus: divdes the closed medulla into 2

halves2. Fasciculus gracilis: on either side of dorsal median

sulcus3. Gracile tubercle: an elevation produced at the upper part

of fasciculus gracilis, marks the site of gracile nucleus4. Fasciculus cuneatus: on either side of fasciculus

gracilis5. Cuneate tubercle: an elevation produced at the upper

part of fasciculus cuneatus, marks the site of cuneate nucleus

BRAIN STEMDORSAL SURFACE

OPEN MEDULLA• Forms the lower part of floor of 4th ventricle• On either side, an inverted V-shaped sulcus

divides the area into 3 parts (from medial to lateral):

1. Hypoglossal triangle: overlies hypoglossal nucleus

2. Vagal triangle: overlies dorsal vagal nucleus

3. Vestibular area: overlies vestibular nuclei

BRAIN STEMDORSAL SURFACE

BRAIN STEMDORSAL SURFACE

PONS• Forms the upper part of floor of 4th ventricle• Separated from the medulla by an imaginary

line passing between the caudal margins of middle cerebellar peduncle

• On either side, a sulcus divides the area into 2 parts (from medial to lateral):

1. Medial eminence: overlies abducent nucleus

2. Vestibular area: overlies vestibular nuclei

BRAIN STEMDORSAL SURFACE

BRAIN STEMDORSAL SURFACE

MIDBRAIN:• Marked by 4 elevations:1. Two superior colliculi: concerned with

visual reflexes2. Two inferior colliculi: forms part of

auditory pathwayNerve emerging from Midbrain (one):• Trochlear (4th): just caudal to inferior

colliculus (The only cranial nerve emerging from dorsal surface of brain stem)

FOURTH VENTRICLE

FOURTH VENTRICLE

FOURTH VENTRICLE

FOURTH VENTRICLE

FOURTH VENTRICLE• Cavity of hindbrain• Diamond (rhomboid) in shape• Triangular in cross section• Communications:1. Rostrally: with cerebral acqueduct

(cavity of midbrain)2. Caudally with central canal (cavity of

spinal cord)• Lateral walls (boundaries): superior &

inferior cerebellar peduncles

FOURTH VENTRICLE• Roof:1. Upper part: superior cerebellar peduncle

& superior medullary velum (a layer of pia & ependyma bridging the space between the 2 peduncles)

2. Middle part: cerebellum3. Lower part: inferior medullary velum (a

layer of pia & ependyma), has a central defect that forms the median aperture of 4th ventricle

FOURTH VENTRICLE• Floor (rhomboid fossa): formed of:1. Whole dorsal surface of pons2. Open medulla (dorsal surface of rostral 1/3

medulla)• Apertures: provide communication

between 4th ventricle & subarachnoid space for circulation of CSF

1. One median aperture (Foramen of Magendi): in the roof of 4th ventricle

2. Two lateral apertures (Foramena of Luschka): at cerebellopontine angle