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Gross Brain and Spinal Cord BLOCK 3 – 2011-12 Robert R. Terreberry, PhD Room 142 Ph 864.327.9827 [email protected] Layers of Scalp Scalp B O N E Skin Connective Tissue Aponeurosis Loose CT Pericranium Scalp • A. Extends from the superior nuchal line posteriorly to the supraorbital margins anteriorly • B. Laterally the scalp extends into the infratemporal fossae to the level of the zygomatic arches • C. Classically defined as having five (5) layers – – – – – 1. 2. 3. 4. 5. Skin Connective tissue Aponeurosis epicranialis Loose connective tissue Pericranium (periosteum) • D. Scalp cont… Skin – 1. – 2. – 3. • E. Thin, especially in elderly persons Contains many sweat and sebaceous glands and hair follicles Abundant arterial supply, good venous and lymphatic drainage Connective tissue (Dense) – 1. Thick, dense subcutaneous layer of connective tissue is richly vascularized and well innervated – 2. Collagen and elastic fibers criss-cross in all directions attaching to the epicranial aponeurosis – 3. Fat is enclosed in lobules between connective tissue fibers • a. Amount of subcutaneous fat in scalp is relatively constant, varying little in emaciation or obesity – Does decrease with advancing age Scalp cont… • F. Aponeurosis epicranialis (epicranial aponeurosis) – 1. Strong membranous sheet that covers the superior aspect of the calvaria • a. Term galea aponeurotica is sometimes used to indicate its helmet-like nature • b. Continuous laterally with the temporal fascia overlying the temporalis muscle – 2. Serves as the membranous tendon of the fleshy bellies of the epicranius muscle – 3. Epicranius muscle • a. • b. Two (2) occipital bellies (occipitalis muscle) Two (2) frontal bellies (frontalis muscle) Frontalis Muscle Epicranial Aponeurosis Frontalis muscle Occipitalis Muscle Epicranial Aponeurosis Occipitalis muscle Scalp cont… • G. Loose connective tissue – 1. • a. Consists of loose, areolar connective tissue Allows for free movement of the superficial 3 layers – 2. Due to loose connective tissue, this layer has numerous potential spaces capable of allowing fluid to accumulate • H. Pericranium (periosteum) – 1. Dense layer of connective tissue firmly attached to the bones of the calvaria via Sharpey’s fibers Innervation of Scalp and Face Blood Supply of Scalp & Face Skull Views • Superior – Norma verticalis • Inferior – Norma basalis • Posterior – Norma occipitalis • Anterior – Norma frontalis • Lateral – Norma lateralis Calvaria • • Calvaria 1. Consists of flat bones of the skull – a.Frontal – b.Parietal – c. Occipital • 2. Each flat bone has an outer (external) table and an inner (internal) table of compact bone – a.Between the two tables is cancellous (spongy) bone termed the diploë • • • 3. Outer table is usually thicker and tough 4. Inner table is thinner, denser and more brittle 5. Removal of calvaria allows one to examine the internal aspects of the skull including the cranial fossae Norma Verticalis • • • • • • • • Frontal bone Parietal bone Occipital bone Coronal suture Sagittal suture Bregma Lambda Parietal foramen Inner Calvaria • • • • • • Frontal bone Parietal bone Coronal suture Sagittal suture Frontal sinus Groove for superior sagittal sinus • Groove for middle meningeal artery • Granular foveolae Cranial Fossae Anterior Middle Posterior Anterior Cranial Fossa • Orbital plate of frontal bone • Cribriform plate of ethmoid bone • Lesser wing of sphenoid bone • Body of sphenoid Anterior Cranial Fossa • • • • • Crista galli of ethmoid bone Frontal sinus Anterior clinoid process Optic groove Optic canal Middle Cranial Fossa • Lesser wing of sphenoid bone • Anterior clinoid process • Chiasmatic sulcus • Petrous temporal • Dorsum sellae of sphenoid bone Middle Cranial Fossa • Squamous temporal bone • Parietal bone • Greater wing of sphenoid bone Middle Cranial Fossa • Sella turcica (TS + HF+ DS) •Tuberculum sellae •Hypophysial fossa •Dorsum sellae Middle Cranial Fossa • Foramen ovale • Foramen spinosum • Foramen lacerum Middle Cranial Fossa • Carotid groove • Hiatus for greater petrosal nerve • Hiatus for lesser petrosal nerve Posterior Cranial Fossa • Basioccipital portion of occipital bone • Petrous temporal • Internal occipital crest • Internal occipital protruberance Posterior Cranial Fossa • Foramen magnum • Jugular foramen • Internal acoustic meatus • Hypoglossal canal Meninges • Dura mater Pachymeninx Outer • Arachnoid Middle • Pia Mater Inner Leptomeninges Meninges Cranial Dura Mater Spinal Dura Mater Spinal Dura Subdural Space Dura Mater Epidural Space • Loose CT • Fat • Epidural venous plexus Spinal Dura • Ends at S2 vertebral level • Filum terminale externum S2 Terminal end Cranial Dura Cranial Dura Meningeal layer Endosteal layer Fused Cranial Dura Cranial Dura • Endosteal layer • Thick bundles of collagen • Cell rich • Numerous blood vessels • Meningeal layer • Thinner than endosteal layer • Inner layer smooth with squamous mesothelium • Inner layer forms sheet-like extensions Cranial Dura – Blood Supply • Anterior meningeal as. • Off ethmoidal as. • Middle meningeal a. • Off maxillary artery • Largest meningeal artery • Posterior meningeal brs. • Off vertebral /occipital as. Cranial Dura - Innervation Spinal Arachnoid Pia mater Arachnoid Dura mater Spinal Arachnoid • Ends at S2 vertebral level • Filum terminale externum S2 Terminal end Cranial Arachnoid • Similar to spinal arachnoid structurally • Does not extend into sulci or fissures • Enlargements of subarachnoid space are termed cisterns Spinal Pia Pia mater Arachnoid Dura mater Spinal Pia Conus Medullaris • Ends at L1/L2 vertebral level • Filum terminale internum conus medullaris Filum Terminale Internum Pia Mater • Tightly adherent to surfaces of CNS • Follows sulci and fissures • Highly avascular • Spinal pia mater is firmer and less vascular than cranial pia mater Cranial Pia Mater • Invaginates to form tela choroidea • 3rd ventricle • 4th ventricle • Forms choroid plexuses • 3rd ventricle • 4th ventricle • Lateral ventricles Dural Folds (Reflections) • The inner (meningeal) layer of cranial dura mater is folded inwards as four (4) septa that partially divide the cranial cavity into freely communicating spaces – – – – 1. Falx cerebri 2. Falx cerebelli 3. Tentorium cerebelli 4. Diaphragma sella Falx Cerebri • • • • • • • • • 1. Strong, crescent-shaped vertical sheet of dura located in the interhemispheric (longitudinal) fissure between the cerebral hemispheres 2. Attached anteriorly to the crista galli of the ethmoid bone 3. Attached posteriorly to the tentorium cerebelli where it blends in the midline of the tentorium 4. Convex upper margin is attached to the internal cranial surface on each side of the median plane as far back as the internal occipital protuberance 5. Narrower anteriorly, broader posteriorly a. Anterior part is thin and may be fenestrated 6. Superior sagittal sinus runs along upper margin 7. Inferior margin is free and concave and contains the inferior sagittal sinus 8. The straight sinus is located along the point of attachment between the falx cerebri and tentorium cerebelli Falx cerebelli • 1. Small, crescent-shaped fold in the midline of the posterior cranial fossa • 2. Attached to posterior part of the internal occipital crest of the occipital bone • 3. Partially separates the lateral hemispheres of the cerebellum • 4. Occipital sinus is located in margin attached along the internal occipital crest Tentorium cerebelli • 1. Crescent-shaped fold of dura located between the occipital lobes and the cerebellum – a.Midline attachment of falx cerebri to superior aspect of tentorium draws the tentorium upwards • • 2. Concave anterior edge is free and between it and the dorsum sellae of the sphenoid bone is the tentorial incisure (notch) that allows the midbrain to pass superiorly 3. Posteriorly it is attached to the petrous portions of the temporal bones and the margins of the sulcus for the transverse sinuses in the occipital bone – a.Transverse sinuses course along this posterior margin of the tentorium • 4. Tentorium cerebelli defines supratentorial and infratentorial compartments of the cranial cavity – a.Infratentorial compartment is commonly referred to as the posterior cranial fossa Diaphragma sella • 1. Roofs over the sella turcica of sphenoid bone • 2. Small, circular layer of dura with a small central opening that transmits the infundibular stalk of the pituitary gland Cranial Dural Folds Falx Cerebri Falx Cerebelli Cranial Dural Folds Falx Cerebri Tentorium Cerebelli Cranial Dural Folds Falx Cerebri Tentorium Cerebelli Cranial Dural Folds Cranial Dural Folds Falx Cerebri Falx Cerebelli Cranial Dural Folds Hypophysis Diaphragma Sella Sphenoid Sinus Pons Spinal Cord 8 Cervical 12 Thoracic 5 Lumbar 5 Sacral 1 Coccygeal Spinal Cord Dorsolateral Sulcus Dorsointermediate Sulcus Dorsal Median Sulcus (Dorsal, in situ) Cervical Segment C8 Dorsal Median Sulcus Dorsointermediate Sulcus Dorsolateral Sulcus Ventrolateral Sulcus Ventral Median Fissure Thoracic Segment T10 Dorsal Median Sulcus Dorsolateral Sulcus Ventrolateral Sulcus Ventral Median Fissure Thoracic (T10) Dorsal Horn Lateral Horn Ventral Horn Thoracic Gray Matter (T10) Lissauer’s Tract Substantia Gelatinosa Nucleus Proprius IML VH Clarke’s Nucleus Ventral (anterior) Horn Rexed's laminae • In 1952, Bror Rexed, a Swedish neuroanatomist, devised a system for subdividing the spinal gray matter into layers or laminae, based upon differences in cytoarchitecture • Scheme was initially developed for animal models, but is widely used in discussions of the human spinal cord • Ten different laminae described for the human spinal cord Laminae I-VI = dorsal horn Lamina VII = intermediate gray matter Laminae VIII & IX = ventral horn (VIII = interneurons) (IX = alpha () motorneurons) Lamina X = midline area of gray matter around the central canal White Matter White matter is made up primarily of neuronal axons, some of which are directed rostrally from neuronal cell bodies in the spinal cord gray matter or the dorsal root ganglia (DRG), while others have descended into the spinal cord from cell bodies in the cerebral cortex or brainstem nuclei Funiculus • Funiculus - composite bundles of tracts – Dorsal (posterior) funiculus or the “dorsal columns” • Between the dorsal root entry zone (dorsolateral sulcus) and dorsomedian sulcus • Composed of ascending tracts – Lateral funiculus • Between the dorsolateral and ventrolateral sulci • Composed of both ascending and descending tracts – Ventral (anterior) funiculus • Between the ventrolateral sulcus and ventromedian fissure • Composed of both ascending and descending tracts Cervical Enlargement (C8) DREZ FC LCST FG STT Thoracic (T10) DREZ FG LCST STT The 9 main pathways of the spinal cord Medulla Ventral Medulla Olive Pyramid Ventral Median Fissure Pyramidal Decussation Ventral Medulla Post-olivary Sulcus Pre-olivary Sulcus Pyramid Lateral Olive Medulla CN IX CN X CN XI Ventral CN XII Medulla CN IX CN X CN XI CN XII Olive Ventrolateral Medulla Rhomboid Fossa of 4th Ventricle Obex Gracile Tubercle Dorsal Cuneate Tubercle Pons Ventral Pons Basilar Pons Basilar Sulcus Ventral Pons CN V CN VI CN VII CN VIII Ventral Pons CN VII CN V CN VIII Ventrolateral CN VI Pons CN V Lateral Middle Cerebellar Peduncle Pons Facial Colliculus Dorsal Rhomboid Fossa of 4th Ventricle Midbrain Ventral Midbrain Interpeduncular Fossa CN III Crus Cerebri Ventral Midbrain CN III Interpeduncular Fossa Ventral Crus Cerebri Midbrain Superior Colliculus Inferior Colliculus CN III Crus Cerebri Lateral Midbrain Superior Colliculus Inferior Colliculus CN IV Dorsal Midbrain Superior Brachium Sup. Coll. Inf. Coll. Dorsal Inferior Brachium CN IV Cerebellum Midbrain Pons 4th Vent Medulla Mid-sagittal Cerebellum Posterosuperior Cerebellar Peduncles Midbrain SCP Pons MCP Medulla ICP Cerebellar Peduncles SCP MCP Ventral ICP Cerebellum Anterior Lobe Posterior Lobe Posterosuperior PF Cerebellum Primary Fissure Anterior Lobe Flocculonodular Lobe Posterior Lobe Posterolateral Fissure Mid-Sagittal Cerebellum Anterior Lobe Posterior Lobe Anterior Lobe Flocculonodular Lobe Posterior Lobe Cerebellum Vermis Paravermis Lateral Hemisphere Cerebellar Cortex Granular layer Deep Cerebellar Nuclei Fastigial nucleus Globose nucleus Emboliform nucleus Dentate nucleus FGED Diencephalon Interventricular Foramen Lamina Terminalis Mid-sagittal Posterior Commissure 3rd Ventricle Diencephalon Thalamus MI Hypothalamus Mid-sagittal Pineal Gland Diencephalon Tuber Cinereum Mamillary Body Optic Chiasm Infundibulum Mid-sagittal Diencephalon Optic Nerve Optic Chiasm Median Eminence Optic Tract Ventral Mamillary Body Cerebral Hemispheres Interhemispheric Fissure Gyri Dorsal Sulci Brodmann’s Areas Select Cortical Areas Functional Designation Brodmann’s Anatomical Name Primary Motor Cortex Area 4 Precentral Gyrus Premotor Cortex Area 6 (lateral) Sup/Mid Frontal Gyri Frontal Eye Fields Area 8 Middle Frontal Gyrus Supplementary Motor Area Area 6 (medial) Sup. Frontal Gyrus Broca’s Area Areas 44 & 45 Inf. Frontal Gyrus Primary Somatosensory Cx Area 3,1,2 Postcentral Gyrus Unimodal SS Assoc. Cx Areas 5 & 7 Sup. Parietal Lobule Multimodal SS Assoc. Cx Areas 5 & 7 Sup. Parietal Lobule Primary Visual Cortex Area 17 Banks Calcarine Sul. Primary Auditory Cortex Areas 41 & 42 Transverse Temp. G. Wernicke’s Area Area 22 Surrounds 41 & 42 Cerebral Hemispheres Parietal Lobe Occipital Lobe Temporal Lobe Lateral – Right Hemisphere Frontal Lobe Centrum Semiovale Horizontal cut Internal Capsule Internal Capsule Corona Radiata Putamen Internal Capsule Anterior Limb Genu Horizontal cut Posterior Limb Corpus Callosum B G R S Deep Gray Matter • There are large masses of gray matter (nuclei or nuclear complexes) located deep within each cerebral hemisphere – Diencephalon – Basal ganglia – Amygdaloid complex Deep Gray matter cont… • Diencephalon – Thalamus and hypothalamus are located at the center of the cerebrum • Basal ganglia – Set of nuclei (gray matter) located deep within each hemisphere • Caudate nucleus • Putamen • Globus pallidus • Amygdaloid complex (amygdala) – Nuclear complex deep to cortex of the uncus – Anterior to hippocampal formation – Part of the limbic system Diencephalon Anterior Commissure Lamina Terminalis Mid-sagittal Posterior Commissure 3rd Ventricle Basal Ganglia Caudate Putamen Globus Pallidus Thalamus Horizontal cut Ventricular System Ependymal Cells • Ciliated, cuboidal epithelium • Lines ventricles of CNS • Discontinuous basal lamina allows for movement of material between CSF and brain rather easily Ventricular System Lateral Ventricle Third Ventricle Cerebral Aqueduct Fourth Ventricle Cerebral Blood Flow • Central nervous system • • • • 2% of body by weight 15% of all cardiac output 20% of all O2 consumed Total brain blood volume every 5-7/min • Loss of consciousness after 10 sec • Necrosis after 4-5 min of hypoxia Cerebral Blood Flow • Arterial supply to brain and much of spinal cord derived from 2 sets of arteries • Internal carotid arteries • Anterior circulation - 80% of blood supply • Vertebral arteries • Posterior circulation - 20% of blood supply • Linear extent of capillaries/Unit volume • Gray matter > White matter • Sensory, interneurons > Motor Questions??