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Neuro-anatomy For the Ophthalmologist
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Neuro-anatomy For the Ophthalmologist



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Raed Behbehani , MD FRCSC , Dipl.ABO



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Neuro-anatomy For the Ophthalmologist Neuro-anatomy For the Ophthalmologist Presentation Transcript

  • Neuro-anatomy for theOphthalmologist Raed Behbehani, MD, ABO
  • Neuro-anatomy Orbits Cranial Cavity Venous sinus Cavernous sinus Cranial Nerves
  • Anterior Cranial Fossa Anteriorly: Frontal bone. Posteriorly: Lesser wing of sphenoid. Floor : Orbital plate, cribriform plate. Anterior clinoids tentorium. View slide
  • Middle Cranial Fossa Floor: “Butterfly shape”. Anteriorly: The lesser wings of the sph., ant. Clinoids. Posteriorly : Petrous port. Of Temp. bone, dorsum sellae. Foramina : SOF, Rotundum, Ovale, Spinosum, Lacerum, View slide
  • Posterior Cranial Fossa Roof: Tent.Cerebelli. Anteriorly : Petrous part of Temp. bone, Dorsum sellae.
  • CSF Circulation
  • Venous Sinuses
  • Venous sinuses Superior SS . Inferior SS join the Great vein of Galen  Straight sinus. SSS, straight S, and two transverse S. frequenly join (confluence of sinuses). Straight S Sigimoid S Int Jugular vein.
  • CSF
  • Cavernous sinus Intercavernous comunications. Tributaries: Sup and Inf Ophthalmic veins, sup cerebral vein. Drainage: Sup and Inf petrosal sinus  Internial Jugular vein ( direct ) or via transverse sinus  Int Jug vein.
  • Cavernous sinus
  • Cranial Nerves
  • Oculomotor Nerve Nuclei lie at level of sup colliculi. Dorsally into the third ventricle. Laterally: MLF. Through tegmentum andRed nucleus  medial toCrus cerebri.
  • Oculomotor Nerve Interpeduncular fossa. Lateral to PCOM (between PCA above and Post Cerebellar art. Below). Lateral wall of cavernous sinus SOF.
  • Oculomotor nucleus MR subnucleus : 3 different masses. SR subnuclue : innervates contralateral SR. Central caudal nucleus: innervates LPS bilaterrally. Visceral subnuclei: anterior median, Edinger-Westphal, nucleus of Perlia.
  • 3rd Nerve
  • Trochlear Nerve Two nuclei in mesencephalon ventral to inferior colliculi. Close to caudal end of IIIrd nerve nuclei. Only somatic nerve to emerge from the dorsal aspect of the CNS. Decussation (anterior medullary velum ). Nucleus: anterior to periacqueductal gray matter.
  • Trochlear nerve Around the crus cerebri between PCA and Sup cerebell art (lateral to 3rd nv.) beneath the free edge of the tentorium  Pierces the dura and enters the lateral wall of the cavernous sinus beneath the 3rd cranial nerve.
  • Abducens Nerve Midpons beneath the facial colliculus. Longest course.
  • Abducens Nerve Emerges at pontomeduallry junnction.
  • Abducens Nerve Pierces the dura early upward onThe clivus.Vertical  Horizontal direction.Runs beneath the petroclinoid(Guber’s) Ligament.Within the cavernous sinus (lateralto the ICA).
  • Trigeminal nerve Gessarian ganglion : Temporal bone within middle cranial fossa (Meckel’s cave). V1 SOF , V2 FR , V3 FO.
  • Trigeminal nerve V1Sensory. V2 carries PS from The facial (superficial Petrosal nv.) for Lacrimation, V3 Motor and Sensory.
  • Facial nerve Supranuclear neurons : in the frontal lobe (pre-central gyrus). Corticobulbar fibers in the middle of internal capsule. Fibers cross (below MB) cross to innervate contralateral facial nucleus , some to ipsilateral.
  • Facial nerve
  • Facial nerve Facial colliculus. PS component : Superior salivatory nucleus (Sub-ling., Sub-Mand., Lacrimal gland). Nervus intermedius “7 ½ nerve” : carries PS and sensory input. Nucleus Solitarius : Sensory nucleus for taste.
  • Facial-Motor visceral Nervus intermedius (tearing,salivation,taste).
  • Facial Nerve
  • Facial Nerve Ventrolateral pons : Facial motor root and 8th nerve exit togather. CPA: Vth, VIIth and VIIIth lie close togather. Facial motor root  internal auditory meatus Fallopian canal. At geniculate ganglion: first branch of VII is Greater superficial petrosal nv. sphenopalatine ganglion lacrimal gland.
  • Facial Nerve
  • Facial nerve In the canal, nerve to stapedius , and chorda tympani. Facial nerve exit through the Stylomastoid foramen Parotid gland.
  • Facial nerve-Motor
  • Facial nerve