Atlas la neurologie


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Atlas la neurologie

  1. 1. Atlas of Neuroanatomy and NeurophysiologySelections from the Netter Collection of Medical Illustrations Illustrations by Frank H. Netter, MD John A. Craig, MD James Perkins, MS, MFA Text by John T. Hansen, PhD Bruce M. Koeppen, MD, PhD
  2. 2. Atlas of Neuroanatomy and NeurophysiologySelections from the Netter Collection of Medical IllustrationsCopyright ©2002 Icon Custom Communications. All rights reserved.The contents of this book may not be reproduced in any form without writtenauthorization from Icon Custom Communications. Requests for permissionshould be addressed to Permissions Department, Icon Custom Communications,295 North St., Teterboro NJ 07608, or can be made at www. effort has been taken to confirm the accuracy of the information presented.Neither the publisher nor the authors can be held responsible for errors or for anyconsequences arising from the use of the information contained herein, and makeno warranty, expressed or implied, with respect to the contents of the publication.Printed in U.S.A.
  3. 3. Foreword Frank Netter: The Physician, The Artist, The Art This selection of the art of Dr. Frank H. Netter on neuroanatomy and neurophysiology is drawnfrom the Atlas of Human Anatomy and Netter’s Atlas of Human Physiology. Viewing these picturesagain prompts reflection on Dr. Netter’s work and his roles as physician and artist. Frank H. Netter was born in 1906 in New York City. He pursued his artistic muse at the Sorbonne,the Art Student’s League, and the National Academy of Design before entering medical school atNew York University, where he received his M.D. degree in 1931. During his student years, Dr.Netter’s notebook sketches attracted the attention of the medical faculty and other physicians, allow-ing him to augment his income by illustrating articles and textbooks. He continued illustrating as asideline after establishing a surgical practice in 1933, but ultimately opted to give up his practice infavor of a full-time commitment to art. After service in the United States Army during the SecondWorld War, Dr. Netter began his long collaboration with the CIBA Pharmaceutical Company (nowNovartis Pharmaceuticals). This 45-year partnership resulted in the production of the extraordinarycollection of medical art so familiar to physicians and other medical professionals worldwide. When Dr. Netter’s work is discussed, attention is focused primarily on Netter the artist and onlysecondarily on Netter the physician. As a student of Dr. Netter’s work for more than forty years, I cansay that the true strength of a Netter illustration was always established well before brush was laid topaper. In that respect each plate is more of an intellectual than an artistic or aesthetic exercise. It iseasy to appreciate the aesthetic qualities of Dr. Netter’s work, but to overlook its intellectual quali-ties is to miss the real strength and intent of the art. This intellectual process requires thorough under-standing of the topic, as Dr. Netter wrote: “Strange as it may seem, the hardest part of making a med-ical picture is not the drawing at all. It is the planning, the conception, the determination of point ofview and the approach which will best clarify the subject which takes the most effort.” Years before the inception of “the integrated curriculum,” Netter the physician realized that agood medical illustration can include clinical information and physiologic functions as well as anato-my. In pursuit of this principle Dr. Netter often integrates pertinent basic and clinical science ele-ments in his anatomic interpretations. Although he was chided for this heresy by a prominentEuropean anatomy professor, many generations of students training to be physicians rather thananatomists have appreciated Dr. Netter’s concept. The integration of physiology and clinical medicine with anatomy has led Dr. Netter to another,more subtle, choice in his art. Many texts and atlases published during the period of Dr. Netter’scareer depict anatomy clearly based on cadaver specimens with renderings of shrunken and shriv-eled tissues and organs. Netter the physician chose to render “live” versions of these structures—notshriveled, colorless, formaldehyde-soaked tissues, but plump, robust organs, glowing with color! The value of Dr. Netter’s approach is clearly demonstrated by the plates in this selection.John A. Craig, MDAustin, Texas
  4. 4. This volume brings together two distinct but related aspects of the work of FrankH. Netter, MD, and associated artists. Netter is best known as the creator of theAtlas of Human Anatomy, a comprehensive textbook of gross anatomy that hasbecome the standard atlas for students of the subject. But Netter’s work includedfar more than anatomical art. In the pages of Clinical Symposia, a series of mono-graphs published over a period of more than 50 years, and in The Netter Collectionof Medical Illustrations, this premier medical artist created superb illustrations ofbiological and physiological processes, disease pathology, clinical presentations,and medical procedures.As a service to the medical community, Novartis Pharmaceuticals has commis-sioned this special edition of Netter’s work, which includes his beautiful andinstructive illustrations of nervous system anatomy as well as his depictions ofneurophysiological concepts and functions. We hope that readers will find Dr.Netter’s renderings of neurological form and function interesting and useful.
  5. 5. Click any title below to link to that plate. Part 1 NeuroanatomyCerebrum—Medial Views . . . . . . . . . . . . . . . . . 2 Oculomotor (III), Trochlear (IV) and Abducent (VI) Nerves: Schema. . . . . . . 27Cerebrum—Inferior View. . . . . . . . . . . . . . . . . . 3 Trigeminal Nerve (V): Schema . . . . . . . . . . . . 28Basal Nuclei (Ganglia). . . . . . . . . . . . . . . . . . . . 4 Facial Nerve (VII): Schema . . . . . . . . . . . . . . . 29Thalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Vestibulocochlear Nerve (VIII): Schema. . . . . 30Cerebellum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Glossopharyngeal Nerve (IX): Schema . . . . . . 31Brainstem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Vagus Nerve (X): Schema . . . . . . . . . . . . . . . . 32Fourth Ventricle and Cerebellum . . . . . . . . . . . 8 Accessory Nerve (XI): Schema . . . . . . . . . . . . 33Accessory Nerve (XI) . . . . . . . . . . . . . . . . . . . . 9 Hypoglossal Nerve (XII): Schema . . . . . . . . . . 34Arteries to Brain and Meninges . . . . . . . . . . . 10 Nerves of Heart . . . . . . . . . . . . . . . . . . . . . . . . 35Arteries to Brain: Schema . . . . . . . . . . . . . . . . 11 Autonomic NervesArteries of Brain: Inferior Views . . . . . . . . . . . 12 and Ganglia of Abdomen. . . . . . . . . . . . . . . 36Cerebral Arterial Circle (Willis) . . . . . . . . . . . 13 Nerves of Stomach and Duodenum . . . . . . . . 37Arteries of Brain: Frontal View and Section . . 14 Nerves of StomachArteries of Brain: and Duodenum (continued) . . . . . . . . . . . . 38 Lateral and Medial Views . . . . . . . . . . . . . . . 15 Nerves of Small Intestine . . . . . . . . . . . . . . . . 39Arteries of Posterior Cranial Fossa . . . . . . . . . 16 Nerves of Large Intestine . . . . . . . . . . . . . . . . 40Veins of Posterior Cranial Fossa . . . . . . . . . . . 17 Nerves of Kidneys,Deep Veins of Brain. . . . . . . . . . . . . . . . . . . . . 18 Ureters and Urinary Bladder . . . . . . . . . . . . 41Subependymal Veins of Brain . . . . . . . . . . . . . 19 Nerves of Pelvic Viscera: Male . . . . . . . . . . . . 42Hypothalamus and Hypophysis . . . . . . . . . . . 20 Nerves of Pelvic Viscera: Female . . . . . . . . . . 43Arteries and Veins Median Nerve . . . . . . . . . . . . . . . . . . . . . . . . . 44 of Hypothalamus and Hypophysis . . . . . . . . 21 Ulnar Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Relation of Spinal Nerve Roots to Vertebrae . . . 22 Radial Nerve in ArmAutonomic Nervous System: and Nerves of Posterior Shoulder . . . . . . . . 46 General Topography. . . . . . . . . . . . . . . . . . . 23 Radial Nerve in Forearm . . . . . . . . . . . . . . . . . 47Spinal Nerve Origin: Cross Sections. . . . . . . . 24 Sciatic Nerve and PosteriorOlfactory Nerve (I): Schema . . . . . . . . . . . . . . 25 Cutaneous Nerve of Thigh . . . . . . . . . . . . . . 48Optic Nerve (II) Tibial Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 (Visual Pathway): Schema . . . . . . . . . . . . . . 26 Common Fibular (Peroneal) Nerve. . . . . . . . . 50
  6. 6. NEUROANATOMY Cerebrum: Medial Views Sagittal section of Cingulate gyrus Paracentral sulcus brain in situ Central sulcus (Rolando) Cingulate sulcus Paracentral lobule Medial frontal gyrus Marginal sulcus Sulcus of corpus callosum Corpus callosum Fornix Precuneus Septum pellucidum Superior sagittal sinus Interventricular Choroid plexus foramen (Monro) of 3rd ventricle Interthalamic Stria medullaris adhesion of thalamus Thalamus and Parietooccipital 3rd ventricle sulcus Subcallosal Cuneus (parolfactory) Habenular area commissure Anterior Pineal body commissure Posterior Subcallosal commissure gyrus Calcarine sulcusHypothalamicsulcus Straight sinus in tentoriumLamina cerebelliterminalis Great cerebral veinSupra- (Galen)opticrecess Superior colliculus Optic chiasm Inferior colliculus Tectal (quadrigeminal) plate Tuber cinereum Cerebellum Hypophysis (pituitary gland) Superior medullary velum Mammillary body 4th ventricle and choroid plexus Cerebral peduncle Inferior medullary velum Pons Cerebral aqueduct Medulla oblongata (Sylvius) Medial surface of cerebral Genu hemisphere: brainstem excised Rostrum of Trunk corpus callosum Splenium Cingulate gyrus Mammillothalamic Isthmus of cingulate gyrus fasciculus Parietooccipital sulcus Mammillary body Cuneus Uncus Calcarine sulcus Optic nerve (II) Lingual gyrus Olfactory tract Collateral sulcus Crus Body of fornix Rhinal sulcus Column Medial occipitotemporal gyrus Fimbria of hippocampus Occipitotemporal sulcus Dentate gyrus Lateral occipitotemporal gyrus Parahippocampal gyrus2
  7. 7. Cerebrum: Inferior View NEUROANATOMYSectioned brainstem Frontal pole of cerebrum Longitudinal cerebral fissure Straight gyrus Genu of corpus callosum Olfactory sulcus Lamina terminalis Orbital sulci Olfactory bulb Orbital gyri Olfactory tract Optic chiasm Temporal pole Optic nerve (II) (cut) Lateral sulcus (Sylvius) Hypophysis Inferior temporal sulcus (pituitary gland)Inferior temporal gyrus Anterior perforated substance Optic tract Tuber cinereumInferior (infero- Mammillary bodylateral) marginof cerebrum Posterior perforated substance (in interpeduncular Rhinal sulcus fossa) Cerebral crus Uncus Lateral geniculate body Inferior temporal gyrus Substantia nigra Medial geniculateOccipitotemporal bodysulcus Red nucleus Lateral occipito- temporal gyrus Pulvinar of thalamus Superior colliculus (of Collateral sulcus corpora quadrigemina) Cerebral aqueduct Parahippocampal gyrus Splenium of corpus callosum Medial occipitotemporal gyrus Apex of cuneus Calcarine sulcus Occipital pole of cerebrum Longitudinal cerebral fissure Isthmus of cingulate gyrus 3
  8. 8. NEUROANATOMY Basal Nuclei (Ganglia) Horizontal sections through cerebrum A B Genu of corpus callosum Head of caudate nucleus Lateral ventricle Anterior limb of internal Genu capsule Septum pellucidum Posterior limb Column of fornix Putamen Lentiform Globus pallidus nucleus Insula (island of Reil) 3rd ventricle Interthalamic adhesion External capsule Thalamus Claustrum Crus of fornix Retrolenticular part of internal capsule Choroid plexus of lateral ventricle Tail of caudate nucleus Splenium of Hippocampus and fimbria corpus callosum Occipital (posterior) horn of lateral ventricle Habenula Organization of basal nuclei (ganglia) A Pineal body B Caudate Putamen Globus nucleus pallidus Cleft for internal capsule Lentiform Striatum nucleus Caudate Body nucleus Head Thalamus Corpus striatum Levels of A A sections above B B Basal nuclei (ganglia) Pulvinar Lentiform nucleus Medial geniculate body (globus pallidus medial to putamen) Lateral geniculate body Amygdaloid body Tail of caudate nucleus Interrelationship of thalamus, lentiform nucleus, caudate nucleus and amygdaloid body (schema): left lateral view4
  9. 9. Thalamus NEUROANATOMY Interventricular foramen (Monro) Corpus callosum (cut) Tela choroidea (cut edge) Head of caudate nucleus of 3rd ventricle Septum pellucidum 3rd ventricle Columns of fornix Choroid plexus Anterior tubercle Superior thalamostriate vein Stria terminalis Pes hippocampi Temporal (inferior) horn Interthalamic adhesion of lateral ventricle Lamina affixa Internal cerebral vein Stria medullaris Dentate gyrus Habenular trigone Collateral eminence Pulvinar (retracted) Hippocampus Lateral geniculate body Fimbria of hippocampus Posterior commissure Medial geniculate body Habenular commissure Brachium of superior colliculus Pineal body Brachium of inferior colliculus Collateral trigone Superior colliculus Calcar avis Inferior colliculus Occipital (posterior) horn Cerebellum of lateral ventricle Calcarine sulcus Internal 3rd ventricle medullary Interthalamic lamina adhesion Pulvinar r rio a n te in dia An m Me ial La d na MD Intralaminar Me llar y lami VA LP nuclei edu L D rn al m Inte LP VL M 3rd ventricle VPL VP Reticular nucleus VI CM M VP M L VP VP Thalamic nuclei Pulvinar External Lateral geniculate body medullary CM Centromedian lamina Medial geniculate body LD Lateral dorsal LP Lateral posterior Median nuclei M Medial Schematic representation of thalamus MD Medial dorsal (external medullary lamina and Schematic section VA Ventral anterior reticular nuclei removed) through thalamus VI Ventral intermedial (at level of broken VL Ventral lateral Lateral nuclei line shown in figure VP Ventral posterior at right) Medial nuclei VPL Ventral posterolateral VPM Ventral posteromedial Anterior nuclei 5
  10. 10. NEUROANATOMY Cerebellum Superior surface Anterior cerebellar notch Anterior lobe Quadrangular lobule (H IV-V) Central lobule (II & III) Primary fissure Horizontal fissure Culmen (IV & V) Simple lobule (H VI) Superior vermis Declive (VI) Posterior lobe Postlunate fissure Folium (VII A) Superior semilunar (anseriform) lobule (H VII A) Horizontal fissure Inferior semilunar Posterior cerebellar notch (caudal) lobule (H VII B) Central lobule Anterior lobe Inferior surface Superior vermis Wing of central lobule Lingula (I) Superior Superior medullary velum Middle Cerebellar peduncles Inferior Flocculus (H X) Flocculonodular lobe 4th ventricle Posterolateral (dorsolateral) Inferior medullary velum fissure Nodule (X) Retrotonsillar fissure Uvula (IX) Posterior lobe Inferior vermis Tonsil Pyramid (VIII) Biventer lobule (H VIII) Tuber (VII B) Secondary (postpyramidal) fissure Posterior cerebellar notch Horizontal fissure Inferior semilunar (caudal) lobule (H VII B) Cerebral crus Decussation of superior cerebellar peduncles Medial longitudinal fasciculus 4th ventricle Nuclear layer of Superior medullary velum medulla oblongata Fastigial Superior cerebellar peduncle Globose Cerebellar nuclei Lingula (I) Dentate Vermis Emboliform Section in plane of superior cerebellar peduncle6
  11. 11. Brainstem NEUROANATOMY Posterolateral view Thalamus (cut surface) Lateral geniculate body Pulvinars of thalami Optic tract Pineal body Medial geniculate body Superior colliculi Brachia of superior and inferior colliculi Inferior colliculi Cerebral crus Trochlear nerve (IV) Pons Superior medullary velum Trigeminal nerve (V) Superior cerebellar peduncle Middle cerebellar peduncle Rhomboid fossa of 4th ventricle Vestibulocochlear nerve (VIII) Glossopharyngeal (IX) and Facial nerve (VII) vagus (X) nerves Inferior cerebellar peduncle Cuneate tubercle Hypoglossal nerve (XII) Gracile tubercle Accessory nerve (XI) Dorsal roots of 1st spinal nerve (C1) Cuneate fasciculus Gracile fasciculus Olfactory tract Anterior view Anterior perforated substance Infundibulum (pituitary stalk) Optic chiasm Mammillary bodies Optic tract Temporal lobe (cut surface) Oculomotor nerve (III) Tuber cinereum Trochlear nerve (IV) Cerebral crus Trigeminal nerve (V) Lateral geniculate body Abducent nerve (VI) Facial nerve (VII) and Posterior perforated substance intermediate nerve Vestibulocochlear nerve (VIII) Pons Flocculus of cerebellum Middle cerebellar peduncle Choroid plexus of 4th ventricle Olive Glossopharyngeal nerve (IX) Pyramid Vagus nerve (X) Ventral roots of 1st spinal nerve (C1) Hypoglossal nerve (XII) Accessory nerve (XI) Decussation of pyramids 7
  12. 12. NEUROANATOMY Fourth Ventricle and Cerebellum Posterior view Habenular trigone Medial Geniculate bodies 3rd ventricle Lateral Pulvinar of thalamus Dorsal median sulcus Pineal body Superior cerebellar peduncle Superior colliculus Locus ceruleus Inferior colliculus Medial eminence Trochlear nerve (IV) Facial colliculus Vestibular area Superior medullary velum Dentate nucleus Superior of cerebellumCerebellar peduncles Middle Inferior Striae medullares Lateral recess Tenia of 4th ventricle Superior fovea Cuneate tubercle Sulcus limitans Gracile tubercle Inferior fovea Dorsal median sulcus Trigeminal tubercle Lateral funiculus Hypoglossal trigone Cuneate fasciculus Vagal trigone Gracile fasciculus Obex Interthalamic adhesion Median sagittal section Posterior commissure Body of fornix Habenular commissure Thalamus (in 3rd ventricle) Pineal body Interventricular Splenium of corpus callosum foramen (Monro) Great cerebral vein (Galen) Anterior commissure Lamina terminalis Lingula (I) Hypothalamic sulcus Central lobule (II-III) Vermis of Cerebral peduncle Culmen (IV-V) cerebellum Cerebral aqueduct (Sylvius) Declive (VI) Superior colliculus Folium (VII A) Tectal (quadrigeminal) plate Superior medullary velum Inferior colliculus Pons Inferior medullary velum Medial longitudinal fasciculus Tuber (VII B) 4th ventricle Pyramid (VIII) Vermis of Choroid plexus of 4th ventricle cerebellum Uvula (IX) Medulla oblongata Nodulus (X) Median aperture (foramen of Magendie) Decussation of pyramids Choroid plexus of 4th ventricle Central canal of spinal cord Tonsil of cerebellum8
  13. 13. Accessory Nerve (XI): Schema NEUROANATOMY Nucleus ambiguus Cranial root of accessory nerve (joins vagus nerve and via recurrent laryngeal nerve supplies muscles of Vagus nerve (X) larynx, except cricothyroid)* Spinal root of accessory nerve Jugular foramen Foramen magnum Superior ganglion of vagus nerve Accessory nerve (XI)* Inferior ganglion of vagus nerve C1 spinal nerve C2 spinal nerve Accessory nerve (to sternocleidomastoid and trapezius muscles) Sternocleidomastoid muscle (cut) C3 spinal nerve C4 spinal nerve Trapezius muscle Efferent fibers Proprioceptive fibers *Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation. 9
  14. 14. NEUROANATOMY Arteries to Brain and Meninges Left middle meningeal artery Middle cerebral artery Posterior cerebral artery Anterior cerebral artery Superior cerebellar artery Anterior communicating artery Basilar artery Ophthalmic artery Left labyrinthine (internal acoustic) artery Posterior communicating Mastoid branch of artery left occipital artery Cavernous sinus Anterior inferior cerebellar artery Middle meningeal Posterior meningeal artery branch of left ascending pharyngeal artery Posterior inferior cerebellar artery Left and right Maxillary vertebral arteries artery (intracranial part) Superficial Posterior meningeal temporal branch of vertebral artery artery External Anterior meningeal carotid branch of vertebral artery artery Posterior auricular artery Facial artery Occipital artery Lingual artery Internal carotid artery Ascending pharyngeal artery Carotid sinus Superior laryngeal artery Carotid body Superior thyroid artery Vertebral artery (cervical part) Common carotid arteryTransverse process of C6 Ascending cervical artery (cut)Deep cervical artery Inferior thyroid artery Supreme intercostal artery Thyrocervical trunk Costocervical trunk Brachiocephalic trunk Subclavian artery Internal thoracic artery10
  15. 15. Arteries to Brain: Schema NEUROANATOMY Anterior cerebral artery Anterior communicating artery 1 Middle cerebral artery Ophthalmic artery Supraorbital artery Posterior communicating artery Supratrochlear artery Caroticotympanic branch 2 3 3 Lacrimal artery of internal carotid artery 3 1 Dorsal nasal artery Posterior cerebral artery Middle meningeal artery Superior cerebellar artery 3 Angular artery Anterior tympanic artery 1 Superficial temporal artery Middle meningeal artery 1 Posterior auricular artery 4 Maxillary artery Facial artery 5 5 Occipital artery Basilar artery 4 Lingual artery Anterior inferior cerebellar artery 5 5 Ascending pharyngeal artery Posterior inferior 5 Anterior spinal artery cerebellar artery Spinal segmental medullary branches External carotid artery 5 Vertebral artery Internal carotid artery 5 Common carotid artery Superior thyroid artery Deep cervical artery 5 Common carotid artery Transverse cervical artery Suprascapular artery Vertebral artery Supreme intercostal artery Ascending cervical artery Costocervical trunk Inferior thyroid artery Thyrocervical trunk Subclavian artery Subclavian artery Internal thoracic artery Brachiocephalic trunk Anastomoses Arch 1 Right–Left Aorta Descending 2 Carotid–Vertebral Ascending 3 Internal carotid–External carotid 4 Subclavian–Carotid 5 Subclavian–Vertebral 11
  16. 16. NEUROANATOMY Arteries of Brain: Inferior Views Medial frontobasal (orbitofrontal) artery Anterior communicating artery Anterior cerebral artery Distal medial striate artery (recurrent artery of Heubner) Internal carotid artery Anterolateral central (lenticulostriate) arteries Middle cerebral artery Lateral frontobasal (orbitofrontal) artery Prefrontal artery Anterior choroidal artery Posterior communicating artery Posterior cerebral artery Superior cerebellar artery Basilar artery Pontine arteries Labyrinthine (internal acoustic) artery Anterior inferior cerebellar artery Vertebral artery Anterior spinal artery Posterior inferior cerebellar artery (PICA) (cut) Posterior spinal artery Cerebral arterial circle (Willis) Distal medial striate artery (broken line) (recurrent artery of Heubner) Anterior communicating artery Anterior cerebral artery Middle cerebral artery Posterior communicating artery Anterior choroidal artery Optic tract Posterior cerebral artery Cerebral crus Lateral geniculate body Posterior medial choroidal artery Posterior lateral choroidal artery Choroid plexus of lateral ventricle Medial geniculate body Pulvinar of thalamus Lateral ventricle12
  17. 17. Cerebral Arterial Circle (Willis) NEUROANATOMY Distal medial striate artery Vessels dissected out: inferior view (recurrent artery of Heubner) Anterior cerebral artery Anteromedial central (perforating) (A2 segment) arteries Anterior communicating artery Hypothalamic artery Anterior cerebral artery (A1 segment) Anterolateral central Ophthalmic artery (lenticulostriate) arteries Internal carotid artery Middle cerebral artery Superior hypophyseal artery Posterior communicating artery Inferior hypophyseal artery Anterior choroidal artery Posterior cerebral artery (P2 segment) Thalamotuberal (P1 segment) (premammillary) artery Posteromedial central Superior cerebellar artery (perforating) arteries Basilar artery Thalamoperforating artery Pontine arteries Posteromedial central (paramedian) arteries Anterior inferior cerebellar artery Labyrinthine (internal acoustic) artery Vertebral artery Vessels in situ: inferior view Anterior cerebral artery Anterior communicating artery Optic chiasm Hypothalamic artery Cavernous sinus Internal carotid artery Infundibulum (pituitary stalk) Superior hypophyseal artery and long hypophyseal portal veins Adenohypophysis (anterior Middle cerebral artery lobe of pituitary gland) Inferior hypophyseal artery Neurohypophysis (posterior lobe of pituitary gland) Posterior communicating artery Posteromedial central (perforating) arteries Efferent hypophyseal veins Superior cerebellar artery Posterior cerebral artery Basilar artery 13
  18. 18. NEUROANATOMY Arteries of Brain: Frontal View and Section Corpus callosum Paracentral artery Medial frontal branches Anterolateral central (lenticulostriate) arteries Pericallosal artery Lateral frontobasal Callosomarginal artery (orbitofrontal) artery Polar frontal artery Prefrontal artery Anterior cerebralPrecentral (pre-rolandic) arteriesand central (rolandic)sulcal arteries Medial frontobasal (orbitofrontal) artery Anterior parietal (postcentral sulcal) Distal medial striate artery artery (recurrent artery of Heubner) Posterior parietal Internal carotid artery artery Branch to Anterior choroidal angular gyrus artery Temporal branches Posterior cerebral (anterior, middle artery and posterior) Superior cerebellar artery Middle cerebral artery and branches Basilar and pontine arteries (deep in lateral cerebral [sylvian] sulcus) Labyrinthine (internal acoustic) artery Anterior communicating artery Vertebral artery Posterior communicating artery Posterior inferior cerebellar artery Anterior inferior cerebellar artery Anterior spinal artery Posterior spinal artery Falx cerebri Callosomarginal arteries Corpus striatum and (caudate and lentiform nuclei) Pericallosal arteries (branches of anterior Anterolateral central cerebral arteries) (lenticulostriate) arteries Insula (island of Reil) Trunk of corpus callosum Limen of insula Internal capsule Precentral (pre-rolandic), central (rolandic) sulcal Septum pellucidum and parietal arteries Rostrum of corpus callosum Lateral cerebral (sylvian) sulcus Anterior cerebral arteries Temporal branches of middle cerebral artery Distal medial striate artery (recurrent artery of Heubner) Temporal lobe Anterior communicating artery Middle cerebral artery Optic chiasm Internal carotid artery14
  19. 19. Arteries of Brain: Lateral and Medial Views NEUROANATOMY Anterior parietal (postcentral sulcal) artery Posterior parietal artery Central (rolandic) sulcal artery Branch to angular gyrus Precentral (pre-rolandic) sulcal artery Terminal branches of posterior Prefrontal sulcal cerebral artery artery Terminal branches of anterior cerebral artery Lateral frontobasal (orbitofrontal) artery Left middle cerebral artery Left anterior cerebral artery Occipitotemporal Anterior communicating artery branches Right anterior cerebral artery Posterior temporal branch Middle temporal branch Left internal carotid artery Superior and inferior terminal branches (trunks) Polar temporal artery Anterior temporal branch Paracentral artery Posterior Pericallosal artery Medial frontal Cingular branches Intermediate branches Right posterior cerebral artery Anterior Precuneal artery Callosomarginal Dorsal branch artery to corpus callosum Parietooccipital branch Polar frontal artery Calcarine branch Right anterior cerebral artery Medial fronto- basal (orbito- frontal) artery Anterior communicating artery (cut) Medial occipital artery Distal medial striate artery Posterior temporal branch (recurrent artery of Heubner) Anterior temporal branch Right internal carotid artery Posterior communicating artery Note: Anterior parietal (postcentral sulcal) artery also occurs as separate anterior parietal and postcentral sulcal arteries 15
  20. 20. NEUROANATOMY Arteries of Posterior Cranial Fossa Thalamogeniculate arteries Lateral and medial geniculate bodies of left thalamus Anterior choroidal artery Choroid plexuses of lateral ventricles Crura of fornix Pulvinars of left and right thalami Splenium of corpus callosum Anterolateral central (lenticulostriate) arteries Occipital (posterior) horn of right lateral ventricle Heads of caudate nuclei Right dorsal branch to corpus callosum (posterior pericallosal artery) Septum pellucidum Parietooccipital Branches of Corpus callosum right posterior Calcarine cerebral artery Anterior cerebral arteriesLongitudinalcerebralfissure Superior colliculi Superior vermianOptic nerve (II) branch IVOphthalmic artery III Posterior medial V choroidal artery Anterior cerebral artery to choroid plexus of 3rd ventricle Middle VIII cerebral artery Posterior lateral choroidal artery Posterior VII communicating artery VI Lateral (marginal) branch IX Thalamoperforating arteries X Inferior vermian artery Left internal carotid artery (phantom) XI Basilar artery Choroidal branch to 4th ventricle (phantom) and Pontine arteries Cerebellar tonsillar branch Labyrinthine (internal acoustic) artery of posterior inferior cerebellar artery Posterior cerebral artery Outline of 4th ventricle (broken line) Superior cerebellar artery Posterior meningeal branch of vertebral artery Anterior inferior cerebellar artery Posterior inferior cerebellar artery (PICA) Anterior meningeal branch of vertebral artery Left posterior spinal artery Temporal branches of posterior cerebral artery Left vertebral artery Anterior spinal artery16
  21. 21. Veins of Posterior Cranial Fossa NEUROANATOMY Left superior and inferior colliculi Left pulvinar Basal vein (Rosenthal) Right pulvinar Posterior mesencephalic vein Internal cerebral veins Medial geniculate body Splenium of corpus callosum Lateral Great cerebral vein (Galen) mesencephalic vein Dorsal vein of corpus callosum Lateral geniculate body Inferior sagittal sinus Left thalamus Straight sinus (cut surface) Falx cerebri Optic tract Confluence of sinuses TentoriumInferior thalamo- cerebelli (cut) Left transversestriate veins sinus (cut)Deep middlecerebral Superiorvein (cut) sagittal sinusAnteriorcerebralveinOpticnerve (II) C C CL D F L TU Superior vermian N P vein U Inferior vermian veinAnterior ponto- Falx cerebelli (cut)mesencephalic vein T and occipital sinus Inferior cerebellarTrigeminal nerve (V) hemispheric veinsTransverse pontine vein Intraculminate veinPetrosal vein (draining Superior cerebellar vein (inconstant)to superior petrosal sinus) Preculminate vein Lateral pontine vein Precentral cerebellar vein Anteromedian medullary vein Superior retrotonsillar vein (Inferior retrotonsillar) Parts of cerebellum Vein of lateral recess of 4th ventricle vein of cerebellomedullary L Lingula TU Tuber Superior, middle and cistern CL Central lobule P Pyramid inferior cerebellar peduncles Posterior spinal vein C Culmen U Uvula D Declive N Nodule Anterior spinal vein 4th ventricle F Folium T Tonsil 17
  22. 22. NEUROANATOMY Deep Veins of Brain Longitudinal cerebral fissure Anterior cerebral veins Rostrum of corpus callosum Septum pellucidum Anterior vein of septum pellucidum Head of caudate nucleus Anterior vein of caudate nucleus Transverse veins of caudate nucleus Interventricular foramen (Monro) Columns of fornix Superior thalamostriate vein Superior choroid vein and choroid plexus of lateral ventricle Thalamus Tela choroidea of 3rd ventricle Lateral direct vein Posterior vein of caudate nucleus Internal cerebral veins Basal vein (Rosenthal) Great cerebral vein (Galen) Inferior sagittal sinus Straight sinus Tentorium cerebelli Transverse sinus Confluence of sinuses Superior sagittal sinus Dissection: superior view Uncal vein Anterior cerebral vein Superficial middle cerebral vein (draining to sphenoparietal sinus) Optic chiasm Deep middle cerebral vein Cerebral crus Basal vein (Rosenthal) Lateral geniculate body Inferior cerebral Medial geniculate body veins Pulvinar of thalamus Splenium of corpus callosum Great cerebral vein (Galen) Inferior anastomotic vein (Labbé) Dissection: inferior view18
  23. 23. Subependymal Veins of Brain NEUROANATOMY Posterior veins of septum pellucidum Lateral direct vein Superior thalamic veins Posterior terminal vein of caudate nucleus (posterior part of thalamostriate vein) Superior choroid vein Internal cerebral veins (right and left) Transverse veins of caudate nucleus Medial (atrial) vein of lateral ventricle Superior thalamostriate vein Lateral (atrial) vein of lateral ventricle Lateral ventricle Splenium of corpus callosum Anterior vein of caudate nucleus Great cerebral vein (Galen) Anterior vein of septum pellucidum Dorsal vein of corpus callosum Genu of corpus Inferior sagittal callosum sinus Internal occipital vein Straight sinus Occipital (posterior) horn of lateral ventricle Interventricular foramen (Monro) Anterior commissure Interthalamic adhesion Anterior cerebral vein Optic chiasm Cerebellum 3rd ventricle Deep middle cerebral vein Inferior thalamostriate veins Basal vein (Rosenthal) Temporal (inferior) horn of lateral ventricle Posterior mesencephalic vein Superior vermian vein Hippocampal and inferior ventricular veins Cerebral aqueduct Veins on lateral wall of ventricle 4th ventricle Veins on medial wall and floor of ventricle Lateral and median apertures of 4th ventricle All other veins 19
  24. 24. NEUROANATOMY Hypothalamus and Hypophysis Septum pellucidum Thalamus Fornix Hypothalamic sulcus Anterior commissure Paraventricular PosteriorPrincipal Dorsomedialnuclei of Supraoptichypothalamus Ventromedial Arcuate (infundibular) Mammillary Mammillothalamic tract Optic chiasm Dorsal longitudinal Infundibulum (pituitary stalk) fasciculus and other descending pathways Hypophysis (pituitary gland) Lamina terminalis Hypothalamic sulcus Paraventricular hypothalamic nucleus Supraoptic hypothalamic nucleus Supraopticohypophyseal tract Tuberohypophyseal tract Mammillary Hypothalamohypophyseal tract body Infundibulum (pituitary stalk) Arcuate (infundibular) nucleus Pars tuberalis Median eminence of tuber cinereumAdenohypophysis Fibrous trabecula(anterior lobe of Neurohypophysispituitary gland) Pars intermedia Infundibular stem (posterior lobe of pituitary gland) Pars distalis Infundibular process Cleft20
  25. 25. Arteries and Veins of Hypothalamus and Hypophysis NEUROANATOMY Hypothalamic vessels Primary plexus of hypophyseal portal system Superior hypophyseal artery Long hypophyseal portal veins Artery of trabecula Short hypophyseal portal veins Trabecula (fibrous tissue)Efferent hypophyseal vein Efferent hypophyseal veinto cavernous sinus to cavernous sinusSecondary plexus Neurohypophysisof hypophyseal (posterior lobe ofportal system pituitary gland) Capillary plexus of infundibular processAdenohypophysis(anterior lobe ofpituitary gland) Efferent hypophyseal vein to cavernous sinus Inferior hypophyseal arteryEfferent hypophysealveins to cavernous sinus 21