Table Of ContentJ. M. Van Buren R. C. Borke
Variations and
Connections of the
Human Thalamus
1
The Nuclei and Cerebral Connections
of the Human Thalamus
With 98 Figures and 110 Plates
Springer-Verlag Berlin Heidelberg GmbH
J. M. Van Buren, A.B., M.D., M.Sc., Ph.D.,
Chief, Surgical Neurology Branch and Clinical Director,
National Institute of Neurological Diseases and Stroke,
Clinical Professor of Neurological Surgery, George Washington University
R. C. Borke, B. S., Biologist
From the Surgical Neurology Branch, National Institute of Neurological Diseases
and Stroke, National Institutes of Health, Bethesda, MD 20014jU.S.A.
ISBN 978-3-642-88596-9 ISBN 978-3-642-88594-5 (eBook)
DOI 10.1007/978-3-642-88594-5
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© by Springer-Verlag Berlin Heidelberg 1972
Originally published by Springer-Verlag Berlin Heidelberg New York 1972
Softcover reprint of the hardcover 1st edition 1972
Library of Congress Catalog
Card Number 73-174253.
The use of general descriptive names, trade marks, etc. in this pUblication, even if the former are not
especially identified, does not imply that such names, as understood by the Trade Marks and Merchan
dise Marks Act, may be freely applied by everyone.
Universitatsdruckerei H. Sturtz AG, Wurzburg
This work is affectionately dedicated to
Paul I. Yakovlev
wise teacher, generous host and kind friend
Foreword
In the past half century since the Vogts stimulated investigations on the anatomi
cal relationships between cortex and subcortical structures, a voluminous literature
has developed on the thalamus. Although much of this writing has been based
upon studies of sub-human primates and carnivora, the prime goal of most investi
gators has been to elucidate clinical experience. And indeed, these researches have
enlightened the neurologist.
From the beginning of anatomical studies of the thalamus, anatomists have
sought a meaningful parcellation of the thalamus on the basis of both topography
and cellular morphology. However, as the internal organization of the thalamus
changes greatly in phylogeny, a topographical designation of thalamic divisions
in different species loses its significance. Hence, the detailed descriptions of the
nuclear configuration of carnivora, which appeared from the laboratories of Huber
and Crosby, could not be readily applied to the thalamus of monkey or man. This
has led to the introduction of different and more or less specific terminologies for
each species rendering attempts at homologies difficult, if not impossible. Recogniz
ing the changes in conceptualization of the thalamus and the advances in neuro
anatomical knowledge, Dr. Van Buren has tackled the formidable tasks of bringing
the thalamic nomenclature up to date. He has based his parcellation of the thala
mus upon the histological morphology of the neuronal components, which are
modified, to some extent at least, by the fiber tracts traversing the area. This
classification, independent of any functional considerations, should allow future
researches which define functional boundaries to be plotted on his fixed anatomical
maps. For this reason, Dr. Van Buren has defined the nuclear structure on the
basis of human topography, and used a slight modification of the Vogt's nomen
clature of the thalamic nuclei. A table is given which the reader may consult for
homologies to other systems of classification.
The individual nuclei are described in terms of their relationships to other
nuclei and fiber tracts. The cellular structure as seen in cresyl violet and Golgi
preparations is depicted, and the dimensions of the cells in three planes are pre
sented in histograms which show the variations in the populations. Dr. Van Buren
discusses the afferent and efferent connections of each thalamic nucleus based
upon the voluminous world literature, and finally gives the results of his own investi
gations. This presentation should be particularly valuable and informative to both
neuroscientists and clinicians.
Concepts of the anatomical organization of the thalamus in the past have been
based almost entirely upon studies of lower animals and monkeys. Any attempts
to carryover these findings to man have encountered great difficulties especially
when authors have tried to use findings in several species to determine subtractive
or additive effects of lesions. This is evident from the confusing literature regarding
the thalamus, which Dr. Van Buren has culled from the massive material on the
subject. Certainly he deserves congratulation for his attempt to integrate the results
of past studies with his own investigations.
VII
For the stereotaxic surgeon, the section on the normal thalamus and its devia
tions will be of particular interest and special value. In these chapters Dr. Van
Buren has presented a set of plates of the cytoarchitectural patterns of the basal
ganglia portraying particularly the thalamic components. The plates are made
from sections cut in horizontal, sagittal and coronal planes at 0.5 mm intervals.
The topographical orientation of the nuclei is outlined so that although the magni
fication is low, the surgeon who often is unfamiliar with the cellular characteristics
of the individual cell groups, may gain an impression of the extent and configura
tion of each nucleus. Because the plates have anterior-posterior commissure refer
ence lines, the stereotaxic surgeon may use them for setting the coordinates of his
target point.
The variations in the topographic relationship of the thalamic nuclei and the
diencephalic ganglia are presented in two chapters with sets of sketches made at
different magnifications. Except for a few medial nuclei, the topographical varia
tions are so great that some other criteria than coordinates must be used if elec
trodes or probes are to be accurately inserted into an anatomical target point.
Dr. Van Buren emphasized this great variation in his sketches of the dience
phalic structures which are based upon the outlines of 25 brains. It is apparent
that although the midline ganglia have slight variations in coronal and horizontal
planes, the variations of the laterally situated structures in the sagittal plane
introduce a disturbing factor which renders any system of coordinates alone quite
inaccurate. The sketches should aid the stereotaxic surgeon in selecting coordinates
which will give the best chance of reaching a given nucleus.
Although Dr. Van Buren makes no claim that this monograph is an atlas, it
does give much information that would serve as a basis for the determination of the
anatomical location of diencephalic structures, in particular, thalamic nuclei.
Dr. Van Buren's personal studies of thalamic connections have been based
upon 64 cases with various lesions, mainly of the cerebral cortex. It is interesting
to note that none of these cases has isolated thalamic damage or a lesion producing
the typical thalamic syndrome. The brains of these cases have been embedded, cut,
stained for cells by the cresyl violet technique and for myelin by the Loyez method.
Fortunately, in a majority of cases, the clinical history and findings are known
so that the reader may correlate the neurological abnormalities and the pathologi
cal anatomy. This makes the case presentations much more interesting and enligh
tening than in many previous dissertations in which such clinical information
was not abailable or inadequately presented.
On the basis of these cases, Dr. Van Buren has constructed his concept of the
organization of the thalamus and of the afferent and efferent connections of the
thalamic nuclei. The reader should not expect in this treatise the solution to thala
mic function for the techniques used in this investigation do not permit such con
clusions. However, the anatomical framework of the thalamus developed by Dr.
VanBuren should be adequate to support the much more precise findings now
being revealed by electrical stimulation and microrecording af the thalamus.
Perhaps, sometime in the future, Dr. Van Buren may be able to add physiological
correlates to the anatomical structures he has so clearly described and depicted in
these precisely written and beautifully illustrated volumes.
Baltimore, Spring 1972 A. Earl Walker, M. D.
Professor of Neurological Surgery
Johns Hopkins University
VIII
Acknowledgments
Material has been gathered from many sources. The normal brains were obtained
from Dr. R. Lindenberg, Director of Neuropathology and Legal Medicine, Maryland
State Department of Mental Hygiene, and from the Department of Pathologic
Anatomy, National Institutes of Health, under the direction of Dr. Louis Thomas.
Dr. Armando Ortiz donated the infarction cases carrying the prefix" MEX." The
overwhelming majority of the pathological material has been taken from the collec
tion at the Warren Museum, Harvard Medical School, at the kind suggestion of
Dr. P. 1. Yakovlev and Dr. R. D. Adams. The author will always be grateful to
those in the Warren Museum who gave of their material and facilities so freely.
A special debt of gratitude is owed Miss Rosemary Borke who had a hand in all
phases of the study. This included tissue preparation and assistance with certain
phases of the reconstruction diagrams. The Golgi preparations of the thalamus are
a tribute to her persistence and skill in staining and microphotography. Mr. Vernon
Mastin assisted with the histological preparations.
Dr. Howard Richter worked in the author's laboratory from January to June,
1967, and the present work is indebted to him for the preparation of the initial cell
size histograms which were later completed by Miss Joan Golub.
The photographic reproduction was the work of Mr. Wallace Strange and Mr.
Wesley Pearson, who supplied a uniformity which is a tribute to their skill.
The laborious portion of the preparation of the many ink diagrams has fallen
the lot of Mrs. Lynn Schultz, Miss Christine French and Mrs. Dawn Weber. Mrs.
Weber has also prepared the typescript and assisted in a myriad of needed ways.
Their good humor with the exacting and repetitive work never ceased to amaze the
author.
The latin terminology was reviewed and corrected by the Department of Latin,
Georgetown University.
Support in all phases has been given by the late Dr. Maitland Baldwin, Chief
Neurosurgeon of the Surgical Neurology Branch, and Dr. Karl Frank and later
Dr. Henry Wagner as Acting Director and Director, respectively, of Intramural
Research of the National Institute of Neurological Diseases and Stroke.
Throughout the work, the author has received the affectionate encouragement
of his wife and the interested forbearance of Derek, Elizabeth and Michael. Without
this climate nothing would have been started in the first place.
In closing, the author would like to thank the Springer-Verlag for their patience
in awaiting the manuscript and their extra efforts which have resulted in photo
graphic reproduction beyond their usual excellence.
J.M. V. B.
IX
Table of Contents
Chapter 1 Introduction C. Computer Correction of Differential
Shrinkage and Preparation of the
A General Statement 3
Variation Diagrams . . . . . . . . 38
The Problem of Human Stereotaxic Surgery 4
Choice of a Thalamic Nomenclature. . . . 5
The Present Thalamic N omenclature-Intro- Chapter 3 The Thalamic Nuclei
duction and Equivalents in the Literature 6
I. Midline and Epithalamic Region 43
List of Abbreviations--Cortical Maps 20
A. N. parataenialis . 45
1. Morphology. . 45
Chapter 2 Material and Methods
2. Connections of N. parataenialis
I. Cytology. . . . . . . . 25
Review of the Literature . . . . . 46
A. Staining Methods. . . 25 3. Connections of N. parataenialis-
1. Cresyl Violet Method. 25 Presen t Material . 46
2. Myelin Methods . . . 25
B. N. paramedianus . 47
3. Golgi Method . . . . 26
1. Morphology. . 47
B. Method of Nuclear Characterization. 27
2. Connections of N. paramedianus
C. Cell Measurement Method . 27
Review of the Literature . . . . . 48
II. Degeneration Studies . . . . 28 3. Connections of N. paramedianus-
Present Material. 48
A. The Nature of the Lesion . 28
B. The Use of the Gyral Pattern to De- C. N. commissuralis . 49
fine Cortical Areas . . . . . . . . . 28
1. Morphology. . 49
C. Evaluation of Thalamic Degeneration. 29 2. Connections of N. commissuralis
D. The Significance of Thalamic Cell Loss 29 Review of the Literature . . . . . 49
1. Retrograde Degeneration . . . . . 29 3. Connections of N. commissuralis-
2. Transynaptic and Transneuronal De- Present Material. 50
generation. . . . . . . . . . 31
D. N. endymalis 51
E. Preparation of the Case Diagrams . . 31
1. Morphology. . 51
III. Preparation of the Gross Variation Dia- 2. Connections of N. endymalis-Re
grams of the Diencephalon . 33 view of the Literature . . . . . . 52
3. Connections of N. endymalis-Pres-
A. Fixation Changes 33
ent Material. 52
B. Brain Marking. . . . . 34
E. N. habenularis. . . . . . . 52
C. Embedding, Section and Preparation
of the Variation Diagrams. 34 1. Morphology. . . . . . . 52
a) N. habenularis medialis. 52
D. Patient Material . . . . . 36
b) N. habenularis lateralis . 52
IV. Preparation of the Diagrams of Thalamic
2. Connections of N. habenularis-Re
Nuclear Variation. . . . 38
view of the Literature . . . . . . 54
A. Initial Preparation . . 38 3. Connections of N. habenularis
B. Shrinkage Estimations 38 Present Material. . . . . . . . . 54
XI
II. Anterodorsal Region. 55 2. Connections of N. reticularis-Re-
A. Anterior Nuclei 55 view of the Literature 91
1. Morphology . 55 3. Connections of N. reticularis-Pres-
2. Connections of Anterior Nuclei- ent Material. 94
Review of the Literature 55 B. N. lateropolaris-fasciculosus Complex 96
3. Connections of Anterior Nuclei- 1. Morphology . 96
Present Material. 58 a) N. lateropolaris 96
B. N. dorsalis superficialis 60 b) N. fasciculosus 97
1. Morphology . 60 2. Connections of N. lateropolaris-fasci
2. Connections of N. dorsalis super- culosus Complex-Review of the
ficialis-Review of the Literature 60 Literature. . 99
3. Connections of N. dorsalis super- 3. Connections of N.lateropolaris-fas
ficialis-Present Material 62 ciculosus Complex-Present Material 101
a) N. lateropolaris Connections 101
III. Medial and Intralaminar Region 66
b) N. fasciculosus Connections . 102
A. N. medialis 66
C. N. ventrooralis externus . 103
1. Morphology . 66
1. Morphology . . 103
2. Connections of N. medialis-Review
2. Connections of N. ventrooralis ex-
of the Literature. 68
ternus-Review of the Literature 104
3. Connections of N. medialis-Present
3. Connections of N. ventrooralis ex-
Material 71
ternus-Present Material 106
B. N. intralamellaris 75
D. N. ventrooralis internus . 108
1. Morphology. 75
1. Morphology . . 108
2. Connections of N. intralamellaris-
2. Connections of N. ventrooralis m-
Review of the Literature 76
ternus-Review of the Literature 108
3. Connections of N. intralamellaris-
3. Connections of N. ventrooralis m-
Present Material. 78
ternus-Present Material 111
C. N. parafascicularis 79
E. N. dorsooralis 114
1. Morphology . 79
1. Morphology . 114
2. Connections of N. parafascicularis-
2. Connections of N. dorsooralis-Re-
Review of the Literature 80
view of the Literature 114
3. Connections of N. parafascicularis--
3. Connections of N. dorsooralis-Pres-
Presen t Material . 80
ent Material. 117
D. N. centralis 81
F. N. ventrointermedius . 119
1. Morphology . 81
1. Morphology . 119
2. Connections of the Parafascicularis
2. Connections of N. ventrointerme-
centralis Complex-Review of the
dius-Review of the Literature 119
Literature. 81
3. Connections of N. centralis-Present 3. Connections of N. ventrointerme-
dius-Present Material . . 123
Material 85
G. N. ventrocaudalis externus et internus. 124
E. N. limitans 87
1. Morphology. . 87 1. Morphology . 124
2. Connections of N. limitans-Review 2. Connections of N. ventrocaudalis-
of the Literature . 88 Review of the Literature . 128
3. Connections of N. limitans-Present a) N. ventrocaudalis externus 128
b) N. ventrocaudalis internus. . 131
Material 90
3. Connections of N. ventrocaudalis-
IV. Lateroventral Region 91
Present Material. 133
A. N. reticularis. . 91 a) N. ventrocaudalis externus 133
1. Morphology . 91 b) N. ventrocaudalis internus 133
XII
