The Human Brain Stem and Cerebellum: Surface, Structure, Vascularization, and Three-Dimensional Sectional Anatomy, with MRI

431 Pages·1995·20.614 MB·English

by  Henri M. Duvernoy (auth.)

Henri M. Duvernoy
The Human Brain Stem
and Cerebellum
Surface, Structure, Vascularization, and
Three-Dimensional Sectional Anatomy
with MRI
In collaboration with
J. F. Bonneville, E. A. Cabanis, F. Cattin,
J. Guyot, and M. T. Iba-Zizen
With drawings by J. L. Vannson
Springer-Verlag Wien New York
H. M. Duvernoy
J. Guyot
Laboratoire d'A natomie
Faculte de Medecine et de Pharmacie
Universite de Franche-Comte
Besall(;on, France
J. F. Bonneville
F. Cattin
Service de Neuroradiologie
Centre Hospitalier Universitaire J. Minjoz
Besan~on, France
E. A. Cabanis
M. T. Iba-Zizen
Service de N euroradiologie
Centre Hospitalier National des Quinze-Vingts
Paris, France
This work is subject to copyright.
All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation,
reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machines or similar means, and
storage in data banks
© 1995 Springer-VerlaglWien
Softcover reprint of the hardcover 1st edition 1995
With 168 Figures
ISBN 978-3-7091-3080-3 ISBN 978-3-7091-3078-0 (eBook)
DOl 10.1007/978-3-7091-3078-0
Acknowledgments
I will at first acknowledge the help of those who have directly participated in this work:
Mr. J. L. Vannson, Mrs. J. Euvrard, Miss A. Barthelet, and Professor J. Guyot. My thanks
also to Professor G. Monnier, Mr. J. Peney, and Dr. J. Godard.
Grateful acknowledgment to those who provided us with the MRI views: Professor
E. A. Cabanis and Dr. M. T. Iba-Zizen, Service de Neuroradiologie, Centre Hospitalier
National des Quinze-Vingts, Paris and the members of that department, Mrs. F. Talib,
Mrs. S. Bengold, Mrs. C. Gonzales, Mrs. N. Bergounoux, and Mr. D. Payet; Professor
J. F. Bonneville, Dr. J. Cattin, and Mrs. J. Verdenet, Service de Neuroradiologie, Centre
Hospitalier Universitaire J. Minjoz, Besan<;on; Professor J. P. Francke, Laboratoire
d'Anatomie, Faculte de Medicine, Universite de Lille II, Lille and Dr. R. Sigal, Institut
Gustave Roussy, Paris. I wish to include in these acknowledgments Professor Ch. Raybaud,
Service de Neuroradiologie, Hopital Nord, Marseille and Professor D. Doyon, Hopital
Bid~tre, Paris.
My thanks to Dr. M. Mohr, Laboratoire d'Anatomie Pathologique, Hopital Central,
Strasbourg and to Professor J. P Carbillet, Laboratoire d' Anatomie Pathologique, Hopital
J. Minjoz, Besan<;on who provided us with the brain specimens.
My deepest thanks to Mrs. C. Alhinc, Mr. C. Duvernoy, and Mr. W. F. C. Duvernoy for
their help with the translation of the manuscript.
I also wish to extend my gratitude to President M. Woronoff, Universite de Franche
Comte, Professor Y. Michel-Briand, Mrs. M. C. Gagelin, and Mrs. M. J. Ferraroli who made
this publication possible. My thanks also go to Mr. R. Petri-Wieder and Mr. T. Redl of
Springer-Verlag Wien for their understanding.
Finally, I would like to lovingly thank my wife Odile and both my sons Charles and
David for their help and support.
Henri M. Duvernoy
Contents
Introduction 1
Methods 2
Surface anatomy, structure, and vascularization of Anatomy of the brain stem and cerebellum
the brain stem and the cerebellum 5 surfaces 7
General remarks 7 . Brain stem surface 10·
Cerebellum surface 16· Relationship between brain
stem and cerebellum; emergence of cranial nerve
roots 24 . The fourth ventricle 27 . The brain stem
and the cerebellum within the posterior cranial
fossa 35
Structure and functions of the brain stem 41
Structure of the brain stem 41 . Functions of the
brain stem 80
Structure and functions of the cerebellum 91
Structure of the cerebellum 91 . Functions of the
cerebellum 96
Vascularization of the cerebellum and the brain
stem 101
Vascularization of the cerebellum 101 .
Vascularization of the brain stem 103
Serial three-dimensional sectional anatomy 145 Axial (horizontal) sections 147
Coronal (frontal) sections 255
Sagittal sections 351
References 405
International nomenclature 414
Subject index 421
Introduction
This study of the brain stem and the cerebellum is the sequel to a previous study of the
brain (cerebral hemispheres and diencephalon) [82]. The brain stem and cerebellum are
dealt with here for the same purpose as was the brain in the previous work, i.e., to reach,
step by step, knowledge that is comprehensive enough for an understanding of an atlas of
sections and its clinical use.
Following a brief survey of the methods used, the first chapter describes the brain stem
and cerebellum surfaces as well as their location in the posterior cranial fossa.
The second and the third chapter, respectively, describe the brain stem and cerebellum
structures followed by brief surveys of their functions, enabling the reader to obtain an
introductory view of the role of both the nuclei and fasciculi.
The fourth chapter studies the brain stem vascular network in detail. Thus, this chapter
sums up the results of research on brainstem superficial blood vessels and their intra
nervous territories that were already presented in two previous works [79, 80]. By contrast,
presentation of the cerebellar vascularization follows the previous literature.
Finally, the main element of this work, composed of another three chapters it should
enable the reader to understand the sectional anatomy of both the brain stem and the
cerebellum and how it corresponds to MRI views. Indeed, one of the aims of this study is to
enable a more accurate interpretation of MRI views. Although most of the structures are
poorly viewed on current MRIs, it is possible to locate them thanks to a precise assessment
of the level of each section.
This study uses the usual nonlatin anatomical terminology. Latin terms, which occur
infrequently in ordinary language, are used only for certain structures (e.g., the reticular
formation).
Methods
Differing methods were used to study (1) the surfaces of the brainstem and cerebellum,
(2) the structures and vascular networks of these regions, and (3) three-dimensional serial
sections.
Study of the surfaces of the brain stem and cerebellum
Thirty human encephala were examined after having been fixed in a 10% formalin
solution sufficiently voluminous to prevent their distortion. Both cerebral hemispheres
were removed. What remained thus comprised the brain stem, cerebellum, and dience
phalon. These structures, after immersion in a 30% alcohol solution were dissected under
a stereoscopic microscope and photographed in distilled water to prevent spoiling
reflections.
Study of the structures and vascular network
of the brain stem and cerebellum
The material and methods used in this study derived from previous works [78-81,84-88].
Sixty brains were examined after having undergone two processes: intravascular
injection (India ink and plastics) and Bodian's method of silver impregnation.
Intravascular injection
India ink intravascular injection. The brains were injected with a 400 cm3 India ink
solution with 5% gelatin added to the mixture. After fixation, dehydration, immersion into
toluene, and imbedding in paraffin, the relevant parts were cut into thick serial sections
(400 /-lm), which were then cleared in a Spalteholz solution (methylsalicylate and benzyl
benzoate).
The difference in vascular density between white and gray matter, and even between
the various gray matter nuclei, enabled the identification of numerous cerebral structures.
Intravascular injection with low viscosity resin (Mercox). This technique was used to
complete the previous one. Thus, accurate observation of the fine vascular network and its
spatial organization became possible. After injection, the tissues were eliminated and the
vascular network was examined with a scanning electron microscope.
Bodian's method of silver impregnation
One of the advantages of the India ink injection method is that it makes the use of
histological techniques possible. Thus, the thick serial sections showing the vascular
Methods 3
pattern alternate with thinner silver-impregnated sections that allow the analysis of the
structures themselves.
It was through this double technique that most of the brain stem and cerebellum gray
matter formations were identified. However, these methods limited the visibility of white
matter to large fasciculi (spinothalamic and corticospinal tracts, lemniscus, medial
longitudinal fasciculus, and central tegmental tract). Thus, the numerous small fasciculi in
the brain stem (seen on Figs. 41-56) were located through the use of references taken
from various atlases used as a basis for this work (see p. 48).
Study of the superficial blood vessels and brain stem
vascular territories
The superficial pial vessels of the brain stem are studied using the same India ink injection
methods described above. These injections show both the arterial and venous pial.
networks (the latter overlapping the former) (Fig. 74-88). This technique has the extra'
advantage of allowing identification of the point of artery penetration in the nervous tissue
(as well as the emergence of veins) and thus by following them, to trace their deep terri
tories through 2 or 3 mm thick sections, cleared by the Spalteholz solution and examined
under a stereoscopic microscope. Figures 89-98 thus show arterial and venous territories
identified by the complete observation of a brain stem [80]. The mapping proposed here
may vary to some extent, though a less detailed examination of ten other brain stems
appears to confirm the initial conclusions reported in this work.
Study of three-dimensional serial sections
Three preparations, each including the brain stem, cerebellum, and diencephalon, were
cut into 2 to 4 mm thick sections by a circular bladed electric cutter.
The bicommissural plane acted as a reference plane for axial sections parallel to this
plane and for coronal sections perpendicular to it. Sagittal sections are parallel to the
median plane.
The bicommissural plane, passing through the center of the anterior and posterior
commissures, slightly differs from the Talairach's standard bicommissural line which is
drawn through the superior edge of the anterior commissure and the inferior edge of the
posterior commissure [230, 231].
Although the neuro-orbital plane recommended by Cabanis [45, 46] would be more
adapted to the sectional anatomy of the brain stem, we have chosen the bicommissural
plane (as defined above) to follow the same orientation as that used in our previous work
about sectional anatomy of the brain [82].
The principle of the three-dimensional serial sections is to gradually erode the
preparation by sectioning it from an inferior to superior way for axial sections, anterior to
posterior for coronal, and lateral to medial for sagittal sections. Each plate (Figs. 99-168)
shows the section surface of the preparation viewed head-on, surrounded by several
oblique views of the rest of the preparation. This three-dimensional method enables the
location of each section to be understood more easily.
4 Methods
The photographs of the serial sections were associated with head sections whenever
possible, thus identifying the relations with the neighboring structures. For the head
sections, the suborbitomeatal plane passing at the lower margins of the orbital openings
and in the center of the external acoustic meatuses was chosen as the reference plane. This
external plane appears to correlate best with the internal bicommissural plane.
Moreover, these anatomical sections help to explain the MRI views which come from:
- The Department of Neuroradiology of the J. Minjoz Hospital, Besan<;on
(Prof. J. F. Bonneville, Dr. F. Cattin) using a 1,5 T Siemens for Figs. 99 B to 105 B,
105B", 106B to 108B, 108B", 109B, 109B', 110B, 110B', 111B', 112B, 112B', 113B,
114B', 115B', 116B', 117B, 117B', 118B, 120B to 122B, 122B', 123B, 124B, 126B to
137B, 141B, 143B, 144B, 146B to 149B, 151B, 153B to 155B, 156B' to 158B', 159B to
161 B, 161 B', 162 B, 163 B, 163 B', 164 B', 165 B, 167B', 168 B'.
- The Department of Neuroradiology, Quinze-Vingts Hospital, Paris (Prof. E. A. Cabanis
and Dr. M. T. Iba-Zizen) using a 1,5 Sigma (General Electric Medical System) for
Figs. 105B', 108B', 111B, 114B, 115B, 116B, 121B', 125B, 129B', 131B', 134B', 136B',
137B', 140B, 141B', 142B, 142B' to 144B', 145B, 146B' to 148B', 150B, 151B', 152B,
157B, 158B, 159B', 160B', 162B', 164B, 166B to 168B.
- The Gustave Roussy Institute, Paris (Dr. R. Sigal) using a 1,5 Sigma (General Electric
Medical System) for Figs. 128B', 135B', and 140B'.
Surface anatomy,
structure, and vascularization
of the brain stem and
the cerebellum