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Sinelnikov Vol III PDF
Sinelnikov Vol III PDF
SINELNIKOV
ATLAS
OF
HUMAN
ANATOMY
IN T H R E E VOLUMES
Volume III
The Science
of the Nervous System,
Sense Organs,
and Endocrine Glands
Translated from the Russian
by
Ludmila Aksenova, M.D.
<&vgy
MIR PUBLISHERS
MOSCOW
T h e Lumbar, Sacral, and Coccygeal Nerves . . . . 212 T h e Nerves of the Intestine . . . . 294
T h e Lumbar Nerves 212 T h e Nerves of the Liver and Gall Bladder 294
T h e Posterior Primary Rami 216 T h e Nerves of the Pancreas 295
T h e Anterior Primary Rami 216 T h e Nerves of the Spleen , , . 296
T h e Lumbar Plexus 216 T h e Nerves of the Kidneys . , 296
T h e Branches of the Lumbar Plexus 216 T h e Nerves of the Urinary Bladder 296
T h e Sacral Nerves 230 T h e Nerves of the Testis 297
T h e Posterior Primary R a m i 230 T h e Nerves of the Uterus . . . 297
T h e Anterior Primary Rami 230 T h e Nerves of the Vagina , , , 298
The Sacral Plexus 231 Development and Age Features of the Nervous System
T h e Short Branches 231 (Ya. R. Siuehukov) 299
T h e Long Branches 231
T H E SCIENCE O F T H E SENSE ORGANS
T h e Coccygeal Plexus 243
[ h e Branches of the Cuccvgeal Plexus . . . . 243 T h e Sense Organs , , 302
The Organ of Sight . , , 303
The Aulimotnic {Vegetative) Nervous System 24-8 T h e Eyeball 303
T h e Sympathetic Part of the Autonomic Nervous T h e Fibrous Coat of the Eye 304
System 248 T h e Vascular Coat of the Eye 304
T h e Cephalic Part of the Sympathetic Nervous T h e Choroid 304
System 249 T h e Ciliary Body , 306
T h e Cervical Part of the Sympathetic Nervous T h e Iris , . , . 307
System 250 T h e Nervous Coat of the Eye . . . . . . . 308
T h e Superior Cervical Ganglion . . . . . . 250 T h e Vitreous C h a m b e r 311
T h e Middle Cervical Ganglion . . . , - ■ » . . 252 T h e Accessory Organs of the Eye 313
The Vertebral Ganglion 258 T h e Lacrimal Apparatus 318
T h e Inferior Cervical Ganglion 258 T h e Muscles of the Eyeball. T h e Fasciae of the Orbit 318
T h e Thoracic Part of the Sympathetic Nervous T h e Vessels of the Eyeball 320
System 258 T h e Arteries 320
T h e Branches of the Thoracic Part of the T h e Veins 321
Sympathetic Trunk 262 T h e Nerves of the Eyeball 322
T h e Lumbar Part of the Sympathetic Nervous Development and Age Features of the Organ of Sight 322
System 263 The Organ oj Hearing 324
T h e Coeliac Plexus 263 T h e External Ear 324
T h e Pelvic Part of the Sympathetic Nervous System 276 T h e Auricle 324
T h e Pelvic Plexus 278 T h e External Auditory MeatUS . . . . . . . 327
T h e Parasympalhetie Part of the Autonomic Nervous T h e Tympanic M e m b r a n e 328
System 280 T h e Middle Ear 329
T h e Cephalic Part of the Parasympathetic Nervous T h e Tympanic Cavity 330
System 281 T h e Pharyiigolympanic T u b e 330
T h e Mcsenccphalic Part of the Parasyrnpathelie T h e Auditory Ossicles 332
Nervous System 281 T h e Malleus 332
T h e Rhombencephalic Part of the Parasympa- T h e Incus 335
thetie Nervous System 281 T h e Stapes 335
T h e Sacral Part of the Parasym pathetic Nervous T h e Mucous Membrane of the Tympanic Cavity , 336
System 284 T h e Internal Ear . 338
T h e Intramural Nervous System 284 T h e Bony Labyrinth 338
T h e Visceral Nerves 287 T h e Vestibule 338
T h e Nerves of the Submandibular and Sublin- T h e Semicircular Canals 339
gual Glands 287 T h e Cochlea 340
T h e Nerves of the Heart 287 T h e Membranous Labyrinth 342
T h e Nerves of the Trachea 288 T h e Duct of the Cochlea 343
T h e Nerves of the Lungs 292 T h e Saccule and the Utricle 344
T h e Nerves of the Oesophagus 293 The Semicircular Ducts 346
T h e Nerves of the Stomach 294 T h e Internal Auditory Mcatus 346
346 THE E N D O C R I N E G L A N D S
The Vessels of the Organ of Hearing . . 347 The Thyroid Gland . . . . 366
The Nerves of the Organ of Hearing . 349 The Parathyroid Glands . . . 371
Development and Age Features of the Or < r ; i l 1 0 "H ear ttg The Thymus 373
350 The Suprarenal Glands . . . 377
The Pariganglia . . . . . 377
The Carotid Body . . . . 379
The Organ of Taste sst The Supracardi&l Faraganglion 380
The Lumbo-Aortic Paraganglion 380
Tht Organ of Smell 352
The Aortic Bodies . . . . 381
353
353 The Coccygcal Body . . . 383
The Appendages of the Skin 356 T h e Sex Glands 383
The Glands of the Skin . , . 356 The Hypophysis Cerebri 384
The Nails 357 The Pineal Body 386
357 The Pancreas (Endocrine Part) 387
The Vessels of the Skin 364 Development and Age Features of the Endocrine Glands
The Nerves of the Skin 364
T h e nervous system (syskma nervoaum)] (Fig. 721) controls and rection (if nerve impulse conduction is from the dendrites and cell
regulates all functions of the body, coordinates its activity as a body on the axon which branches and comes in contact with the
single whole, and ensures an appropriate reaction to stimuli. cell bodies, axons, and dendrites of die neighbouring neurons.
In the living organism the nervous system is concerned with Contact between the neurons is accomplished through the syn
the introduction of information, its analysis and synthesis, integra apse, a zone specialised in transmitting the nerve impulse.
tion and storage in time, and with conduction of the programmed T h e zone of the synapse is structurally the most complicated in
signals to the effector organs, the neuron svstem. T h e nerve impulse is transmitted here via me
T h e anatomo-physiological basis of this activity is the n e u r o n , diators and with delay in time. T h e n u m b e r of nerve connections
or nerve cell, possessing processes and functioning among the sup of the neuron is determined by the number of dendrite branching
porting cells of the neuroglia. points. It is believed that memory is coded dirough the increase in
T h e neuron has a cell body (corpus murtxyti), a long process the number of these points, i.e. is linked with the formation of new
called the axon (the old name for which is neurit) and short pro contacts between the neurons.
cesses known as dentrites (dtndrita). T h e anatomical and functional union of the neurons creates
According to the number of the processes, the following neu the path for die nerve impulse; this is the reflex arc which is
rons are distinguished morphologically: multiped ar (with multiple formed by at least two neurons.
processes); bipolar (with two processes), and pseudo-unipolar T h e neurons function among the cells of the neuroglia, where
(with one process which eventually becomes T-sbaped). as the .subsequent metabolic processes occur in the nerve tissue.
T h e neuron is a highly specialized cell which perceives stimuli, T h e r e are up to ten glial cells per one neuron.
transforms and then conveys them either to other neurons or to T h e formation of the final structure of an individual's nervous
the effector organs. system is preceded by a complex course of ontogenetic develop
T h e neuron interacts with the neighbouring nerve cells to ment.
transmit the signal, the nerve impulse, to them. T h e common di- T h e nervous system develops from the outer germinal layer,
the ectoderm. T h e system is laid down at first as the neural, or
medullary, plate which is a thickening of the ectoderm along the
1
English equivalents to the Latin terms are given according to dorsal surface of the trunk. T h e plate edges thicken eventually and
Birmingham Revision (BR) of the Paris Anatomical Nomenclature approach each other, while the plate itself becomes deeper to form
(NA) {BuUervorths Medical Didionary, 1978, second edition, the neural, or medullary, groove. T h e edges of the plate, which
Editor-in-Chief MacDonald Critchley). have taken die shape of thickened neural folds, fuse to form the
Plexus bracli^lii>r;
Rr. ventrales {nn, inlercostales)
Truncus sympathlcus
N. medianus
Medulla spinalis
-N. radial Is
Rexus lurnlxtlts -t
PfejtMS sacralis
N, femoral is -
- N . coecygeus
N- peroneus (fibuiaris)
eommunis
Neuroporus anterior
Corpora mamiliaria
rosencephaloii
Rhombencephalon
Optic stalk
\ "Mnfundibulum
N. trlgtmtnuS
N. iaclalls
N. vestibulocochlearis
N, accessorlus\\ ,—. 3
1 Ti
^nMl s
723. Brain of 10.2-mm-long embryo; right aspect
(Stage of five cerebral vesicles; reconstruction.)
■—-i,,. .
Thalatnus
Place ol' pineal body \
formation
Fissura
transver&a eerebri
Presence phalon
Cerebellum
Rhorabencephalon
SuJcus KmJtans
Sulcus mesodlencephflllctiB
on
,Y\^
Lamina tccti
Place of pineal body
formation
N. trochlearls Corpora tnafflillaria
-Fissura telodiencephaltca
N. accessorlus
^—Lobus olfactorlus
N. iaclalls y \ S Q ^ ^
r T K, vestibulacochleafis \ \ ^ ^ ^ ^
*G?/J| ....-Hypothalatnus
Tiislamus
Pallium
Flssura chorloldea
Foramen
InterventrlctiUre^*? ^ J
Corpus strlatum .' X Vl ■ -■ Cerebellum
Lamina terrnfnalls-^ ^
Rhltieiict'phalon / /
// \
Recessus
1
Recessus opticus ' / / ""indibuli
Chlasma optlcum/ /
Hypophysis Medulla oblon£ata'
i W*
Sulcus idesodiencephaucus
Polus occipitalis
Cerebellum
composed of the grey matter (subdantia grisea) and the white mat the central canal or the spinal cord (mnalis centralis) containing the
ter (sahftantia alba). The grey matter consists largely (but not only) cerebrospinal fluid (liquor cerebrospinalis).
of a collection of nerve cells, while the white matter is Formed of The brain develops from the expanded cephalic part of the
neuronal axons. The grey colour is also characteristic of those neural tube. This pan is separated by two constrictions first into
areas of the nervous system which contain collections of cell bod three primary vesicles (Fig. 722); the anterior cerebral, or cephalic,
ies of neurons which had migrated far beyond the neural tube vesicle developing into the forebrain (prosencephalon), the middle
(sympathetic and other ganglia). cerebral vesicle, developing into the mid-brain (mesentephatonj, and
In the part of the neural tube giving rise to the spinal cord, the the posterior cerebral vesicle, forming the hind-brain (tkowbmit-
nerve cells are concentrated in the circumference of its cavity to fhaloti). Five secondary vesicles form later (Figs 723-729) when the
form the grey matter, in which a posterior horn (cornu posterius), an forebrain separates into two vesicles: the first cerebral vesicle, or
anterior horn {cornu anterius), and a lateral horn (cornu laterak) are the teleneephaloa (the end brain), and the second cerebral vesicle,
distinguished (see Fig, 733). The processes of these cells are ar^ or the diencephahm (between brain). The mid-brain does not sep
ranged on the periphery or the wall of the tube and take part in die arate but becomes the third cerebral vesicle. The hind-brain sepa
formation of the white matter. With the gradual development of rates to form two vesicles: the metencephalon and die myelence-
the spinal cord the cavity of the tube narrows and transforms into phalon.
Sulcus precentratis
Sulcus Inlraparietalis
Lobus Iron tails
Lobus ocdpitalfs
Fossa laterally cerebri
Diencephalon
■^Lobus temporalts
Cerebellum
H
728. Brain of13-cm-long embryo; right aspect.
As the result of the irregular growth of the brain, a series of come the fourth ventricle (ventriathts quartus) which communicates
flexures Form at this time: parietal — at the level of the raid-brain, posteriorly with the subarachnoid space (cavum stibaraehruiideaU) by
pontine — in the region oF the metencephalon, and occipital—in means of lateral and medial apertures and an opening in the infe
the region of the posterior cerebral vesicle at the junction between rior medullary velum.
the spinal cord and the rayelenccphalon. T h e anterior part of the metencephalon, called the isthmus
Due to the marked thickening of the walls of the cerebral vesi rhnmbencephali, gives rise to the superior cerebellar peduncles
cles and the increasingly complicated relief of the brain surface, (pedunculi eerebellares superiores) and the superior medullary velum
the cavities of the vesicles acquire the shape of slits varying in size (vdum medullare superius); the pons develops from the anterior por
and position. These are the ventricles of the brain (ventriculi cerebri) tion of the metencephalon, and the cerebellum —from the poste
which are filled with the cerebrospinal fluid. The ventricles com rior middle and lateral portions.
municate with one another and with the central canal of the spinal T h e dorsal wall of the mesencephalon forms the tectum of the
cord. The wall of each cerebral vesicle develops into a definite part mid-brain {tedum mesenccphali), or the tectal lamina; the ventral
of the brain, whereas the cavity becomes the cavity of the corre wall develops into the cerebral peduncles (pedurtculi cerebri). The
sponding ventricle, cavity of the mesencephalon becomes a narrow canal known as the
T h e anterior wall of the posterior part of the rhombence- aqueduct of the mid-brain (aqueductus cerebri) which communicates
phalon, the myelencephalon, develops into the medulla ublongata; the third and fourth ventricles (see Fig. 764).
the posterior wall docs not differentiate and remains a thin lamina The intensively developing lateral walls of the diencephalon
forming the inferior medullary velum (velum medullare inferius). form the thalami, and the ventral wall gives rise to the hypothala-
T h e cavities of the metencephalon and myelencephalon be mus; the dorsal wall gives origin to the pineal body (corpus pine&U)
but remains undifferentiated for a considerable distance to form from the external and internal environment and transforming
the Lamina epithelial is. The cavity of the diencephalon transforms these stimuli into nerve impulses which are transmitted to the spi
into a narrow sagittal slit between the right and left tbalami —this nal cord and brain.
is the third ventricle (uentrittilus tertius) which communicates The effector (efferent, or centrifugal) nerves are an aggregate
through the paired interventricular foramen (foramen interventricu- of processes of nerve cells whose bodies form nuclei of the spinal
lart) with each lateral ventricle, respectively. nerves in the spinal cord and nuclei of the crania! nerves in the
The tclcncephalon forms the cerebral hemispheres (hemispfteria brain stem. They terminate on the periphery as effectors which
cerebri) which cover all the other cerebral vesicles and for this rea transmit the impulses From the brain and spinal cord to the effec
son the first cerebral vesicle is known as the pallium (L mantle). tor organs (muscles, glands).
The cavity of the telencephalon Forms two lateral ventricles (ventri- Several neurons take part simultaneously in propagating the
culi laterales) the left one being conventionally considered the first stimulus along the affector and effeelor pathways. They are ar
lateral ventricle. ranged sequentially and come in contact (synapse) to form the re
The spinal eord and the brain developing from the neural flex arc. A simple reflex arc usually consists oF three neurons:
tube, together with the nerves originating from them, are a single affector, intertiuiicial, and effector. Many neurons participate in a
whole, both anatomically and Functionally. complex reflex arc.
The affector (afferent, or centripetal) nerves are an aggregate Taking into consideration the topographic peculiarity of the
of the peripheral processes of cells of the spinal or cranial nerve prevalent localization of most nerve cell bodies in the brain and
ganglia. spinal cord, and the important functional role of the brain and spi
They begin on the periphery as receptors, appreciating stimuli nal cord in the body, the integrated nervous system is arbitrarily
Hemispheriurti
Corpus callosum
CommissLira antcrio
Lamina leiminalis
urn medullare <..j[ier:
Corpus mamillare —
Chiasma optkmn '
erebellum
111 full :ii!i.ihn:i
robus anterior (adeiiohvpophysjs)
Hypophysis
lobus posterior (neuruiiYpophysis) Pedunculus cerebrr y m medfillare itifertus
/
Jsthmus Pons
rhombencephaU
Medulla spinalis
and the newer brain (enaphalon) lodged hi Lhe cavity of the skull.
T h e central nervous system (systema nervosum, centrale) (or the
central part of the nervous system) consist* of the phylogenetically Both are related genetically, morphologically, and functionally and
older spinal cord (medulla spinalis) situated in the vertebral canal are continuous.
Cullkulus inferior
Pedunculus eerebelliiris
Olive superior
PedunenliB cerebdlaris
Medulla oblortgata mod i us
Fossa rhomboidea
DecussaUo
-Intumescentia
■Intumesrcntia CV— c-ervicalis
ccrvk:alis
Suicus medianus
(posterior)
-Suicus laterals
posterior
ThX-
TtiXII— -intumescentia
Intumescentia hnnballs
luniijalis
L1I-.
~Conus medullaris
"onus medullaris.
cord lies a deep anterior median Assure (fisura mediana anterior me~
fr/i.. spinaiis), the lumbar part (pars lumbalis medullat spinaiis), and
dullat spinaiis) (Figs 732, 7S3) into which a fold of the pia mater
tbr comis medullaris (Figs 730 and 839). Each part contains a
dips to form the anterior median septum. The fissure is shallower
definite number of segments, i.e. spinal cord segments which give
at the proximal and distal ends of the spinal cord.
origin to one pair of spinal nerves (right and left),
A very narrow posterior median sulcus (sulcus mtdianus posterior
The spinal cord consists of eight cervical segments (segmenta
mtdulhe spinaiis) runs on the posterior surface of the spinal cord,
wxduUat spinaiis cervkalis 1-VUl), twelve thoracic segments (stg-
into which a plate of gtial tissue penetrates to form the posterior
mtnta mtdullae spinaiis thoraticat I-XII), five lumbar segments (stg-
median septum,
motto medullat spinaiis lumbalis l-V), five sacral segments (stgmwta
The fissure and the sulcus divide the spinal cord into the right
matullae spinaiis sacralis l-V), and one to three coccvgea) segments
and left halves which are joined by means of a narrow bridge of
fjegmenta. meddlae spinaiis couygta l-III).
medullary tissue with the central canal of the spinal cord (canalis
It is easier to study the relationships between the white and
cmtralu medullae spinaiis) m the middle.
grey matter on spinal cord sections, especially those made through
Two shallow suki stretch on the sides of each hair of the spinal
the horizontal planes.
cord. These are the anterior lateral sukus of the spinal cord (sulcus
The spinal cord does not have the same diameter for the whole
lakralu anterior medulla* spinaiis) (BNA) running lateral to the ante
distance, but thickens slightly [rom the distal to the proximal end.
rior median fissure and further away from il in the proximal and
Forming spindle-shaped thickenings, it has the largest swelling in
middle parts of the spinal cord than in the distal part, and the pos
two parts: the cervical enlargement (intumescentia cervkalis) which
terior lateral sulcus of the spinal cord (sukus lateral posterior medul-
corresponds to the exit or the spinal nerves passing to the upper
lae spinaiis) lying lateral to the posterior median sulcus. The ante
limbs, and the lumbar enlargement (tntumescentia lumbalis) coiTe-
rior lateral and the posterior lateral sulci run almost the whole
sponding to the exit of nerves which stretch to the lower limbs.
length of the spinal cord and are the site of exit of the anterior and
The diameter of the spinal cord is 1.3-1.5 cm in the region of the
posterior roots of the spinal nerves, respectively.
cervical enlargement, 1 cm in the middle of the thoracic part, and
In the cervical and partly in the upper thoracic portions is an
1.2 cm in the region of the lumbar enlargement; the antero-poste-
indistinct posterior intermediate sulcus (sukus intermedia posterior)
rior width measures up to 0.9 cm in the region of the enlargements
passing between the posterior median and posterior lateral sulci.
and 0.8 cm in the thoracic part.
Still another sulcus is sometimes found in the foetus and the
The cervical enlargement stretches from the level of the third
newborn. It is called the anterior intermediate sulcus (sulcus intcr-
or fourth cervical vertebra to the second thoracic vertebra and is
medius anterior) (BNA). It stretches on the anterior surface of the
thickest at the level of the fifth or sixth cervical vertebra (fifth to
upper parts of the cervical portion of the spinal cord between the
sixth cervical spinal nerves). The lumbar enlargement is between
anterior median fissure and the anterior lateral sulcus, and sepa
the ninth or tenth thoracic vertebra and the first lumbar vertebra
rates the intersegmental tract (fasciculus proprius medullat spinaiis)
and its diameter is largest in the region of the twelfth thoracic ver
from the anterior corticospinal tract (tractus cortkospimlis fjryrami-
tebra (third lumbar spinal nerve).
dalisj anterior),
Along the entire length of the anterior surface of the spinal
Pedunculus cerebri
-Corpus pineale
-—Medulla spinalis
TectUni mesencephaii
Pedtinculus m e b e l i a r i ; Sultus intdfanu
superior f posterior)
Pedunculus cerebcllaris
medius Fossa rhDirholdea Sulcus lateralis-
posterior
Tuberculum nuclei g r a c i l i s j
»~9
f*. accessorius,_
(pars spinalis)
Funkulus
Fascicjltis
Fasckulus
posteriory
gracilrs-
ctuwsrt
A
IHura mate.
\,
-10
N a thoracici
M l
htumisceutla cervicslis- t;
Fib radicularia-^1^
r a d k l s dorsalis
> N n . cerviuales
Flla r j H l i c u l a r i * " - ^
radtcts venlralis
Sulcus meflianus(posterior) ,
COJIU-S itieduilarla-
f
Dura mater spinalis?'' -2
Radi* dorsalis--"'
Cauda cquina*-"
Ganglion spinal?- —
Ug. rJenlJtutatum^
thoracki •-A
fv. spinalis^
FiJuni durae'/
> Nn.sacrales
>---3
\ 'N. f u t r ^ g e u s
731. % K a / cord (medulla spinalis) with roots (radices) and spinal nerves (nervi spinales); posterior
aspect (%).
(Spinal dura mater U opened; roots are removed on the left within the range of cauda eqiiina.)
Fasciculus interfasciCLilaris
Fasciculus cuneatus. ' (comma tract)
1'rnilu- cortlcospinalis (pyramidalis) lateral!; Fasciculus gracills
Sufciis media mis (posit r in r)
Ttactus splnocetebellarls posterior Septomarynal
\ fasciculus
Fasciculi proprii rnedullae spinal in
Trartus TubrtispijiaJis
— Column a pusleTlor
Traclus splncilectalis
el spinothalaTnicus lateral is -J j Substantla intermedia centralis
frauds spinoccrebeiiatls anterior
Tractns vestibuluspinalis Fasciculus proprius
Flla radiculatia medullae spinalis
L—Ttactus lectospinaUs
radlcls dorsal is
L -Columna anterior
Radix dorsalls
"*"V< j ^ l ~ - - T t a c t u s rorlicosplnalls
fc (pyramidalis) antetior
r-Fila radicuiarla rad
ventralis
732. Spinal cord; anterior and partly lateral aspect (semischematical representation).
(Two spinal segments; topography of white matter is shown on the right side; white matter is removed on the left side to show the shape
of the grey matter.)
white column into two fasciculi: one is thinner, lies medially, and distinguished in the grey matter; a narrow transverse strip, the sub-
is known a? the fasciculus gracilis; the other is thicker, passes later stantia intermedia centralis bridges the lateral parts and extends
ally and is called the fasciculus cuneatus. These Fasciculi continue into their middle as the substantia intermedia lateralis.
also into the initial part of the brain, the medulla oblongata The median parts of the grey matter have a very narrow cav
(Figs 732, 733; 769-771). ity— the central canal of the spinal cord (amalis eentralis medullat
The funieuli Tuse in the distal parts of the spinal cord and be spinalis). Its size and shape vary at different levels: it is oval in the
come indiscernible on the outer surface. region of the cervical and lumbar enlargements but spherical with
The nerve cells and their processes are the main components a diameter of up to 0.1 mm in the thoracic part. In adults the cav
of the grey matter (Fig. 733). It also contains the processes oF cells ity of the canal may be obliterated in some areas. The central canal
located in other parts of the spinal cord and brain, die neuroglia, stretches for the whole length of the spinal cord and is continuous
and blood vessels with the attendant connective tissue. above with the cavity of the fourth ventricle. Below, in the region
The nerve cells form collections, nuclei, or centres of the spinal of the conus medullaris, it h dilated to 1 mm on the average; this
cord. part of the central canal is called the terminal ventricle (ventriculus
Two lateral parts located in both halves of the spinal cord are terminates).
■1 ■>-
1-
Kuntcuiiis laterally
Lornu lalerale'f//
t#\ i f issura median* v \ *,
Fila radicuiari/ Radii venlralis ' (anlcrloi) \ \ JSubstantial intermedia cemralis
[adkis ventrslts j
rmi arueriits \ Cornmissura al5a
Funicuhi-, anterior
horn. It embraces the head of the posterior h o r n (captit cornus poste T h e anterior rootlets (jila radiadaria ankrioni) arising from
riori?) which is continuous with the neck of the posterior horn (cer each segment emerge from the lateral anterior sulcus or close to it.
vix comtupostmoris) • the last named is, in turn, continuous with the They arc the processes of motor cells located in the grey matter of
wide part of the horn called the base of the posterior horn (basis the anterior horn and of cells lying in the grey matter of the lateral
corrnu posteriorisj (Fig. 733). horns (the last named are present only in the thoracic and lumbar
T h e apex of the posterior horn is capped by a layer of neurog- parts of the Spinal cord). The anterior rootlets form the motor an
lia containing many nerve cells, this is the gelatinous matter (sab- terior root of die spinal nerve (radix ventralis nervi spinalis).
stantia gelatinosa). It is circumscribed by a spongy zone which is T h e anterior roots contain centrifugal (efferent) fibres which
continuous with the marginal zone reaching the outer surface of convey motor and autonomic impulses to the periphery of the
the spinal cord. body: the striated and smooth muscles, glands, etc.
T h e lateral horn is a section of the intermedin lateral (autn- T h e posterior rootlets (Jila mdicularia posteriora), which arc
nomic) column {columna inlermedwlaterulis s, aittonomica) stretching made up of processes of cells lodged in the spinal ganglia (ganglia
from the first thoracic to the first or second lumbar segments; in spinale), enter the lateral posterior sulcus. These rootlets form the
the sacral part it contains the sacral parasympathetic nuclei (nuclei sensory posterior root of the spinal nerve (radix dnrsalis neryi spina-
parasympathid sacrales) located in the second to fourth sacral seg- lis).
ments. The posterior roots contain centripetal (afferent) fibres convey
At the medial margin of the base of the posterior horn, is a ing sensory impulses from the periphery, i.e. from all body tissues
small group of nerve cells extending from the level of the seventh and organs, to the central nervous system.
cervical to the third lumbar segment and Forming the thoracic A spinal ganglion (ganglion spinale) (Fig, 732) is a spindle-
nucleus (nucleus tkoracicus). shaped swelling on the posterior root, ft is a. collection mostly of
Between the anterior and posterior horns, at the level of the pseudounipolar nerve cells.
grey commissures, is a transversely lying intermediate part occup T h e process of each pseudounipolar cell bifurcates to form two
ied by intermediate cells. processes, one of which is a long process running to the periphery
Small collections of nerve cells are also found hi the region of in the spinal nerve (nervus spinalis) and terminating there by a sen
the posterior horn. sory nerve ending; the other is a short process stretching along the
T h e location of the horns corresponds to the anterior and pos posterior root into the spinal cord (see Fig. 903).
terior lateral sulci of the spinal cord. This correspondence deter All spinal ganglia, with the exception of the ganglion of the
mines the cross-sectional topography of the white matter (the ante coceygeal root, are closely surrounded by the dura mater; the
rior, lateral, and posterior white columns). ganglia of the cervical, thoracic, and lumbar parts are located in
T h e pattern of the spinal cord cross-sections varies with the le the intervertebral foramina, those of the sacral part lie inside the
vel: it is oval at the level of the lower cervical segments, rounded in sacral canal.
the region of the midthoracic segments, almost square but with a T h e roots stretch differently: they arise almost horizontally in
slightly compressed anterior surface in the upper lumbar seg the cervical part, descend obliquely in the thoracic part, and go
ments, and also almost square but with a mildly flattened posterior right downwards in the lumbar and sacral parts (Figs 731, 8H9).
surface in the sacral portion. Immediately lateral to the spinal ganglion, the anterior and
T h e relationships of the white and grey matter vary m the diff posterior roots merge to form a spinal nerve (nervus spinalis) which
erent regions of the spinal cord. There is much more grey matter is therefore a mixed nerve.
in the cervical part, particularly in the region of the cervical en f.ach pair of spinal nerves (right and left nerve) corresponds to
largement, than in the middle portions of the thoracic part where a certain spinal segment. Consequently, the n u m b e r of spinal cord
the amount of the white matter is much greater, about 10-12 times segments is equal to the n u m b e r of pairs of the spinal nerves.
that of the grey matter. The anterior and posterior horns are mar T h e spinal cord bears 31 pairs of spinal nerves which lie on
kedly larger in the cervical than in the thoracic part, hi the lumbar both side.i almost symmetrically: eight cervical, twelve thoracic,
region, at the level of the lumbar enlargement in particular, the five lumbar, five sacral, and one coceygeal (sec The Spinal Nerves).
amount of the grey matter is greater than that of the white matter. As it is pointed out above, the spinal cord is continuous with
In this region, the horns, mostly the anterior ones, protrude the brain. T h e conditionally accepted topographical junction be
sharply; the amount of the grey matter in the posterior horns also tween these two parts of the central nervous system is the site of
increases. T h e grey matter diminishes in the direction of the sacral exit of the first pair of cervical roots and the lower end of the de-
part, but the grey commissures become thicker and wider and cussation of the pyramids (deaissatio pyramidum) on the anterior
come nearer to the posterior surface of the spinal cord. In the re surface of the brain (see Fig. 743), Skeletopically this junction is on
gion of the conus medullaris the grey matter occupies almost the the level of the upper border of the first cervical vertebra.
whole cross-sectional area, and only a very narrow layer of white
matter is seen on the periphery.
THE BRAIN
The brain (encephabn) is the central organ of the nervous sys
s- verse dimension —13-14 cm, vertical dimension —10.5-12,5 cm;
tem regulating the relationships between the organism and the en
i- its volume is 1200 cm3 on the average,
vironment and coordinating body functions. In this, the followingg The weight of the brain depends on the age and sex of an indi-
levels are distinguished from the anatorno-functkmal standpoint:t: viduaL The brain of a newborn accounts for 10 per cent of the
T—the higher level concerned with coordination of the sensor}' y body weight (455 g on the average); in an adult it makes up 2.5 per
and motor activities and higher intellectual functions (the cortexx cent of body weight (1375g on the average in a male and 100 g
of the brain); II—the centre of emotional control and endocrine le less in a female). The individual variations in the weight of the
regulation, is represented by the limbic system (the hippocampus,s, brain range from 900 to 2000 g. The direct relationship between
hypophysis cerebri, hypothalamus, gyms cinguli, amygdaloid nuc > the weight of an individual's brain and his capabilities has not
leus), and III—the lower level coordinating the autonomic bodyy been verified.
functions and transmitting signals to the centres located higher
as Tile brain is conditionally subdivided into the cerebrum, cer
(the reticular formation and the brain stem}.
ebellum, and the brain stem (trutiats cerebri). Each part differs from
The brain is enclosed in the skull. The shape of the inner sur the other phylogenetically, functionally, and anatomically,
face or the cavity of the skull repeats the shape and contours of thee The cerebrum covers the cerebellum and the brain stem, there
brain. fore both these parts of the brain can be seen from the lower
The brain (without the dura mater} of an adult weighs 1375 g aspect.
on the average, its sagittal dimension measures 16-17 cm, trans-
THE CEREBRUM
The cerebrum is the largest part of the brain and occupiess The surface of each hemisphere is covered by many cerebral
most of the cranial cavity. Its outer, bulging surface called the su- sulci (said cerebri) which vary in depth and length. Between the
perolateral surface of the cerebrum (fades superolaieralii cerebri) ) sulci are the cerebral gyri (gyri cerebri) which also vary in size. The
bears a sagittally directed longitudinal fissure of the cerebrumi sulci and gyri are sufficiently exposed when the arachnoid mater
(fissura, longitudinalis cerebri) (Figs 734, 735) which divides the cere and pia mater of the brain are removed (Figs 734, 736, 739, 741).
brum into right and left hemispheres (hemisphermm cerebri dextrum
et sintstrum) which are joined by means of commissures (commmtt-
mt) the largest of which is the corpus callosum.
The following surfaces arc distinguished in each hemisphere: of the superolateral and medial surfaces of [he hemisphere. The in-
(1) the convex superolatcral surface of the cerebral hemisphere ferolateral border of the cerebrum (marga inferior s. inferoUteratis
(faaes superolatemlis hemispkerii) adjoining the inner surface of the cerebri) is at the junction of the superolateral and inferior surfaces
skutl-cap; (2) the inferior surface of the cerebral hemisphere (fa of the hemisphere. The inferomedial border of the cerebrum
des inferior hemispherii) whose anterior and middle parts lie on the (margo medialis s. inferomedialh cerebri) consists of two parts: a me
inner surface of the base of the skull in the region of the anterior dial occipital border between the hemispheric surface adjoining
and middle cranial fossae, and the posterior parts lie on the tentor- the tcntorium cerehelli and the medial surface, and a medial orbi
ium cercbelli; (3) the medial surface of thp cerebral hemisphere tal border between the orbital part of the inferior and medial sur
(facia medialis kemispheria) facing the longitudinal fissure of the faces of the hemisphere.
cerebrum which passes between the hemispheres.
Each hemisphere has the following projecting parts: a frontal
The three surfaces of each hemisphere are continuous with one pole (polus frontatis) to front, an occipital pole (polus oedpitalis) be
another to form three borders. The superomedial border of the hind, and a temporal pole (polus temporalis) on the lateral side.
cerebrum (margo superior s. superomedialis cerebri) is at the junction The hemisphere is divided into four lobes of the cerebrum (lobi
Polus frnntalis
Lobua frontal !s
Lobus
parletalis
Lobiis occipital is
Polus uccipitalis
cerebri) adjoining the corresponding bones of the skull. These are ralis). T h e frontal lobe is separated from the temporal lobe by the
the Frontal lobe (lobus frontalis), the parietal lobe (lobns parietalis), the insula which is lodged in the depth of the lateral cerebral fossa
occipital lobe (lobus accipitalis)t and the temporal lobe (lobus tempo- (fossa lateralis cerebri).
w / f f M N ^ "hi<:h, however, does not reach the medial border located above the superior frontal sulcus and extending Z> the
medial surface of the hemisphere, the middle frontal gyrus (gyrus
Margo superior
(super medialls)
Polus
n tal is
Sulcus laterals
Polus
occipilatis
LobuIus
semllumrt5
superior--"" ■—f\". tH^eminus
Flocculus - ^ H Pons
N. vestibule cohlearis Margo interior (inferolsteraHsJ
Lobulus N- facialls
semilunarls lnkrloi N. abduicns
N. hypoglos5us
Lobus bivetiter
TonsUla ce rebuild
N. vagus' jVtedulia oblongata
frontalis mtdius) which is bounded by the superior and inferior whose floor is formed by the outer surface of the insufa. Small
frontal sulci and in whose anterior portions a superior and inferior sulci, called rami, branch oft from the lateral sulcus upwards;
parts are distinguished, and, finally, the inferior frontal gyms (gy- those most constantly present are the horizontal ascending rarnus
rus fiantalis inferior) lying between the inferior frontal sulcus and (ramus ascendens) and the horizontal anterior rain us (ramus anterior);
the lateral sutcua of the cerebrum. T h e rami of the lateral sulcus the superoposterior portion of the sulcus is called the posterior ra
(see below) divide the inferior frontal gyrus into several parts. rnus (ramus postrriur) (Fig, 736).
T h e lateral sulcus (suteus tateralis) is one of the deepest cerebral T h e horizontal ascending and anterior rami run on the inferior
sulci and separates the temporal lobe from the Frontal and parietal frontal gyrus and divide it into three parts (Fig.737): (1) the poste
lobes. It lies on the supero lateral surface of each hemisphere and rior part (pan optrculans) which is bounded in front by the horizon
stretches downwards and to the front. Deep in this sultus is a de tal ascending ratnus; (2) the triangular part (pars triangular is)
pression tailed the lateral cerebral fossa (fossa latcralu cercbri) which lies between the horizontal ascending and anterior rami;
(3) the orbital part (pars vrbilalis) located between the horizontal superior) lying above the intraparietal sulcus, and the inferior par
anterior ramus and the anteroittferior border or the frontal lobe. ietal lobule (hbulus paridalis inferior) located below this sulcus.
The parietal lobe (lobus paridalis) (Figs 734, 735) is behind the Two large gyri are distinguished in the lower portions of the in
central sulcus which separates it from the Frontal lobe. The lateral ferior parietal lobule (Figs 736, 737): the anterior part of die infe
sulcus separates the parietal lobe from the temporal lobe, and part rior parietal lobule (gyms supramarginalis) which lies anteriorly and
of the parieto-occipital sulcus (sulcus paridn-occipitalis) separates it caps the posterior portion of the lateral sulcus, and the middle part
from the Occipital lobe, of the inferior parietal lobule (gyms angularis) which caps the supe
The postcentral gyrus (gyms postcentralis) passes parallel to the rior temporal sulcus (sulcus lemporalis superior).
central sulcus. To the back oFit, almost parallel to the longitudinal Between the horizontal ascending and posterior rami of the la
fissure of the cerebrum, runs the intraparietal sulcus (sulcus intra- teral sulcus is an area of the frontal and parietal cortex called the
paridalis) which divides the posterosupcrior parts of the parietal frontoparietal operculum (operculumfionloparietale).It is made up
lobe into two lobules: the superior parietal lobule (lobutus parietalis of the posterior portion of the inferior frontal gyrus, the lower por-
lions of the precentral and postcentral gyri, and the lower portion elongated lateral occipitotemporal gyrus (gyrus ocdpitotemporalis la-
of the anterior part of the parietal lobe. ieraiis) still medial to which h the collateral sulcus (sulcus collatera-
The occipital lobe (lafois occipitalis) (Figs 736, 737) has no lis) bounding the hippocampal gyrus (gyrus pamhippficampalis). This
clearly defined boundaries separating its convex part from the par gyrus is separated by the hippocampal sulcus from a small narrow
ietal and temporal lobes, except for the upper portion of the par- dentate gyrus (gyrus dentatus). The anterior end of the hippocampal
ieto-occipital sulcus (sulcus parieto-oedpitalis) which lies on the me gyrus is mickened to form the uncus, while the posterior part is
dial surface of the hemisphere and separates the occipital lobe continuous with the large medial occipitotemporal gyrus (gyrus oc-
from the neighbouring parietal lobe. The three surfaces of the oc dpitotemparalis medialis) whose posterior portion belongs to the oc
cipital lobe, the lateral (bulging), medial (flat) and inferior (con cipital lobe. The collateral sulcus separates the lateral occipitotem
cave) located on the tentorium cerebelli, bear a scries of sulci and poral gyrus from the medial occipitotemporal gyrus on the inferior
gyri. surface of the hemisphere; its anterior portion is continuous with
In some cases the sulci and gyri on the convex lateral surface the rhinal sulcus (sulcus rhinalis).
of the occipital lobe are absent, and those of one hemisphere may Short transverse temporal sulci (sulci temporales transocrsi) are
differ from the ones of the other hemisphere. found in those areas of the temporal lobe which are directed to the
The transverse occipital sulcus (sulcus oedpitalis transversal) is lateral sulcus of the cerebrum. Between them are two or three
the largest. It is sometimes a continuation of the posterior end of short transverse temporal gyri (gyri tempomlis transversi).
the intraparietal sulcus and is in turn continuous posteriorly with On the orbital, i.e. inferior, surface of the frontal lobe
the inconstantly present lunate sulcus (sulcus lunaius). (Fig. 741), close to the medial border, is an anteriorly directed ol
A pre-occipital notch (indsura pre-nccipitalis) is present on the factory sulcus (sulcus olfactorius). It lodges the olfactory bulb (bulbus
inferior border of the superolateral surface of the hemisphere olfadorius) which is continuous with the olfactory tract (Iractus olfac
about 5 cm to the front of the occipital lobe. torius).
The temporal lobe (lobus temporal^) (Figs 736, 737, 739-742) The olfactory sulcus projects slightly to the front of the ante
has die most defined boundaries. A convex lateral and a concave rior border of the bulb; posteriorly it embraces the olfactory tuber
inferior surfaces are distinguished. The blunt pole of the temporal cle lying on the dorsal surface of the olfactory pyramid (Irigonum
lobe is directed to the front and slightly downwards. The lateral olfadorium).
sulcus of the cerebrum delimits sharply this lobe from the frontal Three olfactory striae (striae olfadoriae) are present in the olfac
lobe. The temporal lobe has on its inferior surface the hippocam- tory pyramid: the medial stria is continuous with the parolfaclory
pal sulcus (sulcus hippocampi) which separates it from the brain area (area subcallosa), paraterminal gyrus (gyrus paraterminalis), and
stem. septum lucidum (septum pellucidum); the intermediate olfactory
The following sulci and gyri are distinguished on the temporal stria runs to the anterior perforated substance (svbstantUi perforata
lobe. There are two sulci located on the superolateral surface, the anterior); the lateral olfactory stria stretches to the uncus.
superior temporal sulcus (sulcus temporalis superior) and the inferior Medial of the olfactory sulcus, between it and the medial bor
temporal sulcus (sulcus temporalis inferior) which run almost parallel der of the hemisphere, is the gyrus rectus which reaches the ante
to the lateral sulcus of the cerebrum and divide the lobe into three rior perforated substance posteriorly. Lateral of the suicus is the
gyri; the superior, middle, and inferior temporal gyri {gyri tempo- remainder lateral part of the orbital surface of the frontal lobe;
rales superior, medius, et inferior). short orbital sulci (svld orhitalts) divide it into a series of small orb
The inferior temporal gyrus passes from the superolateral to ital gyri (gyri orlitaUs),
the inferior surface of the temporal lobe. Medial to this gyrus is an
THE INSULA
The insula (Fig. 738) lies on the floor of the lateral cerebral the limen insulae, lying at the junction with the inferior surface of
fossa (fossa lattralis ctrebri). It is a trihedral pyramid whose apex, the the cerebrum, between the insula and the anterior perforated sub
pole of the insula, is directed forwards and laterally towards the la stance.
teral sulcus. The deep central sulcus of the insula (sulcus ctntralis insulae)
On the periphery the insula is surrounded by die frontal, par stretches on its surface and divides it into a larger anterior and a
ietal and temporal lobes which contribute to the formation of the smaller posterior parts.
walls of the lateral sulcus of the cerebrum. The anterior part has a few short gyri of the insula (gyri breves
The base of the pyramid is surrounded oa three sides by the insulae); the posterior part usually has only one long gyrus «f the
circular sulcus (sulcus drcularis insutae) which disappears gradually insula (gyrus longus insulae).
at the inferior surface of the insula. Here is a small swelling, called
SULC1 A N D G Y R I O F T H E M E D I A L S U R F A C E O F T H E C E R E B R A L H E M I S P H E R E S
T h e medial surface of the hemisphere (furies mediate hemispht- At the junction with the isthmus the gyrus cinguli is separated
rii) (Figs 739, 740, 764), on which the boundaries between the from the lingual gyrus, lying behind it, by (he calcarine sulcus (sul
lobes arc defined less clearly than on the superolateral surface, has cus calcarinus).
the following sulci and gyri. T h e three described gyri—die gyrus cinguli, the isthmus of the
The callosal sulcus (miens carports cathsi) arches the corpus cal- gyrus cinguli, and the hippocampal gyrus—form the gyrus fornica-
loMiin and repeats its contours. T h e anterior part of the sulcus ori tus. T h e last named, together with the parolfactory area in front
ginates in the region of the pamifactory area (area subcallosa), the and the uncus behind, form a ring-like area which is part of the
posterior part is continuous with the hippocampal sulcus. rhinencephalon (sec Fig. 807).
Above the corpus callosum and separated from it by the callo- T h e gyms cinguli is bounded above by the sulcus cinguli. T h e
sal sulcus is the arch-shaped gyrus ciuguli. Its anterior end curves anterior part of the sulcus is convex in the direction of the frontal
round the genii of the corpus callosum (gsnu covporis callosi), the pole; the posterior part runs along the gyrus cinguli and, not
posterior end bends round the splenium of the corpus callosum reaching its posterior end, ascends to the upper, medial margin of
(splenium carports callosi) and is continuous through a narrow strip the longitudinal fissure of the cerebrum. Its outer end is to the
called the isthmus of the gyrus cinguli (isthmus gyri cinguli) with the back of the upper end oT the central sulcus.
hippocampa) gyrus (gyrus parakippocampalis). A little more to the front the sulcus cinguli sends off a small
l
■ E I t
Commlssura anterior j [ ^ Fasciculus mamil!athfliam.icus
Columns fornjds
paracentral sulcus which, together with the subfronta! part, A triangular lobule, the cuneus, is dorsal to the precuneus; its
bounds the paracentral lobule (labulus paracentralts). Anteriorly of bulging, outer surface contributes to the formation of the occipital
this lobule is the medial surface of the superior frontal gyrus (gyms pole. The apex of the cuneus is directed downwards and forwards
frantalis superior) which extends to the beginning of the sulcus cin- almost reaching the posterior part of the gyrus cinguli.
guli. Posteroinfcriorly the cuneus is bounded by a very deep calca-
Behind the sulcus cinguli is a small square-shaped lobule riue sulcus (sulcus cakarinus), anteriorly by the parieto-occipital sul
called the precuneus. It is bounded posteriorly by the deep par- cus. As it is said above, the precuneus is in front of the cuneus,
iclo-occipital sulcus (stilats parieto-oaipitalu'j and inferiorly by the and the medial oecipitotemporal gyrus (gyrus occipitotemporalis rrudi-
suprasplenial sulcus (sulcus stibparittalu) which separates the precu itlis) is under it.
neus Irom the posterior portion of the gyrus cinguli.
»yrw$ tampo
To study the inferior surface of the cerebrum the brain is The posterior parts of the olfactory tract flatten out and are contin
placed so that its ba.se faces upwards (Figs 741-743). On it are the uous with the olfactory pyramid (trtgonum dfirtorivm). The lateral
pallium of the encephalon, structures belonging to the brain stem, and medial sides of the pyramid are bounded by thin strips of grey
and the sites of exit of the cranial nerves. matter, the lateral and medial olfactory gyri.
The structures of the brain stem and the sites of exit of the cra The olfactory tubercle lies in the depth of the olfactory sulcus
nial nerves lie on both sides of the median plane of the inferior on the superior surface of the olfactory pyramid as if forming its
cerebral surface. In the anterior parts of the cerebrum, along the apex. O H the inferior surface of the pyramid, on the level of the
olfactory sulcus (sulcus olfartorius) is a white trihedral strip, the ol anterior margin of the anterior perforated substance are three fine
factory tract (tractns olfattorius). Its anterior expanded part forms olfactory striae into which the olfactory tract separates: (a) the
the olfactory bulb (bulbus nlfactorius) which Ifei on the cribriform medial olfactory stria whose fibres terminate in the paroifactory
plate of the ethmoid bone. The perforations of the plate transmit area (area subcallosa), m the paraterminal gyrus (gyrus parakrmina-
into the inferior surface of the olfactory bulb up to 20 very fine ol lis), and in the septum luridum (septumfiellttridum);(b) the inter
factory filaments which form the olfactory nerves (nervi olfadorii} mediate olfactory stria whose fibres terminate in the anterior per
(tiie first pair of cranial nerves). The filaments terminate in the forated substance; (c) the longest, lateral olfactory stria which
cells of the bulb and are the processes of olfactory cells lodged in curves to the side to stretch on the lateral margin of the anterior
the mucous membrane of the nasal cavity (the superior and middle perforated substance; most of its fibres pass through the limcn in-
nasal conchae and the corresponding portion of the nasal septum). sulae to the hippocampal gyms (gyrus parakippocamp&lit).
FiiSura
Bulhus o l f a c t o r y l o n g i t u d i n a l cerebri ^ ^ „]f3ctnrilJ
Tri^Onum olfadoriu
[nfundlbitluNi
y^iubstiititla perforata
anterior
Slfiii ulfscloria
Corpus mainilhre
Tuber dneirum
Substantla purtorata
Tracttis Qptiws
posterior
Tegmentum
mtcduttUS cerebri
Corpus Eenivulatum'
medlale
Splenium erjrporla caltosf
Nucleus rub'
. ■
riguniim olfjctortum
(iifiMKllhiilinn,
Ttactus opilcus
■N. ucjlomotorijfi
|-':.>S:1
--N. t r o t b k j f l s
id terp«iu ocular is
Substsiitli perforata
posterior
—N. intermedium
N. wstibulocochlearii
Peduncut
cerebrl
glossoptiarytigsus
- N . vagus
occessurlus
Plexus Lhurioideus'
The corpus callosum (Figs 739, 744, 745, 764) is a white, elon
The corpus callosum lies in the depth of the longitudinal
gated from front to back, and slightly Battened mass measuring
fissure of the cerebrum; the anterior, middle, and posterior por
7-9 cm in length. It is the largest cerebral commissure, or the com
tions are distinguished in it.
missure of the most recently evolved parts of the cerebral hemis
The anterior portion curves forwards, downwards, and then
pheres (commissura neopallti) because it joins the grey matter of the
backwards to form the genu of the corpus callosum (goat arrporis
cerebral hemispheres (the neopallium) which is' of later phyloge-
isetical origin. callmi) which is continuous inferiorly with the rostrum of the cor
pus callosum (rostrum corp»ris mllosi). The last-named continues as
Striae longltudinales
me dial PS
■Stria 10-ngltudln.alis
Substantla t t b a ^ j
lalcralli
■Truntus corporis
callos!
Sukus cnlcarmus
Substantia tfrisea'
744. Semwval centre (centrum semiovale) and corpus callosum; superior aspect {%),
(The cerebral hemispheres are removed to the level of the semioval centre; part of the brain matter is removed from the right hemisphere
to expose the corpus callosum.)
the lamina terminalis which lies in front of and below the anterior the epiphysis cerebri, or pineal body fa$*$ pistole), and the tectal
lamina (lamina ledi) of the mid-brain.
commissure.
The superior surface of the corpus callosum bears a thin layer
The trunk of the corpus callosum (truncus corpora cdlmi) is its
of grey matter called the mdusium griseum which in some areas
middle part which is the longest and forms a longitudinal convex forms four small longitudinal thickenings in the fonn of striae, two
ity- on either side of the median sulcus. Two medial longitudinal striae
The posterior portion is the thickest and called the splemum of (itrim longitudinal mediates) and two lateral longitudinal striae
the corpus callosum (splenium corpom callosi). It hangs freely over
S(Miic longitudinals
mediates
Radiaiio corporis
cattosi
j-i.ral;if
brl
745. Corpus callosum and radiation of corpus callosum (radiatio corporis callosi); superior aspect
{Part of the hemispheric matter is removed; the lateral longitudinal stria [stria langitudinalis Lateralis] is removed Oil the left,)
(striae longiludinaks lattralts) arc distinguished. Some of the grey gyrus (gyrus jasdolaris) which is continuous on the medial surface
matter of the anterior portion of the corpus callosum {mainly the of the hippoeampal gyrus with the dentate gyrus (gyrus dentatus).
medial longitudinal stria) is continuous in the region of the ros Besides the longitudinal striae there are also some transverse
trum with the paraterminal gyrus (gyrus pamtcrmintilis). \\\ the pos striae on the superior surface of the corpus callosum which are
terior portions the lateral longitudinal stria curves round the infe seen distinctly between the lateral and medial longitudinal striae.
rior surface of the splenium and continues here as the splenial The arrangement of the white matter of the hemispheres is de-
monstratcd oil a cross-section made on the level of the superior the occipital part, become thinner gradually and form the roof of
surface of the corpus collosum. It has a semioval outline in each the inferior and posterior horns of lateral ventricles (cornu inferius
hemisphere and is called the semioval centre (centrum stmiovale). et cornu posterius ventrkuli lateralis).
On the periphery the white matter is bordered by a layer of grey The fibres of the corpus callosurn passing through the rostrum
matter forming the cortex of the cerebrum (cortex cerebri). White and genu towards the frontal lobes, and those stretching posteri
fibres arising from the corpus callosurn diverge radially in the orly through the splenium towards the occipital and posterior
depth of each hemisphere to form the radiation of the corpus cal- parts of the parietal lobes are arched so that the concavity of one
losum (radiatio corporis calUsi) in which a frontal, parietal, temporal, arch faces the concavity ol'the other arch, thus forming the forceps
and occipital parts are distinguished corresponding lo the kibes of minor and the forceps major respectively (Fig. 745).
the cerebrum. The posterior portions of the radiation, mainly in
T H E LATERAL VENTRICLES
The lateral ventricles (venfriculi laterales) (Figs 74fi-750, rior surface of die anterior portion of the trunk of the corpus callo
752-75H) lie inside both hemispheres and are cavities originating surn superiorly, and the medial surface of the genu and rostrum of
from the vesicle of the telencephalon. the corpus callosurn anteriorly and infcriorly.
The left lateral ventricle (ventrkulus lateralis sinister) and the The right and left laminae form the septum lucidum (septum
right lateral ventricle (vmtriculus lateralis dexter) are distinguished. pdluddum). Between the laminae is a narrow slit-like cavity of the
Each is located in the corresponding hemisphere, the left one be septum lucidum (tavum. sepii pelluddi) which is seen distinctly after
ing conventionally considered the first and the right one, the sec removal of the corpus callosurn. Part of the septum to the front oT
ond ventricle. They are slit-like cavities lodged in the horizontal the anterior commissure (cvmmksura anterior) forms as the prccoin-
plane. The lateral ventricles have the following structures: (1) the missural septum (septum prtcommissuralt). The vein of the septum
anterior horn (cornu anterius); (2) the central part (pan ctntralis); lucidum (vena stpti pelluddi) runs in each lamina; it drains the ante
(3) the posterior horn (cornu posterius); (4) the inferior horn (cgrntt rior portions of the corpus callosurn, septum lucidum, and head of
mjerius). the caudate nucleus and empties into the internal cerebral vein
Each of these structures corresponds to one of the lobes of the (Hg. 757).
cerebral hemisphere. The anterior horn is lodged hi the frontal An oval interventricular foramen (foramen inierventriciilare) is
lobe and is the frontal part of the lateral ventricle; the central part found in the depths of the posterior parts of the medial wall of the
corresponds to the parietal lobe and is the parietal part of the la anterior horn between the thalamua and the anterior column of
teral ventricle; the posterior horn lies in the occipital lobe and is the fornix (columna fornids). By means of this foramen the cavity of
the occipital part of the lateral ventricle; the inferior horn is in the the lateral ventricle communicates with that of the third ventricle
temporal kibe and is the temporal part of the ventricle. (ventrkulus tertius).
The anterior horn of the lateral ventricle (comu (interim ventri- The anterior horn is continuous posteriorly with the central
euli lateralis) lies in the thickness of the frontal lobe. Its cavity is ac part of the lateral ventricle.
tually shaped like a horn bulging medially; on cross-section The ceulral part of the lateral ventricle (pars ctntralis ventrkuli
through the frontal lobe of the hemisphere the cavity is triangular. lateralis) Is located in the parietal lobe of the hemisphere. Its cavity
The superior and anterior walls of the anterior horn are formed by measures up to 4cm in length and 1.5 cm in width and extends
the anterior portions of the corpus callosurn — the frontal part of from the interventricular foramen to the site of origin of the poste
the radiation and the genu of the corpus callosurn. The lateral wall rior and inferior horns of the lateral ventricle. On coronal section
and part of the inferior wall are formed by the medial surface of it appears as a narrow, shallow slit.
the head of the caudate nucleus (caput nuclei caudati) bulging into The parietal part of the radiation of the corpus callosurn forms
the cavity. The head is continuous posteriorly with the body of the the upper wall, or roof of the cavity. The lower wall, or the floor is
caudate nucleus (corpus nuclei caudati) which lies in the central pan formed, counting from the lateral to the medial border, by the
of the lateral ventricle and is in turn continuous with the tail of the body of the caudate nucleus (corpus nuclei caudati), the stria semicir-
caudate nucleus (cauda nuclei caudati) which contributes to the for cularis (stria terminalis), and the thalamus, above which lies the thin
mation of the superior wall of the inferior horn (Fig. 755). lamina affixa and the corresponding part of the choroid plexus of
The fine lamina of the septum lucidum (lamina, septi pellucidi) the lateral ventricle (plexus dioroideus ventriatli lateralis).
(of which there are two, left and right) forms the medial wall of The lamina affixa is an embryonal remnant of the telence
each anterior horn. The lamina is located in the space bounded by phalon wall which is attached here to the superior wall of the di-
the anterior surface of the anterior columns of the fornix (calumiiae encephalon. The inferior surface of the lamina lies on the thala
fornids) and body of the fornix (corpus fernkis) posteriorly, the infe- mus, medially it has a thin curved plate called the taenia choroidea
Lobjs parietalis
Cornu anterias
Recessus supra pine alii veatrtcHlj laterals
Recessus piTieslls
Lobus occfpftsffs
l-obus frontalls
Korameri interveritrlculaK:
Cornu posteriu.
ventrfculi Merit is
entrtrulus tertlus
Lobjs teiTiporalts
F?st ijjJum
Cerebellum
Ventriciifiis ijuartus'
cuii lakralu) is a continuation of the central part and is located in cavity of the posterior horn is surrounded laterally and superiorly
the occipital lobe, Its cavity measuring 1.2-2.0 cm in length is very by fibres of the corpus callosum.
narrow and triangular on frontal section, and three walls can Posteriorly the posterior horn is bounded by the occipital lobe.
therefore be distinguished in it: a concave medial wall, a convex T h e inferior horn of the lateral ventricle (cernv inferitts ventTiculi
lateral wall, and a narrowest anterior, or dorsal wall; the posterior, lakralis) lies in the depths of the temporal lobe, close to its medial
narrowed end of the cavity is directed to the occipital pole. periphery. Its cavity, measuring 3-4 cm in length, curves down
T h e medial wall bears two longitudinal elevations lying one wards, forwards, and medially.
above the other. T h e upper one, the smallest, is often indistinct T h e anterior parts of the cavity end blindly, failing to reach the
and is called the b u l b of the posterior horn (bulbus cornus poslerioris). temporal pole and reaching only the uncus where the amygdaloid
It is formed by a bundle of fibres stretching from the corpus callo- nucleus (corpus amygduhideum} lies in front of the inferior horn in
sum to the occipital lobe along the floor of the paries-occipital the thickness of the cerebrum (see Fig. 762),
sulcus and contributing to the formation of the forceps major of Four walh delimiting the cavity or the inferior horn are de
the corpus callosum. T h e fibres of the trunk and elevation of the monstrated on a frontal section: the lateral wall, the roof, the floor,
corpus callosum making up the roof and lateral wall of the poste and uhe medial wall.
rior horn and the lateral wall of the inferior horn of the lateral ven T h e lateral wall and the roof are formed by fibres of the corpus
tricle form the tapetum.
callosum.
T h e lower elevation is larger and always distinctly seen. It is T h e floor is formed by a triangular, slightly elevated area called
called the calcar avis and corresponds to the calcarine sulcus (sul the collateral trigone (trigonum tollattraU) whose posterior part con
cus cakarinus) projecting into the wall of the posterior horn. T h e tinues into the cavity of the posterior horn. Anteriorly and laterally
Pofus Frontails
1
"V i Erorr^alla
superior
Cornu anterliis
feniricull lateralrs shllstrk
OyrMJ fruntalls
medium
Corns
iriferlus ventricull
lateralls. sinistri ■
IJTLIS preterit rahs
Bukcis c^ntTEJ]ii
Pars
cenlralis ventrl
later; !i'. slni;
-Gyres
postcenl rails
Aquaednciss ^J.obulu^
Ctrehri — ' parfetulla
inferior
Reoessus lateraHs
ventriculJ qiiarfi -
l-obulus parietalts
sujreff&t
VentrirrEilus quartiis
Corriu
jxisterlus van trie a
I a (era Ms sinlsitl-
Polus occipilahs
the trigone is continuous with an elongated collateral eminence Medially of the hippocampus, between it and the dentate gyms
(emincntia collateralu) resulting from projection of the collateral sul- is a narrow white strand fused with the hippocampus called the
cus (sulctis eollatcralif). fimbria (fimbria hippocampi). It is a continuation of the posterior
The medial wall of the inferior horn is formed by the hippocam column of the fornii (crus jornicU) which descends into the cavity
pus, an elevation bulging into its cavity. The elevation measures up of the inferior horn.
to 3 cm in length and forms due to projection of the hippocampal The choroid plexus of the lateral ventricle (pkxus ekoroideus utn-
sulcus (sulcus hippocampi) into the cavity of the inferior horn. The t-nculi lateralis) also takes part in the formation of the medial wall
hippocampus arises posteriorly in the posterior portion of the cen of the inferior horn. It passes into the inferior honi from the cen
tral part of the lateral ventricle, in front of the calcar avis, at the le tral part of the lateral ventricle which it penetrates through the in-
vel of the collateral trigone; it then stretches along the whole of the terventricular foramen. Running towards the posterior horn but
inferior horn as an arched elevation whose convexity faces the la not entering it, the choroid plexus forms an enlargement in the
teral wall. Its anterior, wider part bears three or four digit-like collateral irigone called the glomns chorioideum, and then passes
ridges, called pes hippocampi, which are separated by small interdi- into the cavity of the inferior hom to be attached there to the mar
gital grooves. The end of the hippocampus forms the uncus. gin of the fimbria of the hippocampus by an epithelial strip known
The most superficial layer of hippocampal tissue lying next to as the taenia of the fornix (tenia fornids).
the ependyma of the inferior horn forms the alvcus of the hippo A strip of the grey matter, the dentate gyrus (gyms dentatus) lies
campus (aheus hippocampi). outside the cavity of the inferior horn between the fimbria and the
C-UfpUS L.7jlt(i!sUm—^ Jj
G s p t l nuclei tandnti
Conui antsflus
vcnidcnli luteralis
Cms fornids
^'h'liTihria
hippocampi
Pts
llppocamp
G J T J S dentatus
-^Hippocampus
—Trl£<wum.
cnllaterale
-•Calcir avia
hnlbus c w n i i posterloris
Spkiiiinn'
corpora cilh>s
Sllltru-j calcsrinus onrips major
hippocampal sulqus. Its anterior end is continuous with the uncus, A frontal section through the posterior horn shows a thin plate
while its posterior end ascends and under die splenium of the cor- known as the reticular formation (formatio rdiadaris) (Fig. 755),
pus callosum forms a. grey splenial gyrus (gyrus fatdolaris). This gy- which covers the lateral surface of the hippocampal gyrus (gyrus
rus stretches to the superior surface of the corpus callosum and is parakippocamptdis) in the region of die hippocampal sulcus (sukus
continuous with the lateral longitudinal striae (striae langitudinales hippocampi).
lateraUs) of a thin layer of grey matter called the induseum gri-
sciini of die corpus callosum.
.Septum petluclduni
Lohus frontalts
Carpus inaraillare
Lobus temporal is __
Corpus fornicis
Fasciculus
mamillothafamlcus Ccwnmlssura
Fornicis
Splenium
corporis callosi -
1
obus occipitalis
J\ 7
751. Fomix and hippocampal commissure (commissura fornicis); inferior aspect viewed slightly
from the front (%).
(The inferior pails of the temporal and occipital lobes and the brain stem are removed.)
THE FORNfX
The fomix (Figs 751, 754-758; 764) is an arched and elon cerebrum it has the shape of a trihedral prism. Its superior surface
gated band composed almost entirely of longitudinal fibres. A fuses with the inferiur border of the septum lucidum and further
body (corpusfornicis), posterior columns (crurafornicis),and anterior with the inferior surface of the corpus callosum. At the lateral bor
columns (eokttmat famkis) are distinguished in it. der of the body of the Tomix lies the choroid plexus of die lateral
The middle, thickest part of the body of the fornbt (corpus forni ventricle whose epithelial layer fuses with the border to form the
cis) lies under the corpus callosura. On a frontal section of the taenia of the fomix (tenktfornich).The last-named descends along
Corpus callosum
Ventrlculus laleralis
(cormi anterlus)
/
t
__
Capaula exterrta
—Sulcus lateralis
x
Lohus ti'mporalls
A- cerebri anterior
Oaustrmn
the posterior column of the fornix into the inferior horn of the lat the laterally located hippocampus. T h e posterior columns are con
eral ventricle. The lateral surfaces of the body of the fornix are di nected by a thin triangular liippocauipal commissure (commissura
rected obliquely downwards and abut freely partly against the up fumkisj from the sites of tiieir divergence to the entry into the infe
per surfaces and partly against the medial superior borders of the rior horns. The apex of the triangle is directed forwards and the
thalami. The rounded inferior border of the body overlies the tela base backwards. T h e commissure is composed of transverse fibres
churioidea of the third ventricle (tela diorioidea ventrkuli tertii). which are seen distinctly at the base. It connects the right and left
The posterior part of the fornix is formed by the right and left hippocampus.
posterior columns (crura j'ornkis) which are fused with the inferior T h e anterior parts of the fornix slightly diverge forming an up
surface of the corpus callosum in their initial parts but do not ex ward convexity and are then continuous with the anterior columns
tend to the splenium. Behind the pulvinar (puhinar tkalami) they of the fornix (columnae fornicis). This segment is called the free part
curve laterally and downwards, diverge, and then, each enters the of the anterior columns. They are located behind the anterior com
inferior horn of the corresponding lateral ventricle. There each missure and above the anterior parts of the thalami, as a result of
posterior column stretches along the course of the hippocampus to which a crescent shaped slit, called the intervetitricular foramen
its uncus to be continuous with the fimbria of the hippocampus (foramen intewentriculare), forms between each anterior column of
(Jimbria hippocampi) between the medially lying dentate gyrus and the fornix and the thalamus. Each foramen transmits a vascular
plexus and connects the cavity of the third ventricle with that of T h e medial nucleus of the mamillary body gives origin to the
the respective lateral ventricle. nerve fibres which run into the depths of the thatamus as the main
Each anterior column curves behind the anterior commissure, bundle of the mamillary body. O n e part of the bundle, passing to
runs downwards, and plunges into the hypothalamus nearer to the the cells of the anterior nuclei of the thalamus, forms the mamilh]-
medial surface of the thalatnus, i.e. close to the cavity of the third thiilamic tract (jasticulits mamitlnthalamicu.f) (see Fig. 739); the other
ventricle. Alter that, each column enters the corresponding mamil part forms the mamillotegmental tract (fasciculus mamiltottgmenta-
lary body (corpus, mamillars), the medial nucleus of the mamillary lis), whose fibres end in the cells of the regmental nuclei (nuclei teg-
body (nucleus corporis mamillaris medialis). This segment is called the menti).
hidden part of the anterior column of the fornix.
T h e fornix extends, therefore, from the hippocampus to the
mamillary body.
■v Corpus callosum
Crus fornlcis
COTtimlssura ioniicis
M / Fasciculus mamillothaiamicus
/
Gyrus fasti oliiris^jS
Coinmissura anterior
Bulbus cotnu posierioris^jf
Colunina fornlds
^Corpus mamlllare
Calcar avIs-Vi JK.-Fimbria hippocampi
^ t ^-Unciis
Trlgonum coilsrersle-J
Flmbria hippocampi —
Ventriculus laterals (opened)
Gyrus d m tut us
Hippocampus^ 1 ^Sfcjiif.
^ G y t u s parahippocampalis
J
Pts hippocampi
THE DIENCEPHALON
The diencephaion (see Figs 723-729, 743, 758) develops from trudes freely into the cavity of the third ventricle and forms its la
the Forebrain (prosencephalon) whose anterior part gives rise to teral wall; this surface bears the hypothalamtc sulcus (salcus kypo-
the teleiicephaloti. The diencephaion comprises a number or com tkalamieus) separating the thalamus from the hypothalamus.
plex structures among which the hypothalamus, developing from The dorsal surface of the thalamus carries an anterior tubercle
its inferior wall, is plrylogeneticaily the oldest, whereas the paired (tuberculvm anterius thalami). Between the tubercle, and the corre
thalamus, forming from the lateral walls of the diencephaion, is sponding anterior column (columna fornicis) lies the interventricular
phylogenetically the newest. A ventral tha)amus (thalamus ventralh) foramen.
and a thicker dorsal thalamus (thalamus dorsalis) arc distinguished. A prominence, called the pulvinar, is found on the posterior
Besides, another two regions, also diencephaion derivatives, are re surface of the thalamus; lateral and slightly posterior to it are two
cognized in relation to the thalamus: the epi thalamus and the me- small eminences, the geniculate bodies (svrpoTa geniculata) which
tathalamus, are developmentally related to the metathalamus.
The cavity of the diencephaion is the third ventricle (vtntriatlus The corpus striatum is located laterally and slightly to the
lertittt) (see Figs 746-748, 758, 759). front of the thalami; it is bounded by a layer of the white matter
The thalamus is an egg-shaped structure containing many nuc called the internal capsule (capsula interim) (Fig. 760),
lei which are centres of efferent conduction pathways. As is men T h e superior surface of the thalamus is free and forms a por
tioned ahove, the thalamus develops from the lateral wall of the di tion of the floor of the central part of the lateral ventricle.
encephaion where die optic vesicles project, and is a complex T h e grey matter of the thalamus Forms nuclei (nucUi thalami)
combination of the white and grey matter. Its medial surface pro (Figs 759, 762, 763). These are as follows : (1) the anterior nuclei
Capsula extcrna
Clan strum
/ Nucleus jFntiioimls j ^ , ^ intern
—Thalamus
Tenla chorioidea-^
"-Formatio retitularls
Alveus-'
-SUIL-LIS collateral is
Cortex cwebri
^ubstantia alba
755. Inferior horn of right lateral ventricle (cornu inferius ventricull lateralis); posterior aspect
(Frontal section; pia mater of the brain is shown red, the ependyma U shown blue.)
of the thalamus (nuclei anteriores thalami) located in the anterior tu leus (nucleus ventralis posterolateralis) and the posteromedial ventral
bercle (tuberculum anterius thalami): diey are represented by (a) the nucleus (nucleus ventralis posteromediatis); (4) the intralaminar nuclei
anterodorsal nucleus (nucleus anterodorsalis), (b) the anteroventra! of the thalamus (nuclei intrahminares thalami) which are small struc
nucleus (nucleus anteroveniratis), and (c) the anteromedial nucleus tures lodged in the medullary laminae oF the thalamus; they in
(nucleus anttromtdialis); (2) the medial nuclei of the thalamus (nuclei clude (a) the central median nucleus (nucleus centromedianus),
mediates thalami) Found at the medial surface of the thalamus in (b) the paracentral nucleus (nucleus paracentralis), (c) the parafasci-
cluding: (a) the anterior and posterior paraventricular nuclei (nuc eular nucleus (nucleus parnfaseicufaris), (d) the central lateral nuc
lei parasentriculares anteriores et posteriores) (b) the rhomboid nucleus leus (nucleus centralis lateralis), and (e) the central medial nucleus
(nucleus rkombaidalis), (c) the reunietis nucleus, and (d) the dorsal (nucleus centralis medialis); (5) the posterior nuclei of the thalamus
medial nucleus (nucleus medialis dorsalis) which lies separately; (nuclei posteriores thalami) located in the pulvinar; (6) the subthal-
(3) the ventrolateral nuclei of the thalamus which are largest and ainic nucleus (nucleus subihalamicus) which lies in the lower part of
located laterally to the anterior and medial nuclei and are as fol the anterior thalamus and is a collection of grey matter pierced by
lows: (a) the posterior lateral nucleus (nucleus lateralis posterior), fibres; (7) the reticular nuclei of the thalamus (nuclei reticulares thai-
(b) the dorsal lateral nucleus (nucleus lateralis dorsalis), (c) the ante ami) located in the anterior thalamus; (8) the zona incetta which
rior ventral nucleus (nucleus centralis anterior), (d) the lateral ventral lies in the anterior thalamus next to the reticular nuclei.
nucleus (nucleus ventralis lateralis), (e) the medial ventral nucleus All the main nuclei listed above, except for the nuclei in the
(nucleus ventralis medialis), and (f) the posterior ventral nuclei (nuclei pulvinar, are separated from one another and divided into smaller
ventrnUs posteriores) represented by the poslerolateral ventral nuc nuclei by medullary laminae. An external medullary lamina of the
^Pltxwi thorloldeus
cntrK'ulL lattiralis
Stria termlngiis
Cavern sept] pellucidi~
Curpus f o r n i c l s ^
~*SpleniLini
Comu interlus
ventricuil lateralls'
Crus Fomicis/
thalamus (lamina medullaris lakralis tkalami) and an internal m e d the h a b e n u l a r commissure (comrnissnra habeiudarum), is separated
ullary lamina of ihe thalamus (lamina mediillaris medialis tkalami) from the superior quadrigcminal bodies by the h a b e n u l a r sulcus
are distinguished. (minis haknulae), and contains in its depths the medial and lateral
T h e epithalamus consists of the following structures: (a) i h e nuclei {nuclei habenalae medialis et lateralis); (c) the epithalamic
pineal body (corpus pinealis) which is an endocrine (ductless) gland (posterior) commissure (commissitra epitkalamica s. postfrior). These
developing from the posterior area of the roof of the dieiicephalon; structures contribute to the formation of the walls of t h e third ven
(b) the habenula, which consists of t h e trigonuin hahenulae a n d tricle.
X a v u m scpti pellucitti
.•Septum ptlEutlJum
^^.--Coirnu antcrius
k ventrlculi latErslis
Corpus striatum
(caput nuclei csudatl)
Plexus churioidcus
v-.ijtri'. IIIL laterally
--V, diurioideo
Tela choriaitk.
vctitnrull tertil _ H
R - - Pcs hippocampi
V. [hulamoilriiita J M
V. cefebri mag
""^TrlguHUiTi collateral
""•Caksr avi*
757. Lateral ventricles (ventriculi laterales) and tela chorioidea of the third ventricle (tela ckoroidea
veniriculi tertii); superior aspect (%).
(The corpus callosum and body of the Fornix are divided and reflected to the back.)
T h e metathalamus is made u p oF paired structures, the medial bodies (corpora mamillarid), each containing two collections of grey
geniculate body (corpus geniculaium tmdiale) and the lateral genicu matter. O n e collection lies medially and is called the medial nuc
late body (corpus genitulatum lattrate). These are elongated oval ele leus of the mamillary body (nucleus medialis corporis mamillaris); the
vations lying inferoiateral to the pulviuar, Each geniculate body other is smaller, lies laterally, and is called the lateral nucleus of
contains a collection of grey matter forming the nucleus of the me the mamillary body (nucleus lateralis corporis matnilluris). Most of the
dial geniculate body (nucleus corporis geniatlati medialis) and the nuc fibres of the fornix end in them.
leus uf the lateral geniculate body (nucleus corporis geniculati latera- T h e subthalamie nucleus (nucleus sabthalamicus) (Figs 759, 7til)
Us). These nuclei have dorsal parts (paries dorsales) lying in the is also related to this area; this is a collection of grey matter
metathalamus, and ventral parts (paries ventrales) located in die an pierced by fibres and located in the posteroinfeiior parts.
terior thalamus. Besides, the hypothalamus contains a collection of 32 pairs of
T h e hypothalamus corresponds in position to the anteroinfe- nuclei which are subdivided into anterior, medial, and posterior
rior area of the diencephalon and lies below the thalamus under groups. Some of them are connected with the hypophysis cerebri.
the hypothalamic sulcus (Figs 764, 765), Some of its structures can The nuclei of these groups correlate the parasympathetic and sym
also be seen on the inferior aspect of the cerebrum between its pe pathetic functions. The Following nuclei are distinguished: the su-
duncles, in Front of the pons. This area includes the mamillary praopdc nucleus (nucleus supraopticus), the paraventricular nucleus
Carpus calltjsuin
f Colt!tilnae famid5
Commissure anEerfoiv
Caininissura posterior
Commlssura habenularum^
Ventriculus tertlus
Pes hlppSKffl
-■Stria termirtalis
Lamina affisa
Gyrus dentatus
-Hippocampus
-Flmbria
tiippocampi
Tenla fornicls
Cornu posterius
'-■'■v. !■ I!I lateralis
Cakar avis
Trlgotium haben
Stria tenninalis
Caput nudei can da I K
,Lamina affixa
^.,^-Nu-fcus anterior
Tela thorloidea
ventrlculi t*;rtr* — — — ^•-■Nucleus rtiedialis ■ Thalamns
Tenla ilialaml - — * j L ^ N u c l e u s lateralls
Pies us ctK>rio1(]«us_
veritric-uli. tertll
Claustrurri^—~
•V^-Adhesro interrhatamica
Fasciculus
mami llo(haldiTiic:LE5
Capsula esterna -
£ , - Surjstantia nlgra
Nucleus f ftrfauttof
lentlformls j Olphtis '
1- paltidns ,Jj
-'PeduncLlus terebri
Lamina medullary
Fossa interpeduncularis
G U M fnferins
ventrlculi lak'falis
ot'ulomolorius
PiMta cliojfoldei...
ventrlcuJ; lateralls paraliipp'ocampalis
TradgK opttcus )
NasJei carports mamllTarii
Ventrlt'ujus Itrtlus
759. Third ventricle (ventrkulus tertius), dorsal part; anterior aspect (%).
(Frontal section of cerebrum through the connexus m t e r d i a l a m k u s and mamillary bodies,)
(nucleusparavetitriatlaris), the iuferomedial nucleus (nucleus inferome- formed by the walls of the tuber cinereum, and the hypophysis
dialis), the sup era medial nucleus (nucleus superomedialvi)^ the poste cerebri (see The Dudleys Glands and The Inferior Surface of the Cere-
rior nucleus (nucleus posterior), the tuberal nuclei (nuclei tuberales), brat Hemispheres). T h e optic chiasma (chiasma oplicum) with the op
and the subthalamic nucleus (nucleus subthalamicus) (Figs 759, 765). tic tracts (tmctus optici) (see The Inferior Surface of the Cerebral Hemi
T h e optic part of the hypothalamus includes the tuber ciner- spheres and Sites of Exit cf Twelve Pairs of Cranial Nerves and The
eum, the infundibulum which is the narrowest part of the cavity Third Ventricle) are related to this part of the hypothalamus.
T h e third ventricle (oentrkulus tertius) (see Figs 7 4 6 - 7 4 8 , 758, tricuiar foramina (foramina interventriadaria.) located anteriorly,
759) is unpaired. Its slit-like cavity lies in the median sagittal plane avid with the fourth ventricle by means of the aqueduct of the mid-
and communicates with the lateral ventricles through the interven- brain (aquedudus cerebri) (Fig, 764).
Flssura l o n g i t u d i n a l s cerebri
Cormi anterius ventrieull laleralts ^Genu corporls callosi
C a v n m sepU pellucidl
Columns i o r n i
Capsula interna
(cms ;iiif:-| lus .
Ventriculus l e r t i u \
Capsula exlerna
Fasciculus
ma m i I lol hal a m 5 c ns
Clan strum
Pulamen
ubiiii pallldus
Lamina
Capsula Interna —medullarls
(crus postcrlus )■
lateral Is
■Trialamiis
Fimuria
hippocampi
Cautla
rcjdei Csiictsil
Hippocampus
Fastlculus
lurigitudJntlls Inferioi
^](jrnii posterEus
ventrjculi lateralCs
Rarlislio optics*
Commissnra [ocnfci*
Sulcus cakarinus
CoimntSsura arlteHory
Fasciculus
mamiHotliaJamicHs
Insuia\
Capsula exten
Cruj posterius
cipsulae Internae
Nucleus
siibtSslainicm
Te^mEntui
Aquseductuf
terebri —
Corpus
genicuJatutn
medltil-e
-Nucleus rubsr
Hippocampus
Piilvir
Radlatto
aptica
^Ciornii poster! us
ventricall latEralis
Fimbrla lilppnca
^Tsctetn mewnceptiali
The cavity of the third ventricle is limited by six walls: superior plexus is covered ventrally, i.e. from the aspect or the cavity of the
(roof), anterior, inferior (floor), posterior, and two lateral walls. third ventricle, by ependyma forming the lamina epitheliali_<i chor
The roof of the third ventricle, the tda chorioidea of the third ioidea of the third ventricle. On removal of this lamina the cavity
ventricle (tela chorioidea ventriculi iertii) (Fig. 757), consists of two of the third ventricle is opened. Thus, the lamina epithelialis chor-
layers - a superior, dorsal layer lying under the fornix and the cor ioidea serves directly as the roof of the ventricle. Dorsal to it are
pus cailosum, and an inferior, ventral layer facing the cavity of the the choroid plexus of the third ventricle, then the tela chorioidea
ventricle. Between the layers is loose connective tissue in which of the third ventricle, still higher the fornix and, finally, the corpus
two internal cerebral veins (venae eerebri inttmae) pass on both sides cailosum. When the choroid plexus of the third ventricle is re
of the midline. They drain blood from the veins of the thalamus moved, a transverse depression tan be seen between the splenium
and corpus strratum (venue thalamostriatae), the veins of the septum of the corpus cailosum and the junction of the roof of the third
lucidum (venae septiptUucidi), the veins of the choroid plexus (venae ventricle with the tectum; this is the transverse fissure of the cere
chorioideae), and the lateral ventricles and empty into the great cere brum (fismra trattwersa cerebri).
bral vein (vena eerebri magtiit). The tela chorioidea of the third ven The lateral walls are formed by the medial surfaces of the thai-
tricle, lying under the forntx, is continuous laterally with the supe ami between which, in the median areas, is the connexus interthal-
rior portion of the choroid plexus of the lateral ventricle. Villi atnicus (adhtsia interthalamica). On the thalamus itself are distin
project from the ventral layer into the cavity of the third ventricle guished an anterior part bearing the anterior tubercle of the
to form the choroid plexus of the third ventricle (plexus chorioidem ventri
thalamus (tttberailum anterius tknlami), and a posterior, considerably
culi tertiij. In the anterior parts it is continuous with the plexus of thickened part called the pulvinar which covers partly the lateral
both lateral ventricles. One plexus is continuous with the other at surfaces of the anterior portions of the tectum of the mid-brain.
each interventricula.r foramen. The interventricular foramen forms between the anterior tubercle
Like the tela chorioidea of the third ventricle, the choroid of each thalamus and the anterior columns of the fornix.
Flssura l o n g i t u d h a l l s cerebri
Oyni5 cinguli Corpus callosutn
Septum p t l l u c l d u m
Corpus fnrnicts Radiatio corporis catlosl
^Venlrtculus lateralis
Plesus claorioicieus
Adhesio intertliaLaniiea
ventficuJi laterals x
Capsula intern a
Capsula esterna
Can da nuclei t a u d a l i
Nucleus anterior
tlialam!
Nucleus medlallSh
thaiainl
Nucleus lentif&fmls
.Nucleus
suKhilamicus
—Substantla nigra
N u c l t u s laterals
ihalami
Cornu lnferius -
ventriuuli lateraiis ^edunenlus t-erebrl
B ~ - Peduncular CKrebcLlirli
twdba
Henus c h « t t f k k u 5 / N V B i ^ ?
ventrlcull quartl cochlearls / , | I ucleus olivarls
porpjs formers
TruntuE corporis call™i. Teia ehorloidea vcntricuH lertii
Colurniu fornkis
Lamina sg|
pellucid!
Velum (ucduHire
super IJS
Commissure iintLTi^T
II? quartus
Lamina rerralnalls*'
Adhesio interthalamka y
Tuber cluweufrK
• ' i. ; ~~i
Corpus [TK'dullare vermin
/1 > .' I i i t cerebelll
Cbiasma o p t l c u m ' t f I I j 1 '
1 1
> ' ! i
/ / ' ! I I i
Kctussus opticus' / ' i i ! i
/ f ! i I '
j
Recfssijs inFuradibutr f i t t
lnluiKHbuluiii' ' ' I t I
Pfetus i-horloldeus verilriculi quart.
Hypaphysls I /j t! ! .
"I'hfiSiirnu.s
I
^Medulla oWottgnU
Suldft hyputhalamfcus j ^ gcftltifnoMni
Co-TfHi? m-amlllurc'
Vertical b u n d l e s of periventricular fibres (fibres perivmtriculares) T h e stria habenularis becomes wider posteriorly to form a
stretch u n d e r the ependyma of the lateral wall of the third ventri small triangular area called t h e t r i g o n u m h a b e n u l a c . R u n n i n g to
cle. They connect die medial group of thslamic nuclei with the hy- t h e middle, t h e trigonum is continuous with a narrow b a n d of
pothalamic nuclei. white matter, t h e habenula, which joins the contralatcral h a b e n u l a
T h e dorsal surface of t h e thalamus is covered by a d i m layer of t o form t h e h a b e n u l a r commissure (cfimmiauTa hahesiularwm,)
white m a t t e r Forming the stratum zonale. A narrow b a u d called (Fig. 758). T h e groove separating t h e trigonum habenulac and the
t h e stria h a b e n u l a r i s of t h e t h a l a m u s (stria medutiaris thalami) runs dorso-rnedial surface or t h e pulvinar of t h e posterior thalamus is
along the j u n c t i o n of t h e dorsal a n d medial surfaces. It is b o u n d e d designated the sulcus h a b e n u l a c .
medially by the lamina epithclialis of the third ventricle. A In the trigonum habenulac is a collection of grey matter, t h e
notched border called t h e taenia of the t h a l a m u s ftenia tkalami) re h a b e n u l a r nucleus (nucleus kabcnulae), in whose cells most of the
mains after removal of the lamina epithclialis and die choroid fibres of the stria habenularis (medullaris) end. T h e lesser p a r t of
plexus. t h e fibres passes through the h a b e n u l a r commissure, some of them
Nucleus *uprar>p(jcus.
Chiasma opticura
N. oculomotorius
Tcgmentutn
. . - N u c l e u s ruber
-SubsUntia nigm
Crus cerebri
uniting with the cells of the cOntralateral habenular nucleus, and T h e fornix, its anterior columns, and the anterior commissure
others stretching to the superior quadrigeminal body (collicuhis su adjoining the posterior surface of the lamina terminalis limit ante
perior tecti mesencepkali) of the other side. riorly (he cavity of the third ventricle. T h e interior commissure is
T h e main part of the fibres from the habenular nuclei r u n in a cylindrical bundle of transverse fibres stretching from one cere
the habenulo-interpeduncular tract (tractus kahmulointtrptdunaila- bral hemisphere to the other; only its small middle segment lies at
ris) stretching dorsoventrally to the interpeduncular nucleus (nuc the anterior wall of the third ventricle, while the larger segment,
leus inhrpeduticuiaris) which lies close to the basal surface of the an stretching posteriorly, enters the frontal lobe and reaches its cor
terior perforated substance. tex. Two parts are distinguished in the anterior commissure: the
T h e plueal body (corpus pineaU) is attached to the posterior sur olfactory part (pars anterior) whose fibres connect the cortical cells
face of the habenular commissure (Figs 758, 764, 773); between of both olfactory lobes, and Lite posterior, or interhemispheric, bet
the pineal body and the commissure is the suprapineal recess frt- ter developed part (parsposterior) whose fibres connect the cortical
cesssis siiprapinealis), and below the commissure is the pineal recess cells of the parahippocampal gyri of both hemispheres.
(recessns pinealis) opening into the cavity of the third ventricle, T h e Ventral to the posterior commissure lies a collection of special
pineal body itself, lying between the superior colliculi of the tec- ized ependymal cells called tanycytes, They accomplish a secretory
tuin of the mid-brain, is completely surrounded by the choroid function and take part in the transport of hormonal and mediator
plexus extending from the third ventricle. T h e choroid plexus substances from the neighboring tissue and the cerebrospinal
should be removed with care during dissection so as not to tear fluid. This area of the ependyma of the third ventricle is known as
away the pineal body (see The Endocrine Glands). the ofgiiuum Subcommissurale.
Section through the middle of the cavity of the third ventricle A small triangular depression is found between the diverging
(see Fig. 764) shows the hypothalamic suicus (sulats hypoihalamieus) anterior columns of the fornix and the anterior commissure. It also
lying on the medial surface of the thalamus and stretching from contains a collection of specialized ependymal cells forming; the
the entry into the aqueduct to the interventricular foramen. It sep orgatium suhfornicale. Below the commissure is the lamina termi
arates the thalamus from the hypothalamus. nalis {see Fig, 764) which forms the anterior wall of the third ven-
us pyramldalis(fibrae
icospl nates et rorticu-
nucleares)
Ptdunculus eerebrl
Pedunculus cerebellaris A
medius
Pons
radix
N. Irrgtf-| sensoria
minus I radix / leus basilaiis
motor ia
N. intermedfus f
f—* — N, vestibulncochleans
-N. glossopharynjrt'us
■—'PyramJs
S
Hssura mediana (anterior) N . accessorius
N. hypoglossun
Decwratto pyranikium —
Nucleus n. hypoglossi
Fasciculus lungitudlnslis nicdlalis S
. Pormatio rt-tlcularis
Nucleus tractus spinalts
a. trigemlnl
Nucleus amhlguiis
Pedunculus cerebetlaris
inferior
Nucleus ollvarls
accessorlus dorsalis Tractus olivocerebellaris
Tradus rubrospinalls «, Nucleus ollvarls accessurius
Tractus tectospfnalls —— mediaHs
Tractus
— jL ^-Nucleus olivaris
spi n ocerebel lari s anterior ■f
Hitus nuclei ollvarls — — N . vagus
Raphe
OHvaJ^-.
—N. accessorlus
N. hypoglossHS
Pyramis
768. Medulla oblongata; superoanterior view slightly from the front (semischematical
representation).
(Horizontal section at the level of the olive foUvaj.)
tricle; the optic recess (recessvs option) is located at the inferior mar postoptic commissures {commusurae svpraopticae dorsalis et omtralis).
gin of the lamina termhialis where it adjoins the optic chiasma; Strictly speaking, the fibres are not commissures but decussations;
d u r i n g early development of the brain it is the end part of the neu they connect the medial geniculate bodies and ensure the trans
ral tube cavity. mission of signals from the retina to the hypothalamic nuclei,
T h e floor of the tilird ventricle is formed by structures indi which is important for biorhythm regulation.
cated in the description of the base of the brain (see Figs741-743). T o the back of the corpus cinereum are the mamillary bodies,
Here we shall simply list them. From front to back is the optic chi and posteriorly to them are the cerebral peduncles with the poste
asma to the back of which is the luher rlnereum. T h e tuber ciner- rior perforated substance lodged between them.
c u m is continuous downwards with the infundibulum whose cavity T h e posterior commissure (commissura posterior) forms the bulk
forms the infundibular recess. T h e infundibulum is joined to the of the posterior wall ol the third ventricle. It is a curved plate bulg
hypophysis (see The Endocrine Glands). ing into the cavity of the ventricle and is made up of transverse
Bundles of fibres which are not related to the optic nerves pass fibres. Below it is the entry into the aqueduct, above is the pineal
dorsally arid in the optic chiasma; these are the dorsal and ventral recess, and still higher is the habenular commissure (Fig.758).
T H E BASAL N U C L E I O F T H E T E L E N C E P H A L O N
THE MID-BRAIN
T h e mid-brain (mesencephalon) develops from the middle cere
T h e following structures are distinguished on the dorsal sur
bral vesicle (Figs 722-729) and corresponds on the dorsal surface
face of the mid-brain: (a) the tectal lamina (lamina tecti); (b) the in
to an area of the brain stem bounded by the base of the pineal
ferior and superior brachia (brachia collicvli superitiris el calliculi infe-
body (or the level of the posterior commissure) anteriorly and by
rioris). O n the ventral surface are: (c) the cerebral peduncles
the anterior margin of the superior medullary velum (or the site of
(pedunculi cerebri) and (d) the posterior perforated substance fab-
exit of the trochlear nerves) posteriorly. O n the ventral surface the
stantiu perforata posterior).
mesencephalon corresponds to the posterior surface of the mancil
lary bodies anteriorly and the anterior margin of the pons posteri T h e cavity of the mesencephalon is the aqueduct of the mid-
orly. brain (aquaedudus cerebri); it connects the cavity of the third ventri
cle with that of (he fourth ventricle.
T H E TECTUM O F T H E MID-BRAIN
T h e quadrigeminal bodies are limited by a transverse groove quadrigeminal body (nucleus colliatli inferioris). Several systems of
separating them into two, right and left, superior quadrigeminal conduction pathways end and arise in the cells of these collections.
bodies (cotticuli superiors) and two smaller, also right and left, infe Ventral to the grey matter is a deep white layer.
rior quadrigeminai bodies (coltkuls mferiores). A bundle of fibres connecting both inferior bodies form the
T h e splenium of the corpus callosum overhangs the tectal lam commissure of the inferior quadrigerainal bodies (commissure, colli-
ina and both are covered dorsalty and laterally by the correspond culorum inferiorum). A commissure of the superior quadrigeminal
ing areas of the cerebral hemispheres. bodies (comrnissura colliculorum superiorum) can also be traced be
T h e pineal body lies partly above the superior quadrigeminal tween the superior bodies.
bodies and partly between them. T h e anterior surface of the cere T h e zone of the junction of the mesencephalon and the dience-
bellum stretches above the inferior quadrigeminal bodies. phalon is called the pretectal area (area pretecfalis). It contains col
T h e quadrigeminal bodies, just like the whole tectal lamina, lections oTgrey matter, the pretectal nuclei (nucleiprtiedales), which
are enclosed in a thiti layer of the white matter. In their depths is a have two-way connections with the superior quadrigeminal bodies
collection of the grey matter. In the superior body it is called the and the parasympathetic nuclei of the oculomotor nerves. T h e
nucleus of the superior quadrigeminal bndy (stratum griseum colli- two-way character of these connections ensures the coordinated
cuU superioris), and in the inferior—the nucleus of the inferior reaction of both pupils to exposure of the retina of o n e eye to light.
White ridges stretch laterally from each quadrigeminal body. late body, partly passes into the thalamus and partly is continuous
T h e one arising from the inferior body is much thicker. These aie with the lateral root of the optic tract. The inferior brachium
called the superior brachium (brachium coUiculi superiors) and the passes u n d e r the medial geniculate body and fades in it, while the
inferior b r a c h i u m (brachium cdliculi inferioris) {Figs 769, 774). body itself gives rise to a bundle which is continuous with the me
Both brachia reach the elevations formed by the geniculate dial root of the optic tract.
bodies which belong to die iiietathalamus of the diencephalou. T h e optic tract (Iraclus option) by-passes the cervical peduncles,
O n e of the elevations, the medial geniculate body (corpus genicula- approaches the geniculate bodies, and divides into two bundles—a
tum mediate) lies medially, nearer to the cerebral peduncle, the thicker lateral root of the optic tract (radix laterals tractus optici)
other, the lateral geniculate body (corpus geniculatum Uteralc) is lo r u n n i n g to the lateral geniculate body, and a thinner medial root
cated laterally. Both are under the pulvinar of the thalamus and of the optic tract (radix medialis tracius optici) which fades in the m e
are separated from it and from one another by a groove. dial geniculate body.
T h e superior brachium inns between the thalamic pulvinar These roots, just like the optic tract, belong to die optic part of
and the medial geniculate body to the region of the lateral genicu the hypothalamus of the dieucephalon.
T h e cerebral peduncles (pcdunculi cerebri) and the posterior per T h e posterior part of the cerebral peduncles stretches from the
forated substance (substantia perforattt posterior) arc located on the substautia nigra to the aqueduct of the mid-brain and contains the
inferior surface of the brain (see Fig. 741). nuclei of the crania! nerves, collections of reticular formation neu
O n transverse sections of the cerebral peduncles made through rons, and longitudinal bundles of fibres.
different levels, an anterior part (pars ventralis) and a posterior part T h e substantia nigra is rich in pigment; it is crescent-shaped
(pars dorsalis) can be distinguished; the substautia nigra lies at their with its convexity directed towards the anterior part of the cerebral
junction. peduncles. A dorsal compact part (pars cntnpacta) and a ventral reti
T h e anterior part of the cerebral peduncles is crescent-shaped cular part (pars reticularis) are distinguished.
and contains longitudinal bundles of fibres: the cerebrospimll and T h e decussations of the tegtnentum (dtamaliones tegmenti)
c o r t k o n u c l e a r fibres {fibrae corttcospinaUs et corticonudeares) which formed by the intercrossing fibres of the rubrospinal and tectospi-
occupy the middle two-thirds of this part oT the cerebral pedun nal tracta (tractus rubrospmalis et tectosjdnalis) are also components
cles, and the cerebropontine fibres (fibrae cortkvpontinae). of the posterior part of the cerebral peduncles.
(CQ1I1CU]U5 superior j
; Tectum mesencephali
iColliculus Inferior I
Frenulum veli meduUaris pup^rioris I i
I F . . .
... .. „, „ . ■ ', - t i Brachium colliculi infenons
Brach um colliculi S U p e r ! o n s ^ ^ ^ ^ | \ ( i
N. trochleariO
—Lfngula cerebelli
^PetJunculii^ cerebellaris
iiledius
-Flocculus cerebelli
Fasciculus gracills
Sulcus inettianus (posterior)
769. Fourth ventricle (ventriculus quartus) and its tela chorioidea (tela chorioidea ventriculi quarti);
superoposterior view (%).
(The whole cerebellum is removed; the middle eerebellar peduncles are partly removed; the tela chorioidea of the foarth ventricle is
coloured violet.)
tal lamina to the cerebellum; these are the superior cerebellar pe
Another structure of the mesencephalon, the tectal lamina
duncles fadtmadi cerebdlares supenores) (Figs 769. 770, 781). These
(lamina tetti), lies above the tegmentum. In the middle, on the line
are derivatives of the isthmus rhombcncephali. The fibres of each
conventionally separating the right and left quadrigeinmal bodies,
peduncle arise in the cerebellar nuclei and run to the tectum of the
is the opening of the aqueduct of the mid-brain (aquaedvctits cerebri)
mid-brain to embrace the superior medullary velum (velum mtdul-
by means of which the third ventricle communicates with the
lart supenus). After that the fibres stretch ventrally of the aqueduct
fourth ventricle.
and the central grey matter (sufctantia gnsett centralis), cross to form
Two slightly compressed cylindrical bands stretch from the tec
the decussation of t h e superior cerebellar peduncles (decussatio pe- the vestibular nuclei to t h e nuclei of t h e third, fourth, and sixth
dvnailorum cerehellarium superitxrum), after which most of them termi pairs of cranial nerves. These structures are also connected with
nate in the red nucleus (nucleus tuber) to form the cerebellorubral the motor-neurons of the anterior grey columns of the superior cer
tract; the remaining lesser part of the fibres penetrate the red nuc vical segments of the spinal cord which innervate the muscles of
leus a n d run to the thalamus as the cerebellotbalamic tract. the neck. T h e fibres of the medial longitudinal bundle arc respon
W i t h i n the red nucleus a rostrally lying parvocelluiar part (pars sible for the coordinated movements of the head and eyeballs.
parvocellularis) and a caudally located magnocellular part (pars mag- Longitudinal fibres of t h e dorsal longitudinal bundle (fasciculus
ncicellularis) are distinguished. longitudinalis dorsalis) stretch ventrolateral to the aqueduct of t h e
In front of the red nucleus, level with the cranial end of the mid-brain. They connect t h e thalamus and hypothalamus with the
aqueduct, ties the interstitial nucleus (nttcUuS mterstitialis). Most of brain stem nuclei.
the fibres of t h e medial longitudinal bundle of t h e mid-brain (fasci Rostral to the red nucleus, in the region of the ventral margin
culus longitudinalis medialis) originate in the neurons of this nucleus. of t h e internal capsule, a collection of neurons lies along the dis
T h e bundle extends along the entire length of the brain stem para- tribution of a loop-like structure, the ansa lenticnlaris; the collec
medial ly. It contains fibres connecting the nuclei of the oculomo tion forms the enlopeduncular nucleus (nucleus eittopeduncularis), or
tor, trochlear, and abducent nerves, as well as fibres running from the nucleus of ansa lenticularis (nucleus ansue leniicu.la.ris).
Colliculus superior
f \ TeclLiin mesencephah
/ .Colliculus inferior
^ N . (mchlearis
Velum mediilEare^'3JB^_
super ius
Sulcus medianus
^Fovea .superior
Locus cerukus
Pedunculus cere be I Colliculus facia lis
superior
Peduncular
cerebellaris medium
t -VII
3—-— N- intermorfius
Plexus chorioideus
ventrtculi quarti
(reflected)
^-Fasciculus gracilis
Nuclei vesttbulare'
EmlnerHia medialls— Nuclei n. vestibulo-
coehlearis
Peiluncuhis eerebellaris Nuclei cochleares
superior
Colliculus facialas—i
Pedunculus eerebellaris / , N. facialis
mediui
Fasciculus gracili
Sulcus medianus{poster 10
771. Nuclei of cranial nerves (nuclei nervorum cerebralium) in the region of the mid-brain and hind-
brain (semischematical representation).
(Projection of the nuclei on the posterior aspect.)
THE HIND-BRAIN
THE PONS
T h e p o n s is a derivative of the hind-brain proper (metencepk- run to the points at which the facial nerve (nervus fadalis) and the
alon). It is a large almost four-sided white ridge lying to the back of auditory nerve (nernus vedibulacochlearis) emerge.
the centre of the base of the brain. It is sharply delimited from the T h e longitudinal bundles of the pons (fasciculi longitudinales
cerebral peduncles anteriorly and From the medulla oblongata pos pontis) belong to the system of the pyramidal tracts and pass be
teriorly (see Figs 743, 764, 767). tween the transverse bundles but medial to the oblique bundle.
A longitudinal line drawn through the points of emergence of They arise from the cells of the cerebral cortex, pass in the internal
the roots of the trigeminal nerve (nermt trigeminus) (fifth pair of capsule to enter the cerebral peduncle through the pons, and run
cranial nerves) and the facial nerve (nerotts fadalis) (seventh pair of into the medulla oblongata as components of the cmrtieonuclear
cranial nerves) is accepted as the lateral boundary of die pons. T h e tract (tradus corticonudearis) and then to the spinal cord as compo
middle cerebellar peduncle (pedunadus ccrebellaris medius) lies lat nents of the cerebrospinal tract (tmdus cortkospinaUs) (Figs 763,
eral to this line. 767).
T h e pons is therefore connected to the cerebellum by the right T h e reticular formation (formalin reticularis) is detected for the
and left middle cerebellar peduncles. whole length of the tegmentum of the pons and is directly continu
Lying on the clivus of the skull, the pons is directed rather o b ous with the reticular formation of the medulla oblongata and that
liquely, descending from front t o back. As a result a ventral (ante of the mid-brain.
rior) part (pars anterior) and a dorsal (posterior) part (pars posferitrr) T h e central stalk of the tegmentum formed by collections of
are distinguished. T h e ventral part lies on the base of the skull, the reticular neurons and their processes is called die median raphe of
dorsal part contributes to the formation of the anterior portions of the pons (raphe pontis).
the floor of the fourth ventricle (fossa rhomboidea) (see The Fourth Small collections of the grey matter lie in the depths of the
Ventricle). ventral part of the pons; these are the nuclei pontis (proper). Fi
A longitudinal basilar sulcus (sulats laiilaris) lodging the basi- bres arising in the cells of the cerebral cortex and forming the
lar artery (arteria basilaris) stretches on the midline of the bulging cerebropontine tract (tractus corticapontinus) terminate in the cells of
anterior surface of the pons. T o either side of the sulcus is a well these nuclei. The same cells give rise to fibres which intercross with
- pronounced elongated pyramidal eminence in whose depths the the fibres of the contralateral side and form the pontocerebellar
pyramidal tract passes. tract which stretches in die middle cerebellar peduncle to the cor
T h e anterior surface of the pons bears slriations formed by tex of the cerebellum.
bundles of nerve fibres (Kg- 767). At the junction of the ventral and dorsal parts of the pons is a
T h e arrangement of bundles of nerve fibres and collections of bundle of transverse fibres furmiug the corpus trapezoideum.
the grey matter (nerve cells) are demonstrated on frontal sections These Iibres arise from the cells of the ventral cothlcar nucleus
of the pons made through various levels. (nucleus cochkans ventralis), and some of t h e m reach the ventral nuc
T h e ventral part of the pons (pars anterior pontis) is thicker and leus of the corpus trapezoideum (nudeus anterior corp&ris trapezoidei)
the n u m b e r of nerve fibres is greater in it than in the dorsal part whose cells are scattered between the fibres of the corpus trapezoi
(parsposterior pontis), which contains more collections of nerve cells. d e u m , while others terminate in the cells of the dorsal nucleus of
In front of the longitudinal pytamidal bundles in the ventral corpus trapezoideum (nudeus posterior corporis trapezoidei). Both
part of the pons are transverse superficial fibres forming the supe groups of these fibres form synapses in the named nuclei and then
rior pontine bundle. continue in the bundle of the lateral lemniscus (iemnhcus laterals)
More to the hack, between the pyramidal bundles stretch the of the same side. Finally, a large group of fibres of the corpus tra
transverse fibres of the pons (fibrae pontis transversal) to the poste pezoideum run through the layer of the medial lemniscus (lemniscus
rior parts of the middle cerebellar peduncles; they form the infe medialis) and pass to the opposite side to reach the cells of the nuc
rior pontine bundle. leus of the lateral lemniscus (nudeus lemnisa lateralis) (Fig. 767).
Both the superficial and the deep fibres belong to the system of T h e facial nerve (nervus fadalis) emerges medially, closer to the
transverse fibres of the pons (see Fig. 782). Together they form the posterior border of the pons, while the auditory nerve (ntrvus vestib-
corresponding layers of iibres —the superficial and deep layers of ulocochlearis) is lateral to it. T h e sensory root of the facial nerve
the middle cerebellar peduncles, and connect the brain stem with (nersus inttrmtdivs) lies between them. Posteriorly the pons is sepa
the cerebellum. T h e transverse fibres intercross on the midline. rated from the anterior parts of the medulla oblongata by a trans
Closer to the lateral surface of the base of the pons passes a late verse groove.
rally arched oblique, or middle, bundle of the pons whose fibres
T H E MEDULLA OELONGATA
T h e medulla oblongata develops from the posterior cerebral From the spinal cord to the medulla oblongata is made indistinct
vesicle and becomes the myelencephalon at the stage of the five by die transverse external arcuate fibres (fibrae arcuatae eitemae)
vesicles (sec Figs 722-729), stretching at the inferior border of the olive to the pyramid. Ante
T h e medulla nblongata is a continuation of the spinal cord ex rior and posterior external arcuate fibres {jibrae arcuatae exUrnac
tending forwards as its thickening (Fig. 743). ventrales et dorsales) are distinguished.
T h e medulla oblongata is cone-shaped, and slightly com T h e anterior external arcuate fibres are processes of cells of the
pressed in the posterior and r o u n d e d in the anterior parts. Its nar a r c u a t e nuclei (nuclei arcuati), which are collections of the grey mat
row end is directed downwards to the spinal cord, the upper, ex ter and lie next to the anterior and medial surfaces of the pyramids
panded end —to the pons and cerebellum. T h e site of emergence of the medulla oblongata. These fibres emerge on the surface of
of the superior rootlets of the first cervical nerve, or the lower level the medulla oblongata in the region of its anterior median fissure,
of the decussation of the pyramids (decussatio pyramidum) is ac curve round the pyramid and olive, and run in the inferior cerebel-
cepted as the junction between the medulla oblongata and die spi lar peduncle to its nuclei.
nal cord (see Figs 743, 767), T h e medulla oblongata is separated T h e posterior external arcuate fibres are formed by processes
from the pons by a transverse groove which is easily detectable on of cells of the accessory cuneale nucleus (nucleus cuneatus accessorius)
the anterior surface; the abducent nerve (nervus abducens) emerges and run into the cerebellum in the inferior cerebellar peduncle of
o n t o the surface of the brain from this groove. T h e medulla oblon the same side. T h e accessory cuneate nucleus lies dorsolateral to
gata measures 3 cm in length, u p to L 5 cm un die average in the cuneate nucleus (nucleus cuneatus). From six to ten roots of the
width, and up to 1,0 cm anteroposteriorly. hypoglossal nerve (nervus hypoglossus) emerge on the surface of the
T h e anterior surface of the medulla oblongata lies on the lower medulla oblongata from the depths of the anterolateral sulcus.
part of the clivus and extends to the foramen m a g n u m (Figs 763, Collections of the grey matter are also seen in addition to the
764, 767-771). nerve fibres in cross-sections of the olive; the largest has a folded
T h e anterior median fissure (fissura mediana anterior) stretches structure and is called the olivary nucleus (nucleus olh'aris) which
on the anterior surface of the medulla oblongata and is a continua has a hiluin (hilus nuclei olivaris) with the nlivocerebellar tract (trac
tion of the anterior median fissure of the spinal cord. It ascends tus oliaicerebdlark), T h e other nuclei are smaller; one lies medially
arid terminates by a small pit, the foramen caecum of the medulla and is called the medial accessory oh'vary nucleus (nucleus olivaris
oblongata, lying on the above-mentioned transverse groove sepa atxessorivs medialis), and the other is located to the back and is the
rating the medulla oblongata from the pons. dorsal accessory olivary nucleus (nucleus olk'&ris accessorius dorsalis)
At the site of emergence of the rootlets of the first pair of cervi (Fig. 768).
cal nerves, the anterior median fissure becomes somewhat inter T h e association of fibres of ihe lateral spinothalamic tract in
rupted and shallow due to the decussation of the pyramids. the tectum of the medulla oblongata and the pons is known as the
In the superior parts of the anterior surface of the medulla o b spinal Lemniscus (lemntscus spinalis). In the tectum these fibres lie
longata, on either side of the anterior median fissure, is a conical lateral to the olivary nucleus,
elevation called the pyramid of the medulla oblongata (pyramis me A g r o u p of descending efferent fibres pass in the dorsal part of
dulla? oblongatae). the medulla oblongata; this is the tractus solitarius whose fibres
Transverse sections through the medulla oblongata show that end in the cells of the nucleus of ihe tractus solitarius (nucleus trac
each pyramid is a complex of partially intercrossing bundles (this tus solitarii) lying alongside the tract. T h e tractus solitarius can be
can be seen if the margins of the anterior median fissure are drawn seen along the whole length of the medulla oblongata; it contains
apart) and forming the decussation of the pyramids (decussatio pyr the gustatory and interoceptive fibres of the intermediate (sensory
amidum). T h e fibres then pass into the system of the lateral wliite root of the facial nerve), glossopharyngeal, and vagus nerves.
column of the spinal cord (funiculus lateralis medulla? spinalis) where T h e posterior surface of the medulla oblongata bears the poste
they run as the lateral cerebrospinal, or pyramidal, tract (tractus rior median fissure (sulcus rnedianus posterior) which ascends to reach
corticospinalis fpyramidalisj laterals). T h e remaining, lesser portion the thin m e m b r a n e called the obex. T h e last-named is stretched
of the bundles does not enter the decussation but runs in the sys between the gracile tubercles (tuberculum nuclei gracilis) and is part
tem of the anterior while column (funiculus anterior) as the anterior of the roof of the Fourth ventricle over the posterior angle of its
cerebrospinal, or pyramidal, tract (tractus corticospinalis [pyramidalkj floor (fossa rhomboidea). U n d e r the obex the cavity of the central
anteiior). Together these tracts form the pyramidal tract. canal of the spinal cord is continuous with the cavity oF the fourth
Lateral to the pyramid of the medulla oblongata is an elon ventricle (Figs 769, 770).
gated-rounded elevation called the olive (diva) which projects on Two grooves r u n lateral of the posterior median fissure, one is
the anterior surface of the lateral white column. closer to it and is called the intermediate sulcus, the other
T h e olive is separated from the pyramid by the anterolateral stretches lateral to it and is the postcrolateral sulcus (sulcus lateralis
s u k u s (sukus lateralis anterior) which is a continuation of the ante posterior). Four to live roots of the glossopharyngeal nerve (nervus
rolateral sulcus of the spinal cord. T h e continuation of the sulcus glossopkaryngeus), 12 to 16 roots of the vagus nerve, and three lo six
THE F O U R T H VENTRICLE
76 T H E HIND-BRAIN
median aperture of (he fourth ventricle (apertura mtdiana ventrkuli bellar peduncles divides the Iloor of the fourth ventricle into two
quarti), and two are the lateral apertures of the fourth ventricle (ap- triangles, superior and inferior, of unequal size.
ertitrae Literates tisntrieulis quarti). T h e median aperture is larger than O n either side of the median sulcus are two eminentiae medi-
the lateral ones; it lies in lower parts of the roof, slightly above the ales which are defined particularly well in the anterior parts of the
obex, and leads into the cavity of the subarachiioid space, into the fossa. T h e motor nuclei of the cranial nerves lie in the depths of
ccrebellomedullary cisterna (dsttma cerebdlomeduilaris). these eminences. A facial colliculus (coliiculus fadalis) formed by
Each lateral aperture lies in the region of the corresponding the geniculum of the facial nerve lies in the posterior part of each
lateral recess of the fourth ventricle (reussus laterals ventriculi eminence, which corresponds to the posterior parts of the superior
quarti)^ extends to the lobe of the cerebellar hemisphere, called the triangle.
flocculus, and leads into the subarachnotd space. T h e eminentia medialis and the facial colliculus are bounded
T h e (cla chorioidea bears villus-like protrusions on the surface laterally by the sulcus limitans of the fourth ventricle. In the upper
facing the cavity of the ventricle; together with the connective tis parts of the sulcus, nearer to the superior cerebellar peduncle, is a
sue and the ingrowing vessels the protrusions form the choroid small bluish area called the locus coeruleus (locus ceruleus) whose
plexus of the fourth ventricle (plexus chonoideus vmtriculi quarti) colour is due to the presence of pigmented cells.
which is covered in the cavity by the lamina epithelialis. T o the back of the locus coeruleus and at the lateral surface of
In front of the nodulus of the vermis the choroid plexus di the facial colliculus is a shallow depression, fovea superior, appear
vides to form a median choroid plexus, which stretches as two ing as if a widening of the sulcus limitans. In the lower parts the
bands on either side of the median plane to the median aperture of sulcus limitans is continuous with the fovea inferior.
the tela chorioidea, and two lateral choroid plexuses which run A series of thin white bands called the auditory striae (striae me-
towards the lateral recesses. dullares t'tntriatli quarti) pass posteriorly of the lower portion of the
O n removal, the choroid plexus leaves a mark at the site of its facial colliculus, across the intermediate part of the floor of the
attachment to the lateral walls of the fourth ventricle; it is called ventricle. They arise in the cells of the dorsal cochlear nucleus
the taenia of the fourth ventricle (ienia ventriadi quarti). To the which is lodged in the laterally located acoustic tubercle. T h e
back of and above the taenia is the inferior cerebellar peduncle striae run on the surface of the area vestibularis, a flattened eleva
running to the medulla oblongata; the taenia is continuous with tion between the acoustic tubercle and the sulcus limitans.
the gracilc tubercle posteriorly and extends to the obex inferiorly. Inferior to the area vestibularis lies the hypo glossal triangle
Anteriorly and laterally the taenia runs in the region of the lateral (trigonum nervi hypoglossi); medially and slightly downwards of it,
recess (reccssus lateralis) which it borders, and then passes on tile pe under the fovea inferior, is a small dark-brown area called the va-
duncle of the flocculus (pedunculus flacculi) to the free margin of the gal triangle (trigonum nsrvi vagi). Still further downwards is an area
inferior medullary velum and stretches on it to the nodulus. T h e which is speckled with small grooves, posteriorly oT which the me
coutralateral taenia reaches the nodulus in the same manner. T h e dian sulcus of the fourth ventricle is continuous with the central
taenia of both sides are therefore continuous. canal of the spinal cord. This place is covered by the obex, i.e. the
T h e floor of the fourth ventricle is formed by the fossa rhom- terminal area of the inferior border of the roof of the fourth ventri
boidea (whose name corresponds to its shape), which is covered by cle; the entry into the central canal is right u n d e r it.
a thin layer of the grey matter. It is formed ontogenetically of three A narrow elevation bordering the inferior margin oT the vagal
parts: its superior part arises from the isthmus rhombencephali triangle is designated the funiculus separans. Between this funicu-
and lies between the superior cerebellar peduncles; the intermedi lus and the gracile tubercle is a small petal-shaped area postrema-
ate part forms from the nictencephalon and is situated between the Both these structures are covered by specialized thickened epen-
right and left lateral recesses; the inferior part develops from the dyma; its cells are engaged in chemoreceptor function.
myeleucephalon and is located between the right and left inferior T h e posterior median sulcus (sulcus medtanus posterior) runs pos
cerebellar peduncles. terior to the obex, outside the cavity of the fourth ventricle, on the
The fossa rhomboidea (Fig. 770) extends from the aqueduct of midliue of the medulla oblongata, and passes onto the spinal cord.
the mid-brain in front to the spinal cord behind. T h e apex of its Lateral to it is an elongated eminence, the gracile tubercle (tubercu*
acute anterior angle faces the mid-brain, that of the acute poste lum nuda gradlis). Laterally and upwards the tubercle is continuous
rior angle —the spinal cord, and the apices of the two obtuse with the inferior cerebellar peduncle; downwards it is continuous
angles face the lateral recesses. with the fasciculus gracitis. T h e tubercle and the fasciculus are
T h e median sulcus (sulcus medianvs) of the fourth ventricle bounded laterally by the intctniediate sulcus. Superior and lateral
stretches along the long diagonal of its floor and is continuous a n to the sulcus is an elongated cuneate tubercle (tuberculum nuclei cs-
teriorly with the aqueduct of the mid-brain on whose floor it runs. nmti). T h e upper end of die cuneate tubercle is continuous with
T h e median sulcus divides the fossa rhomboidei into two, right the inferior cerebellar peduncle, the lower end — with the fascicu
and left, triangles. T h e base of each triangle lies at the median sul lus cuneatus. T h e lateral part of die fasciculus cuneatus bears an
cus, while the apex is directed to the widest part of the fossa, the elongated eminence, the grey tubercle, which lies between the cu
lateral recess, located in the region of the anterior part of the infe neate tubercle and the olive, and is separated from the cuneate tu
rior cerebellar peduncle. A line drawn between both inferior cere bercle by a small groove.
THE CEREBELLUM
Thalarrius ^ £$i
Tractus opticus
Collktilus superior
Nuclei n, oculomotor! i
Nucleus n. trouhlearis
N r trarhlearis'""
I N. Irigerninus
Nucleus sensor [us principals kudu sentcria ]
n. trigemini
i K - Nucleus n, lacialis
Nucleus n, shductniis
N, v e st 1 bn Ifieo c h I e d T 5 s
" ^ K . facialis
Nuclei n.vestibulocaclUefl
N, abducens
-^Nuclei salivalorii, superior et inferior
tf, vagus
f
Nucleus n hypoglossi fajf
^ N. accessorius
Nucleus tractus solitflm N
Nucleus ambiguus
Nucleus Iractus spinaHs n, trigemini—■
— Nucleus spinalis n. accessorii
Medulla spinalis
N. acce*sorius — ■
772. Nuclei of cranial nerves (nuclei nervorum cerebralium) in the region of the mid-brain and hind-
,. brain (semischematical representation).
% (Projection of the nuclei on the lateral aspect.)
Collieulus superior
PulvSflw.
Fissurae cerebelli ^
V
Lobuli
Folia cerebelli -~_. quadrangulares
Lotiulus semilunaris
superior
Cuhuen '
Derive ^■
Fissura horizontal is
Folium vermis Lobulus semilunaris Inferior
cerebelli, stretching over the posterior cranial fossa, is wedged (see superior) which is relatively even and descends obliquely to the bor
Fig. 796). In front of the cerebellum are the ports and medulla ob- ders, and a bulging lower surface (fades inferior).
longata.. Like the cerebrum, the cerebellum is invested in mem T h e lower surface of the cerebellum lies on the medulla oblon-
branes called meninges. O n their removal, separate parts of the gata which is pressed into it to form a hollow called the vallecula
cerebellum and the arrangement of numerous sulci and gyri on its of the cerebellum (vallecula cerebelli) on whose floor lies the vermis.
surface can be seen. T h e vermis is the middle part of the cerebellum lodged be
T h e cerebellum consists of the right and left cerebellar hemi tween its hemispheres. It bears numerous narrow, parallel folia. A
spheres (hemispheria cerebelli dexlrnm et sinistrum) which are sepa superior surface, or part (the superior vermis) and an inferior sur
rated by a shallow anterior cerebellar notch and a deeper posterior face, or part (the inferior vermis) are distinguished.
cerebellar notch. Two small longitudinal grooves, r u n n i n g on either side of the
Each notch is located on the corresponding border of the cer superior and inferior vermis, separate them from the cerebellar
ebellum: the anterior notch lies on the anterior b o r d e r and the hemispheres; the grooves on the anterior surface are shallow, those
posterior notch on the posterior border. T h e most prominent parts on the posterior surface are deeper.
of the anterior and posterior borders form the corresponding ante T h e cerebellum is made u p of the grey and white matter
rior and posterior angles; the most prominent lateral parts fortu (Figs 781, 782). T h e grey matter lying in the superficial layer forms
the lateral angles. the cortex of die cerebellum (cortex cerebelli), while Gt!ji|pctions of
T h e horizontal fissure (fissura horizontal^}, r u n n i n g from the grey matter in the depths of the cerebellum form its cefltal nuclei.
middle cerebellar peduncles to the posterior cerebellar notch, di T h e white matter of the cerebellum (corpus meiullare cerebelli) lies in
vides the surface of each hemisphere into an u p p e r surface (fades its depths and connects its grey matter with the cerebrum and spi-
i
/ ■
% ^ - N . ficlahs
V
\ N . vestibulocochlearis
''is LA
c ^ f O ^N. abducens
\ N . glossopharyngeus
N. Kypoglossus
m \ TJ. vsffus
1 \
s
Medul!a spinalis
Fibsurfiecerebel!
T h e lower surface (jades inferior) of the cerebellar hemisphere by the postnodular fissure (Jissura posterolattralis). A group of small
bears the following lobules (Figs 777-778).
convolutions, called the secondary (or accessory) flocculus, is
I. T h e ansiform lobule, inferior surface (lobulus semiiunaris in- sometimes seen next to the middle cerebellar peduncle. T h e floc
Jenor) is separated From the superior surface of the ansiform lobule culus corresponds to the nodule (nodulus).
by a horizontal fissure. Its folia curve distinctly laterally and poste
T h e biventral lobule, tonsil, and flocculus form the posterior
riorly, and its medial parts are thicker at the posterior notch of the
lobe of the cerebellum.
cerebellum than the lateral parts.
T h e vermis is a narrow part of the cerebellum which is located
A posterior inferior groove separates the inferior surface of the in the median plane a n d connects the right and left hemispheres.
ansiform lobule from a thin lobule; both these lobules correspond
Like the cerebellar hemispheres, the vermis is covered on the pe
to the lobulus tuberis (tuber vermis) and together with the superior
riphery by the grey matter forming the cortex of the cerebellum
surface of the ansiform lobule form the middle lobe of the cerebel
(cortex cerebelli); in the depths of the vermis is the white matter of
lum.
the cerebellum (carpus medullare) (Figs 779, 780).
2. T h e biventral lobule (lobulus biventer) is separated from the Fissures, most of which run transversely, divide the vermis into
inferior surface of the ansiform lobule by an anterior inferior a series of short folia forming the lobules (lobuli).
groove. T h e folia of this lobule can be separated into two parts ac
As it is pointed out above, the vermis is divided into two parts,
cording to their direction: the posterior lateral part has short folia
a superior and an inferior vermis, whose lobules correspond to cer
directed laterally, the anterior medial part has long folia most of
tain lobules of the cerebellar hemispheres.
which run from front to back. T h e whole lobule corresponds to t h e
T h e superior vermis has the following lobules.
p y r a m i d of the vermis (pyratnis vermis).
1. T h e lingula of the cerebellum (lingula certbtlli) is the front
3. T h e tonsil of the cerebellum (iovsilla cerebelli) lies medial to lobule. It consists of four or five narrow, transverse folia forming a
the biventral lobule, in a depression called the nidus avis located plate which covers the middle and posterior parts of the superior
at the inferior medullary velum; its short folia run from front to
surface of the superior medullary velum; posteriorly the lingula is
back. T h e tonsil corresponds to the uvula of the vermis (uvula ver
connected to the centra] lobule (lobulus centralis).
mis).
2. T h e central lobule (lobulus centralis) lies in the region of the
4. T h e flocculus is the smallest lobule of the cerebellar hemi anterior cerebellar notch, partly covers the lingula, and by means
sphere and is suspended on a thin peduncle (peiunculus Jlocculi). ot the alae of the central lobule is continuous with the anterior
T h e peduncle lies behind the middle and inferior cerebellar pe folia of the u p p e r surface of the cerebellar hemispheres.
duncles and is continuous with the inferior medullary velum at the 3. T h e monticulus is the largest part of the superior vermis
medial surface of the tonsil. Posteriorly the flocculus is bounded and connects the anterior lunate lobules of both hemispheres, ft
k*
^^angulaTis
semUtmaris
in*"'
Velum
medulla re super ius
Vermis
r
I Lingula cercnelli
/ /
/ / PetliiTvculus cerebellaris superior
Velum medullare — \
inierius PeduncuLLis cerebeilaris inferior
Peduncuius cerebeliaris medius
Flocculus.
Fissura
posterolateralis
^Pedunciilus floccul!
Fissura horiianlalis
Lohulus^semtlunarls
Inferior
Vermis
HemispheriLim oerebelli
(teeies superior)
.Corpus rneduhare
Fissura horizontal^
cere belli
Velum
nredullare infer! u s -
Tel a chorioidea .,
ventriculi quarti'
Hemispheriimi cerebeill
(factes inferior)
As it is stated above, the cerebellum is m a d e u p of the white ebellum: (1) the inferior peduncles (peduncult cerebeilares inferiores)
and grey matter (Figs 779-782). T h e white matter (corpus medul- stretch from the medulla oblongata to the cerebellum (sec The Me
tare) lies in the depths of the cerebellum where it branches and dulla Oblongata and The Candueting Pathways); (2) the middle pe
penetrates each folium to form the white laminae (laminae albae) duncles (peduncxti cerebeilares medii) pass from (he pons to the cere
which are covered by the grey matter; as a result, on sagittal sec bellum (see The Pons and The Conducting Pathways); (3) the
tion of the cerebellum the white and grey matter form a tree-like superior peduncles (peduiuuli cerebeilares superiores) stretch from the
pattern which is called (he arbor vitae of the cerebellum (arbor vitae cerebellum to the mid-hrain (see The Tectum of the Mui-brain and
cerebelU). The Conducting Pathways).
T h e cerebellar peduncles. T h e cerebellum is connected to the T h e grey matter forms the cortex of the cerebellum (cortex cere-
cerebrum by three pairs of peduncles (pedunatli). These arc a sys belli) and its nuclei. A molecular layer (stratum mokculare) and a
tem of conducting pathways whose fibres pass to and from the cer granular layer (stratum granulosum.) are distinguished in the cortex.
T h e nuclei of the cerebellum (nuclei eertbelli) (figs 7 8 1 , 782) are 2. T h e nucleus emboliformis lies medial and parallel to the
paired collections of the grey matter in the depths of the white dentate nucleus.
matter of the cerebellum. T h e following nuclei are distin
3. T h e nucleus globosus is located slightly medial of the nu
guished,
cleus embolifonnis, and on section may have the appearance of
1. T h e dentate nucleus (nucleus dentalus) lies in the inferome- several small globules,
dial areas of the white matter. It is a flask-shaped lamina of the 4. T h e nucleus fasiigu lies in the white matter of the vcrmis to
grey matter with an open mouth in the medial part which is called either side of its median plane, u n d e r the lingula of the cerebellum
the hilum of the dentate nucleus (kilus nuclei dentati). and the central lobule, in the roof of the fourth ventricle,
I ■ iiiil
-.Corpus striatum
(Caput nuclei caudati)
V. thalamostriata
Adhesio
intertbalamica _-Tenia chorioidea
Thalamus
_ ^Colllculus superior
„ - T r a c t us cerelidlorubralis
Nucleus (icntatus
Laminae albac^
/
/
/
Hiius nut lei denial'
Nucleus globosus Veriuis
Corpus medullare
Nucleus cmboliformis
\->
^^Tractus opticus
Culliculus Inferior %
.orpora roaraillaria
HernispheriuiTi cerebeill ■ffc-'Chiasma opticuin
f i d e s superi
^ N . opllcus
Laminae atbae ?
"""--InfLiridibulum
-Hypophysis
~~.Pedunciilus cerebri
"" Pons
Corpus inedultare—
—Medulls oblongata
1
Nucleus olivaris
tiemispherinm cerebetll^
Ftbrae arruatae externae
t facies inferior)
Nucleus denlatus
Trmsilla cerefettit
— jvtedulla spinalls
782. Cerebellum and brain stem (truncus cerebri); right aspect {%).
(Sagittal section of cerebellum slightly to the right of the mi dp lane.)
along the path of the afferent or efferent impulses form sensory or the cerebral cortex with the nuclei of the cranial nerves in the
motor nuclei. brain stem:
T h e aggregate of ueuronal axons stretching in the spinal cord (c) the corticoreticular fibres (fibrae (oriiarrdtculares) r u n n i n g
and brain and conveying impulses of the same kind is called the from the cortex to the nuclei of the brain stem reticular formation;
conducting tract. (2) the extrapyramidal tracts which connect the cerebral cor
All conducting pathways of die spinal cord and brain are sub tex, the premolor zone, with the bodies of the efferent neurons via
divided into efferent (descending), association, and afferent (as the subcortical nuclei and nuclei of the diencephalon and mid-
cending). brain: the corpus striatum, substantia nigra, red nucleus, and sub-
T h e association tracts accomplish connections between neu thai atnic nucleus;
rons in the spinal cord or between brain areas within the deriva (3) the efferent tracts of (he autonomic nervous system which
tives of each cerebral vesicle. are believed to pass from the cortex to the hyputhalamus either di
T h e efferent pathways (Figs 786, 792) are subdivided as fol rectly or through the subcortical nuclei.
lows: From the hypothalamus the impulses are transmitted to the eff
(1) the pyramidal tract (tractus pyramidalis) which is made u p erent neurons of the autonomic (vegetative) nervous system.
of; T h e afferent pathways (Fig. 790) convey impulses from the ex
(a) the cerebrospinal fibres (fibrae wrtimspmahs) connecting the tern- and inleroceptors to the cerebellum, thalamus, olives, and
cerebral cortex with the cell bodies of efferent (motor) neurons of tectum of the mid-brain.
the anterior horns of the grey matter of the spinal cord; T h e ascending tracts, each conveying impulses from certain re
(b) the corticonuclear fibres (fibrat wrticonudearzs) connecting ceptors, are represented in the spinal cord by: (1) axons of spinal
ganglia cells (Jasdadus gradlis et fasdatlits tumaius), which termi terminate i n the nerve cells of its nuclei. In these nuclei the third
nate in the medulla oblongata; (2) axons of nerve cells of the spi neurons (neuron III) of the ascending tracts begin, along which
nal cord on which axons of afferent neurons of the spinal ganglia the afferent impulses reach die cortex of the cerebrum.
terminate; in the brain they are represented by axons of cells of T h e areas of the cerebral cortex at which the ascending path
the sensory cranial nerves nuclei on which terminate axons of cells ways (from t h e organs of vision, taste, hearing, and smell, a n d from
forming the peripheral ganglia of t h e cranial nerves (the trigeminal the skin a n d viscera) terminate are known as the cortical parts of
ganglion and others). the visual, gustatory, auditory, olfactory, cutaneous, internal (inter-
T h e axons of afferent neurons do not reach t h e cerebral cortex. roceptive), a n d muscular (motor) analysers.
O n t h e way to t h e cerebellum or to the nuclei in the thai ami c T h e analyser comprises the receptor neuron and t h e nerve
brain (thalamencephalon) t h e afferent impulses pass along two cells of t h e spinal cord, brain stem, a n d diencephalon. The dien-
neurons: (a) an afferent neuron lying in a peripheral ganglion, a n d cephalon neurons convey impulses to the corresponding areas of
(b) an intemuncial neuron located in the spinal cord or brain stem the cerebral cortex. All cortical cells responding to impulses in
(the medulla oblongata, pons). duced by stimulation of the receptors are related to analysers.
O n reaching the region of the thalamus the ascending tracts
T h e grey matter (see Fig. 733) extends throughout the whole (2) the nucleus proper of the posterior horn is located in its
length of the spinal cord around t h e centra] canal. I n each half of central parts;
the spinal cord (see Fig. 732) it forms anterior, lateral, and poste (3) the thoracic nucleus lies on the medial part of the base of
rior grey columns (mlumnae griseae anterimes, later ahs et posteriores) the posterior horn;
which are joined by an intermediate part (or zone) (pars intermedia). (4) the intermediomedial nucleus lies to the front of t h e thor
T h e intermediate part consists of substanlia intermedia centralis acic nucleus;
surrounding the central canal of t h e spinal cord, and substantia in (5) the intermediolateral nucleus is situated in the lateral horn;
termedia laieralis wedged between the anterior and posterior (6) a group of nerve cells found in the region of the apices of
horns. O n transverse section of the spinal cord (Fig. 786) the co the posterior horn a n d form the gelatinous matter (suhtantia gelat-
lumns of grey matter are identified as the anterior horns (corrnia an- itiosa} and the so-called zona spongiosa;
teriora), lateral horns (carnua later alia), a n d posterior horns (corona (7) cells scattered diffusely in the grey matter and called t h e
postmora). T h e lateral horns are present only from the first thor cellulae disscminatae;
acic to t h e Erst or second lumbar segments and form projections (8) the reticular formation lies lateral to the grey matter of the
called the substantia intermedia lateralis. lateral horn a n d the adjoining parts of the anterior and posterior
The nerve cells of t h e spinal grey matter are grouped as fol horns. It is composed of numerous small islets of grey matter
lows: which are separated from one, another by white vertical and hori
(1) motor cells of the anterior horns which send axons into the zontal fibres.
anterior roots of the spinal cord;
T H E W H I T E MATTER O F T H E SPINAL C O R D
T h e white matter of the spinal cord (see Figs 732, 7 3 3 , 786) is T h e white matter of the spinal cord contains projection fibres
arranged around the grey matter to form the white columns (fitni- consisting of efferent (motor) and afferent (sensory) conducting
culi medulfae spinalis). T h e anterior, posterior, and lateral white co tracts (see below), and association fibres. T h e last-named are re
l u m n s {Junuuli anteriores, potteriores et laterales) a r c distinguished. sponsible for intersegmental links within the spinal cord a n d form
the irttersegmemal tracts (fasciculi proprii anterior, lateralis et poste thin bundle of descending fibres lying in close contact with the
rior medullas spinalis) which adjoin the grey matter and surround it posterior median fissure; it is found only in the lower thoracic and
completely. They include: (1) the dorsolateral tract (tratius dorsola- lumbar segments of the spinal cord; (3) the interfascicular fascicu
teralish a small bundle of fibres lying between the apex of the pos lus (fasciculus interfascicularis), made up of descending fibres situ
terior horn and the surface of the spinal cord close to the posterior ated in the medial part of the fasciculus cuneatus; it is found in
root; (2) the septomarginal fasciculus (fasciculus septomarginalis), a the cervical and upper thoracic segments.
21 22 37iib
20 h Wop
23/
flit
31/ 6p 1 2 724 a
7 32 if I I
3 3!
\ 19 ' /7
31 '
na ia H
SeptQBWgiFfil fasciculus
' ~—Sukus mediarms (posterior)
Fasciculus graeilU \ *
Fasciculus iuterfasciculaii? (comma tract)
Fasciculus cuneatus Radix dorsal is
i
Fasciculus posterior proprius I
Tractus
corticoBpinalis (pyx-ami daJJs)
lateral Is
Tractus rubrospinali*
T radus
sptnoccrerjellaris Longitudinal bundle
posterior iSieriorgiey cnlumf)
\
fasciculi proprii
>..,,[-.-M;v.- spinalis
(Fasciculi
tnteTsegrnejUa Its)
...
The cortex of the cerebrum (cortex cerebri) is the most highly (3) the pyramidal layer, lamina pyramidalis;
differentiated part of the nervous system. It is heterogeneous ac (4) the internal granular layer, lamina granularis interns;
cording to the time of origin in phylogeny. The oldest cortex, ar- (5) the ganglionic layer, lamina gangiionaris;
chicortex, is represented by the cortex of the hippocampal Forma (6) the multiform, or polymorphous, layer, lamina multiformis.
tion. The old cortex, palaeocortex, is identified in the region of the The structure of the cortex in various areas of the cerebrum
pyrifomi gyrus. The new cortex, neocortex, includes the remainder possesses specific features which are displayed by a different num
parts of the cortex of the cerebral hemispheres. ber of layers as well as a different number, size, topography, and
The cortex of the cerebrum is composed of a great number of structure of the nerve ceils forming it.
nerve cells which can be separated into the following six layers ac Many areas have been described in the cortex to date on the
cording to morphological features (Fig. 783): basis of its morphophysiological study (Figs 784, 785). Each area is
(1) the external zonal, or molecular, layer called the lamina characterized by individual architectural features, which made it
zonalis; possible to construct a diagram of the cerebral cortex areas (cyto-
(2) the external granular layer known as the lamina granularis architectural pattern) and to determine the peculiarities of the ar
externa; rangement of the cortical fibres (myeloarchitectonics).
T h e cortical parts of each analyser have definite areas ill the superior temporal gyrus; slightly to the back, in the posterior part
cerebral cortex in which their nuclei are lodged, and also definite of the superior temporal gyros lies the auditory analyser of speech
groups of nerve ceils outside these areas. T h e nuclei of the m o t o r signals (control of the individual's own speech and perception of
analyser are situated in the paracentral lobule, the precentral gy the speech of others).
m s , the posterior parts of the middle and inferior frontal gyri. T h e visual analyser of written signs is located in the middle
T h e cortical parts of the motor analysers of the lower limb part of the inferior parietal lobule (}grs$ angulnris).
muscles are lodged in the upper parts of the precentral gynts and T h e cortical part of the analyser of general sensation (tempera
paracentral lobule; below lie regions related to the muscles of the ture, pain, tactile, muscle and joint sensation) is situated in the
abdomen, trunk, u p p e r limbs, neck, and, finally, in the lowest part, postcentral gyms; the projection of body regions here is the same
the muscles of the head. as that in the motor analyser. In addition, the superior parietal lob
T h e posterior part of the middle frontal gyros lodges the corti ule (lobulus parietalis superior) contains the cortical area concerned
cal part of the motor analyser of the associate turning of the head widi the ability to recognize objects by louch (stereognosis), where
and eyes. T h e motor analyser of written speech, related to volun as die inferior parietal lobule (lobulus parktatu inferior) lodges the
tary movements linked with writing letters, figures, and other motor analyser responsible for performance of co-ordinated move
signs, is also situated there. ments mastered throughout life (praxis, on the left side in right-
T h e posterior part of the inferior frontal gyms lodges the m o handed individuals).
tor analyser of speech. T h e connection between the cortical end and peripheral (re
T h e cortical parts of the olfactory and gustatory analysers lie in ceptor) part of each analyser is accomplished by the system of con
the uncus (the hippocampal gyros of the temporal lobe); the corti ducting tracts of the brain and spinal cords and the nerves arising
cal part of the visual analyser occupies the borders of the calcarine from them.
sulcus and that of the auditory analyser—the middle part of the
T H E W H I T E MATTER O F T H E BRAIN
T h e white matter of the cerebral hemispheres consists of: pkalicus medialh). This is a system of longitudinal, ascending and
(1) descending projection fibres connecting the cortex of the brain descending, hypothalamic fibres. These are responsible for form
with the parts of the nervous system located below; (2) ascending ing two-way connections between the septum lucidum, hypothala-
projection fibres connecting the th a lam us (neuron III of the sen m u s , and the centres of the tectum of the mid-brain. T h e fibres of
sory tract) with the cerebral cortex, and (3) association fibres link this bundle arc detected throughout the length of the hypoth ala
ing either different areas in one hemisphere or similar contralat- m o s in whose lateral part they stretch;
eral areas in the right and left hemispheres. All these groups of (6) the association tracts interconnecting die subcortical nuclei
fibres stretch in definite regions of the white matter. of the hemispheres and the fibres linking these nuclei with the cor
T h e association tracts of the hemispheres are divided into two tex.
groups; (1) short and long association fibres and, (2) association T h e commissural fibres (Figs 7H9, 791) link similar areas of the
commissural fibres. right and left hemispheres; they include:
T h e short association tracts are represented by the association (1) the corpus callosum connecting all parts of the cerebral
fibres (fibrae arcuatae cerebri) interconnecting the neighbouring gyri cortex of both hemispheres with the exception of the temporal
(Fig. 788). poles;
T h e long association tracts are as follows (Figs 787, 788): (2) the anterior commissure (cammissura anterior) consisting of
(1) the superior longitudinal bundle (fascicuhs longitudinalis su two parts: the olfactory part (pars anterior) linking the olfactory
perior) interconnecting the Frontal, occipital, and temporal lobes; lobules, and the posterior part (pars posterior) connecting the h i p
(2) the uncinate bundle (fasciculus vncmalus) interconnecting pocampal gyri (gyri parahiftpocampaUs);
the region of the inferior frontal gyrus with the uncus of the tem (3) the hippocampal commissure (commissura fomicis) lying in
poral lobe and the neighbouring gyri; the form of a triangular plate under the splenium of the corpus
(3) the inferior longitudinal bundle (fasciculus longitvdinalis infe callosum, between the posterior columns of the forms.
rior) interconnecting the frontal lobe with the temporal lobe; T h e white matter of the hemispheres forms layers, called cap
(4) the cingulum connecting the region of the olfactory pyr sules, between the subcortical nuclei (Figs 7 6 0 - 7 6 3 , 789); these
amid (trigonum olfactorium) and the parolfactory area (area subcal- are:
losa) with the uncus. (1) the external capsule (capsula txlcrna) lying between the
(5) the medial bundle of the lelencephalon (fasciculus telencc- claustrum and the lentifonn nucleus (nucleus lentifonnis);
— Sulcus cenlralis
Lobus parietal is
Fasciculus
lungltudinalls superior<r^§§
l.obus ironlali?
Lobus occlpltalis -
Cerebellum —
Fasciculus uncinatus
Lobus temporalis
-Medulla obkmgata
(2) the internal capsule (capsule, interna) separating the lenti- the medial dorsal nucleus of the thalamus (nucleus medialis dorsalis
fomi nucleus from Ihe caudate nucleus (nucleus caudatusj and the thalami) and run radially to the cortex of the frontal lobe. Some of
thalamus. the fibres form connections between the anterior thalamic nuclei
All projection fibres of the hemispheres pass through the inter and the cortex of the medial surface oi the frontal lobe as well as
nal capsule to form the corona radiata in the hemispheric white the anterior part of the gyrus cinguli.
matter. T h e genu of the internal capsule (genu capsulae internac) trans
T h e internal capsule has ati anterior limb, a genu, and a poste mits the corticonudear fibres (fibrae. coHkonucUaris) connecting the
rior limb. cortical motor area with the motor nuclei of the crania] nerves
T h e anterior limb of the internal capsule (crus animus mpmlae (Fig. 792).
internae) is formed by the frontopontinc tract (tradusfnmioponiinia) T h r e e parts are distinguished in the posterior limb of the inter
(Fig. 789) which connects the cortex of the frontal lobe with the nal capsule (cr&s posterius capsulae intemae} \ (a) the (ha la mo lenticu
nuclei of the pons and is a component of the cerebropontine tract lar part (pars Ihalarrwlenticularu) which includes the cerehrospinal
(tradus antkopontinus). In addition, the anterior limb contains the fibres (fibrae aurttcospinales), the cerebrorubral Ebres (fibrae cariicoru-
anterior thalamic radiations (radiationes thaUimkae anterioresj in brales), the corticoreticular fibres (fibrae corticareikulares), the corti-
cluding fibres of the hemispheric white matter which arise from colhalamic fibres (fibrae wrtkotkalamcae), and the thalamoparietal
Sulcus cingull
Fibrae arcuatae
cerebrl
Lobus parietalis
^ Corpus catlosum
Cyrus cingull
^L Sulcus parietooccipitalis
Cingulum | i 3 ^ t - Thalamus
• - Cuneus
Polus frontalis
fm- PolllS OCCipltaliS
— Sulcus calcaritius
Uricus
Sulcus collaterals
Gyrus parahippftcampalis
fibres (fibrae thalamopamtaUs) r u n n i n g as components of the ten* diations optka et acustka) (Fig. 789); (c) the retrolentiform part
tral thalamic radiations (radiationen thalamicae centrales); (b) the len- (pan retrolenliformis) including the fibres of the posterior thalamic
liform part (pars suUeniiformis) which contains the corticotectai radian mis (radiationes thalamicae posteriores) and the parietooccip-
fibres (fibrae airticciiedcdes), the temporopontine fibres (fibrae tempor- itopontine Fasciculus (fasciculus parietoaccipitopontinus).
ttpontinae), and the bundles of the optic and auditory radiations (ra
Lobus frontalis
Capsula externa
Ventrlculus lateralis
II strum
Insula
Crus anterius
Capsula
Tractus f r o n t o p o n t i n u s
Snterna Genu
-Putamenl Nttclws
-Olobus \ lenttcularis
pallidus I
Lobus temporalisr"
Thalamus
Tractus" occ i p i topont 1 mis
et temporoponiinus ' Corpus pincale
l.ohus occipital is —
789. Capsules and course of tracts through internal capsule {semischematical representation).
The cell bodies of neurons I, which are conductors of all types fibres. The medial group of fibres stretches to the posterior while
of sensibility running to the spinal cord, lie in the spinal ganglia column (junicuiusposterior) where each fibre divides into an ascend
(ganglia spinalia). ing and descending branch. The ascending branches come in con
The axons of spinal ganglia cells stretch to the spinal cord and tact with the cells of the spinal grey matter in the gelatinous matter
form the posterior roots (radices dorsalis) (Figs 786, 903). and posterior horn, while some of them reach the medulla oblon-
\ On entering the spinal cord, the posterior roots fibres divide gata to form the fasciculus gracilis and fasciculus cuneatus of the
into two groups: a medial group consisting of thick, richly myeli- spinal cord. The medially situated fasciculus gracilis contains
natcd fibres, and a lateral group formed by thin, less myelinated fibres from the inferior (sacral, lumbar, and inferothoracic) spinal
Fasciculi thalamocnflicales
Corpus rallcisum
Lob us pMrietaUa
Tractus splnocerebellarj;;
anterior
790. Ascending tracts of spinal cord and brain; right hemisphere (semischematical
representation).
(Projection of fibres on the surface of t h e hemisphere.)
Cornmissural fibres of
V corpus callosum
Corpus callosum \\ ~ " ^ - — ^ k . Fibres from cortex to
nucleus caudatus
Fasciculi cortlcothalamicae 1
radlaflo thalan
Fasciculi thalamocortlcaks f
Cortex
Fibres from cortex to
Nucleus caudatus nucleus lentiformis
Fibrae corticospinales^
(tractus pyramidatis)
Clausfrurn - ,
Capsula i n t e r n a l ____
;-Tractus cerebellorubralls
Nuclei of crania] nerves
^\^*^Kr~Nucleus dent;
ntatus
J]/~~' Cerebellum
j ^ [Jons
Pyramls —-
Ollva
"""^Tractus rubrospinalfs
791. Descending tracts of spinal cord and brain; frontal section (semischematical
representation).
(Projection of fibres on the surface of the brain.)
segments. T h e laterally lying fasciculus cuneatus contains fibres lateral and anterior white columns, and end in the olivary nuclei.
from the superior (superothoracic and cervical) segments. T h e fibres of this tract carry information from the skin, muscle,
T h e descending branches of the fibres come in contact with the and tendon receptors.
grey matter cells of the posterior columns for the distance of six to 4. T h e spinoreticular tract (tradus spinoretkularis) is formed of
seven segments next below. In the thoracic and cervical parts oT fibres passing in the spinothalamic tracts; the fibres do not inter
the spinal cord some of these fibres Torm a bundle between the fu- cross b u t form bilateral projections in all parts of the stem reticu-
niculus gracilis and funiculus cuneatus, which is comma-shaped lar formation.
on cross-section; in the lumbar part the bundle is shaped like a 5. T h e anterior and lateral spinothalamic tracts (iradus spitw-
medial b a n d ; in the sacral part it is seen as an oval b u n d l e of the thalajnici anterior et latcralis) (Fig. 786) are made up of fibres con
posterior white column lying next to the medial surface of the fas veying impulses of pain, temperature, and tactile sensibility. T h e
ciculus gracilis. neurons. I cell bodies lie in the spinal ganglia. T h e processes of
T h e lateral g r o u p of the posterior root fibres passes into the neurons II begin from the cells of the posterior root nucleus
zona terminalis and t h e n into the posterior grey column to come in proper and run through the white commissure (mmmissura alba)
contact with the funicular cells and with the cells of the posterior into the anterior and lateral white columns on the opposite side.
horn. Ascending, the fibres of these tracts pass in the posterior parts of
Some of the fibres arising from the cells of the spinal cord nu the medulla oblongata, pons, and cerebral peduncles and reach the
clei ascend in the lateral white column (funiculus latcralis) of the thalamus as components of the medial temniscus. Neurons III of
same side, while others pass in the white commissure (commksura these tracts are lodged there; their processes stretch to the cerebral
alba) to the contra! ateral side of the spinal cord and also ascend in cortex in the thalamocortical fasciculus (fasciculus ikaiamocortkalis),
the lateral white column. Besides the ascending tracts, some des passing through the posterior limb of the internal capsule (cruspos-
cending tracts pass in the lateral white column of the spinal cord. terius capsulae intcrnae).
T h e following ascending tracts arise in the spinal cord 6. T h e spinoteclal t r a d (tractus spitiatedalis) passes together
(Figs 786, 790). with the spinothalamic tract in the lateral white columns of the
1. T h e posterior spinocerebellar tract (iradus spinocerebdtaris spinal cord and terminates in the tectal lamina of the mid-brain.
posterior) is a direct cerebellar pathway conveying impulses from 7. T h e fasciculus gracilis and fasciculus cuneatus conduct im
muscle and tendon receptors to the cerebellum. Neuron I is lo pulses from the muscles and joints and the receptors of tactile sen
cated in the spinal ganglion. T h e cell bodies of neurons II lie in sibility. T h e cell bodies of neurons I of these tracts lie in the corre
the thoracic nucleus of the posterior horn throughout the whole sponding spinal ganglia. Their axoiis pass in the posterior roots
length of the spinal cord. T h e long process of neuron II runs later and, on entering the posterior white columns of the spinal cord, as
ally, to the posterolateral part of the spinal cord on the same side, cend to reach the nuclei of the medulla oblongata.
turns upwards and ascends on the lateral white column, and then T h e fasciculus gracilis occupies a media) position and carries
passes on the inferior cerebellar peduncle to the cortex of the ver- Ore corresponding impulses from the lower limbs and lower parts
mis of the cerebellum. of the trunk—below the fourth thoracic s e g m e n t
2. T h e anterior spinocerebellar tract (tradns spinocerebdlaris an T h e fasciculus cuneatus is formed by fibres arising from the
terior) transmits impulses from the muscle and tendon receptors to cells of all spinal ganglia lying proximal to the fourth thoracic seg
the cerebellum. Neuron I lies in the spinal ganglion, neuron II is ment.
situated in the medial nucleus of the transition zone and sends O n reaching the medulla oblongata, the fibres of the fasciculus
some of its fibres through the white commissure (commisswra alba) gracilis come in contact with the cells of its nucleus in a swelling
into the lateral grey columns on the opposite side, and the rest — called the gracile tubercle (tubenulum nuclei gracilis); the fasciculus
into the lateral grey columns o n the same side. These fibres run in cuneatus fibres terminate in the cuneate tubercle (tubcrculum nuclei
front of the posterior spinocerebellar tract and reach the anterola- cuneati). T h e cells of both tubercles are the cell bodies of neu
tcral parts of the lateral columns. T h e r e the fibres of the anterior rons II of these pathways. Their axons stretch forwards and up
spinocerebellar tract turn upwards, pass in the spinal cord, in the wards as the internal arcuate fibres (fibrae arcuaiae internae), pass to
medulla oblongata, in the pons, and then in the superior cerebellar the opposite side, and intercrossing with the contralateral fibres
peduncles to reach the superior vermis. pass as components of the medial lemniscus. After reaching the
3. T h e spino-olivary tract (iradus spmo-olivaris) arises from the thalamus, these fibres come in contact with the cell bodies of neu
cells of the deep grey matter layers; their axons intercross and as rons III of this pathway which send processes to the cortex of the
cend close to the surface of the spinal cord, at the junction of the cerebrum via the internal capsule.
1. T h e cell bodies of neuTons 1 of the cranial nerve sensoiy medial geniculate body (corpus geniculatum mediule) and the inferior
tracts are lodged in the peripheral ganglia: the trigeminal ganglion quadrigeminai body (colhculus inferior) of the tectum of the mid-
(ganglion IrigeminaleJ (fifth pair); the ganglion of the facial nerve brain, through the posterior limb of the internal capsule (ems poste-
(ganglion geniculi) lodged along the course of the seventh pair; the rius capsulae internae), and reaches the middle part of the superior
superior ganglion (ganglion superius) and the inferior ganglion temporal gyrus.
(ganglion inferius) of the glossopharyngeal nerve (ninth pair); and 5, T h e optic radiation (radiatia optica) connects the subcortical
the superior and inferior ganglia [ganglia suptrvus et inferius) of the visual centres with the cortex of the ealcarme sulcus (sulcus cakari-
vagus nerve (tenth pair). mts).
T h e axons of the nerve cells of these ganglia form the sensory T h e optic radiation contains two systems of ascending fibres:
roots of the above-mentioned nerves, which pass into the pons and (a) the geniculocortical optic tract originating from the cells of
the medulla oblongata. T h e r e the fibres of the sensory roots come the lateral geniculate body (corpus genieuhtum laterate);
in contact with the cells of the cranial nerve sensory nuclei. T h e (b) the pulvinar-cortical tract arising from the cells of the nu
cells of the sensory nuclei are therefore internuncial neurons. cleus lodged in the pulvinar; in m a n it is poorly developed.
T h e sensory nuclei of the cranial nerves are a collection of cell Ascending to the cortex of the cerebrum, both systems of these
bodies of neurons IE of the ascending pathways of these nerves. fibres pass through the posterior limb of the internal capsule (cms
T h e nuclei for the fifth pair of cranial nerves (nervus trigemimis) are pusterius capsulae internae), and are known as posterior thalatnic ra
represented by the superior sensory nucleus (nucleus sensorius supe diations.
rior nersi trigemini) and the nucleus of the spinal tract of the trigem 6, T h e th alamo cortical fasciculus (fasciculus thalamocartiealis)
inal nerve (nucleus tractus spinalis nervi trigemini); the sensory nuclei passes through the posterior limb of the internal capsule (erus paste-
of the sensory root of the facial nerve (nervus intermedius), and those rius capsulae internae) and connects the cells of the thalamic nuclei
of the glossopharyngeal nerve (nervus glossopharyngetts) and the va with the cortex of the cerebrum.
gus nerve are united in the nucleus of the tractus solitarius (nucleus T h e components of the thalamic radiations are as follows:
traclus solitarii). (a) the anterior thalamic radiations (rudiationes tkalamkcae anteri-
T h e fibres originating in diese nuclei cross to the opposite side ores) are radially stretching fibres of white matter of the cerebral
(some run on their own side) and stretch to the thalarnus in whose hemispheres, which arise mostly from the dorsomedial nucleus of
nuclei they terminate. the thalarnus (nucleus medialis dorsalis thaiami) and run through the
T h e thalamic nerve cells are the cell bodies of neurons (II of anterior limb of the internal capsule into the cortex of the lateral
die ascending pathways of the crania] nerves. T h e axons of these and inferior surface of the frontal lobe. Some fibres of the anterior
neurons pass in the thalamocortical fasciculus (fasciculus thalamo- thalamic radiations connect the anterior group of the thalamic
cortkalii) to the cerebral cortex (postcentral gyrus) via the internal nuclei with the cortex of the medial surface of the frontal lobes
capsule. and the anterior part of the gyrus cinguli;
2. T h e lateral temniscus (letnnisats lateralis) (Fig. 826) contains (b) the central dialamic radiations (radiatianes thalamkae een-
the ascending decussated fibres of the eighth pair of cranical trales) are radially running fibres connecting the ventrolateral
nerves (see the description of the auditory nerve), g r o u p of the thalamic nuclei with the cortex of the pre- and post-
3. T h e medial lemriiscus (lemniscus jnedialis) is an aggregate of central gyri and with the adjoining parts of the frontal and parietal
ascending fibres arising in the nuclei of the fasciculus gracilis and cortex. They pass in the posterior limb of the internal capsule;
fasciculus cuneatus, the fibres of the spinnothalamic tract, and as (c) the inferior thalamic peduncle (peduntulus tkalami inferior)
cending fibres arising from the sensory nuclei of some cranial contains radial fibres connecting the pulvinar and medial genicu
nerves. late bodies with limited areas of the temporal cortex.
4. T h e auditory radiation (radiatio acusiica) stretches Irom the
T h e white matter of the cerebellum is made up of three groups scending (Figs 790-792), connect it with the spinal cord and brain
of fibres: (1) association fibres interconnecting various convolu stem, with the subcortical nuclei and the cortex of the hemi
tions within one cerebellar hemisphere; (2) commissural, or arci- spheres.
Tomi fibres passing from one hemisphere to the other; (3) projec These fibres form three pairs of cerebellar peduncles, the infe
tion fibres. rior, middle and superior peduncles (peduncuti cerebellares inferiores,
T h e projection fibres of the cerebellum, ascending and de medii et superiores) (see Fig. 777).
T H E A S C E N D I N G (AFFERENT) P A T H W A Y S O F T H E C E R E B E L L U M
T H E D E S C E N D I N G (EFFERENT) PATHWAYS O F T H E C E R E B E L L U M
T h e following are the descending (motor, efferent) tracts terior cerebrospinal tract (tractus cortkospinalis jpyramidalis] ante-
(Figs 79 i, 792). riorj; these fibres decussate level with the segment where they ter
1. T h e corticothalamic fasciculi (fasciculi corikothalamki) con minate on the cells of the anterior white columns.
nect the cortex of the cerebrum with the thai am us, T h e lateral cerebrospinal tract (tractus tortkospinalis jpyramida-
2. T h e corticorubral tract passes from the cortex of the frontal lis] lateralis) stretches throughout the whole length of the lateral
lobe (the pars opercularis) to the red nucleus, white column of the spinal cord, medial of the posterior spinocer-
3. T h e radiation of the corpus striatum is a system of fibres ebellar tract, and comes in contact with the cells of the anterior
connecting the cortical cells (extrapyramidal areas of the frontal grey columns of the spinal cord.
and parietal lobes) with the nuclei of the corpus striatum, and T h e anterior cerebrospinal tract (tractus corticospinalis fpymmida-
fibres connecting the caudate and lentiform nuclei with the thala- lisj anterior) descends in the medial part of the anterior white col
m u s and forming the ansa lenticularis. u m n of the spinal cord. Some of the fibres of this tract r u n , seg
4. T h e cerebropontine fibres (fibrae corticopontitiae) arise in ment by segment, in the white commissure (commissura alba) of the
different areas of the cortex of the cerebral hemispheres and termi spinal cord to the opposite side to come in contact there with the
nate in the nuclei pontis where the pontocerebellar fibres originate cells of the anterior grey columns, A lesser part of the fibres may
and stretch to the contralateral cerebellar hemisphere. T h e cere contact the cells of the ipsilateral anterior grey columns.
bropontine fibres are subdivided into the frontopontine (fibrae T h e cerebrospinal fibres (fibrae corticespinales) are processes of
frontepvntinae) and the parietotemporopontine (fibrae panetotetapor- neurons I of the motor pathway of voluntary movements; neu
optmiinae) fibres, ron II of this pathway is represented by the cells of the spinal ante
(a) the frontopontine fibres begin in the cortex of the frontal rior horns whose processes are components of the anterior roots
lobe, pass in the anterior limb of me internal capsule and the ven (radices anteriores) of the spinal nerves.
tral part of the cerebral peduncle, and terminate in the pontine 6. T h e rubro&pinal tract (tractus rubrospinalis) begins in the red
nuclei; nucleus (nucleus ruber) and stretches to the spinal cord. T h e fibres
(b) the parietotemporopontine fibres arise in the cortex of the descending from the cells of the red nucleus form a deeussation in
parietal and temporal lobes, stretch in the posterior limb of the in the mid-brain with the contralateral fibres and stretch downwards
ternal capsule and in the ventral part of the cerebral peduncle, and in the cerebral peduncles, pons, and medulla oblongata.
end in the pontine nuclei. In the spinal cord the rubrospinal tract passes in the lateral
5. T h e pyramidal tracts (tractus Pyramidalis) arise from die white columns in front of the lateral cerebrospinal tract (tractus cor-
large pyramidal cells of the cortical motor zone (the precentral gy licospinalis jpyramidalisj lateralis), and comes in contact with the
m s ) , run as components of the corona radtata, leave the hemi cfJIs of tile anterior grey columns.
spheres via the posterior limb of the internal capsule, and enter the
T h e rubrospinal tract links the extrapyramidal system and cer
cerebral peduncle. Descending, the pyramidal tracts stretch
ebellum with the spinal cord.
through the base of the cerebral peduncle and on the way form the
7. T h e tectospinal tract (tradus tedospinalis) is formed by the
pyramids (pyramides) on the anterior surface of the medulla ob
descending fibres of the cells of the quadrigeminal bodies nuclei.
longata.
They decussate in the mid-brain with the contralateral fibres and
T h e pyramidal tract fibres which run in the ventral part of the descend in the spinal cord as components of the anterior white col
cerebral peduncles, pons, and medulla oblongata are known as the u m n s to make contact with the cells of the anterior grey columns.
pyramidal fasciculi (fasciculi pyramidales). Some of the crossed fibres terminate on the cells of the pontine
Corticonuclear fibres (fibrae cortiamudeares), corticoreticular nuclei and motor nuclei of the cranial nerves, mostly those inner
fibres (fibrae cortkonticulares), and the cerebrospinal tracts (tractus vating the extrinsic muscles of the eye. These fibres form the tecto-
wrtkospinales) are components of the pyramidal tracts. bulbar tract (tractus iectobulbaris).
(a) T h e eorticonuclear fibres (fibrae corticanuckares) arise from 8. T h e vestibulospinal tract (tractus vestibulospinalis) (see
the inferior parts of the internal capsule and run in the basal part? Fig, 826) is formed by the descending fibres of the lateral vestibu-
of the cerebral peduncle, pons, and medulla oblongata to termi lar nucleus (nucleus lateralis acstibulark). Some of the fibres stretch
nate in the m o t o r nuclei of the cranial nerves on the opposite side. in the lateral white columns of the spinal cord and form the lateral
(b) T h e corticoreticular fibres (fibrae corticoreticulares) stretch ventriculospinal tract r u n n i n g ventral to the rubrospinal tract; the
from the cerebral cortex to the nuclei of the reticular formation. other fibres run in the anterior white column and form the anterior
(c) The cerebrospinal tracts (tradus cortkospinales) stretch to ventriculospinal tract. T h e fibres of this tract which occupy the
wards the spinal cord, and at the junction of the medulla oblon most medial position are known as the sukomarginal fasciculus
gata and the spinal cord, at the decussatiou of the pyramids (de- (fasckulm sulcomarginalis). T h e fibres of the lateral and anterior ven
cussatio pyramidum), become partially crossed, some of the fibres triculospinal tracts make contact with the cells of the anterior
passing to the other side to form the lateral cerebrospinal tract horns.
(tractus corticaspinalis /pyramidalis/ lateraUs) which enters the lateral 9. T h e olivospinal tract is a group of fibres descending from
white columns of the spinal cord, the other fibres stretch uncrossed the olive in the anterior white columns cord and terminating on
into the anterior white columns of the spinal cord to form the an the cells of the anterior grey columns in its cervical segments.
10. The bulboreticulospmal tract (tractus bulboretiailospinalis) is 12. The central tegroental Fasciculus (tractus tegmentalis centra-
formed by the axons of large cells of the medulla oblongata reticu- lis) passes in the tectum of the mid-brain lateral to the medial
lar formation. Its Sbres decussate, pass in the lateral white column longitudinal bundle (fasciculus Itmgitudinalis medialis). Its fibres arise
of the spinal cord, and make contact with the internuncial and mo for the most part from the grey matter around the aqueduct of the
tor neurons of the anterior grey columns, mid-brain, basal ganglia, optic thalamus, and red nucleus; de
11. The pontoreticulospinal tract (tractus pontoretkulospmalis) is scending, they connect these structures with the reticular forma
formed by the axons of the cells of the pontine reticular formation. tion of the brain stem and the nuclei of the inferior olive.
Its fibres are uncrossed and descend in the medial part of the ante 13. The otivocochlear tract (tractus olwocechlearis) is formed by
rior white column to come in contact with the internuncial neu the effector fibres of the cochlear nerve innervating the spiral or
rons of the anterior grey columns. As part of the anterior white gan. These fibres originate from the superior olive and stretch to
columns of the spinal cord this tract fibres are designated the reti- the spiral organ, both ipsi- and contralateral.
culospinal tract (tractus retiatlospinatis}.
Tractus
Kcipitopurtlinus et
ternpoTGpotllJnuii
Thalamus
Lob us
Erontalis
v
m— Medu]ia spjnails
" N. spirals*
792. Descending tracts of spinal cord and brain; superolateral surface (semischematical
representation).
(Projection of fibres on the surface of the hemisphere.)
— ——Corpus vertebrae
*" N. splnalls.
— I*ediculusarcuivcrterjrali5
(vertebral arch is removed)
Processes Ir^nsversus
■.. .a?'
nl.
Processus splnostis
Dura meter
Arachnoidea
Plexus venosus A
; rte bralis i nt emus (posterior) JM
Lig. Navum Pla mater
j / X splnalis pcskrlor
Substantia alba
Arcus vertebrae ,-ifam Radii dorsalis
Substantia grisea v
Medulla s p i n s l l ^ \ ^
l.Sg. dentJr.ulalum
Radix vetitralls ^ \
Ganglion spinale
^.(cotumunlcaas)
grtseus
f I
Ramus
ventral is
[1. spinalts
R.(communicans)
a! bus Ganglion
trund symfatlikl'
T h e spinal dura m a t e r (dura mater spinalis) (Figs 793, 794) lis, where the terminal ventricle (ventriailus termmalis) forms.
forms a wide, elongated from top to bottom, cylindrical sac. Its su Below the conus the d u r a mater is continuous with the filum of
perior border is at the level of the foramen m a g n u m . T h e dura ma the spinal dura mater (filum durue matris spinalis) which is attached
ter fuses with the periosteum of the inner surface of the foramen to the periosteum of the coccyx,
magnum and the first cervical vertebra. It is also fused intimately T h e roots, ganglia, and nerves arising from the spinal cord are
with the membrana tectoria of the atlanto-occipital joint and the invested in the dura mater as in sheaths which become wider to
posterior atlanto-occipital m e m b r a n e (membrana. atlanto-occipitalis wards the intervertebral foramina, which, consequently, also take
posterior), and is pierced here by the vertebral artery (artetiA vtrtebra- part in the fixation of the meninx.
lis). Very short connective-tissue bands join the dura mater to the T h e spinal dura mater is innervated by the meniugeal branches
posterior longitudinal ligament (ligamentum longitudinale posterius). of the spinal nerves (ram menitigri nervi spinalis) and supplied with
Downwards the dura mater sac becomes slightly wider, and at the blood by the branches ol the vertebral arteries and parietal
level of the second or third l u m b a r vertebra, i.e. below the level of branches of the abdominal and thoracic aorta; the venous blood is
the spinal cord, it is continuous with the narrowed cotius termina- collected in the vertebral plexuses.
T h e d u r a mater of the brain (dura muter encepkali) (Figs 677, T h e inner surface of the dura mater faces the brain. It is
796', 797, H02, HIM) is a strong connective-tissue structure in which smooth, shiny, and covered by endothelium. T h e dura mater of the
the outer and inner surfaces are distinguished. T h e outer surface is brain forms processes which stretch between the parts of the brain
rough and rich in vessels; it is directly adherent to the Cranial and separate them.
bones and is their inner periosteum. Penetrating the foramina Spaces form along the lines of attachment of the processes
through which the nerves leave the cranial cavity, it provides which are prismatic or triangular on section. These are the sinuses
sheaths for them. of the d u r a m a t e r (sinus durae matrix), the collectors draining the
T h e dura mater is poorly connected with the bones of the cal- veins of the brain, eyes, d u r a mater, and cranial bones into the sys
varia, except for the places where the sutures of the skull pass. In t e m of the internal jugular veins (venae jugu.la.res intemae). T h e si
contrast, on the base of the skull it is intimately fused with the nuses are devoid of valves and have tightly stretched walls which
hones. do not collapse when cut. Emissary veins (venae emissariae) open
Before closure of the fontanelies in children, the dura mater is into some of the sinuses and communicate them with the super
closely fused with the m e m b r a n o u s skull at the sites of their loca ficial veins of the head via the canals in the bones of the skull,
tion and is intimately connected with the bones of the calvaria.
T H E P R O C E S S E S O F T H E D U R A MATl'.R O F T H E BRAIN
T h e dura mater of the brain has the Following processes berance and stretches o n the internal occipital crest to the poste
(Figs 796, 797). rior border of the foramen m a g n u m , where it is continuous with
1. T h e falx cerebri lies in the sagittal plane between both two folds bounding the foramen posteriorly. T h e falx cerebelli is
cerebral hemispheres with the anterior part penetrating more deep situated between the hemispheres of the cerebellum in the region
ly. It arises in front from the crista galli of the ethmoid b o n e and of its posterior notch.
is attached by its convex margin to the lateral edges of the sagittal 3. T h e tentorium cerebelli stretches over the posterior cranial
groove of the frontal bone; it reaches the internal occipital protu fossa, between the superior angles of the petrous parts of the tem
berance and is continuous there with the superior surface of the poral bones and the grooves for the transverse sinuses of the occi
tentorium cerebelli. pital bone, and separates the occipital lobes of the cerebrum from
2, T h e falx cerebelli passes from the internal occipital protu- the cerebellum. It is a horizontally situated plate whose middle
( a d i j rloisalii
t
R. spinalls intercostaSia
pasterioris
A. tplrialis i n f e r i o r '
\i. spinahs'
A
..
Funiculus posterJot
-GorriLJ posteriLis
^-^ -"'X
R. dorsalis
a. intercostalis
\i
K. dorsal is
posteriori? R spinalis V intercostalis
J 1
\
« :
BHL^k-'FmiTCiilus latwalls
Cornu poaterius1
1
™*—Ckjrmi antenna
Radix venltati
795. Arteries and veins of spinal cord (artenae et venae spinales) (%).
A—anterior aspect; B — posterior aspect; C—superior aspect.
N oplicus
Sinus iransversus
Tentoriunr cerebelli
796. Dura mater of brain (dura mater encephalt); right and left aspect (%).
(The right part of the skull-cap is removed with horizontal and sagittal cuts.)
part is pulled upwards to form a tent. The free anterior margin is In the region of the trigeminal impression fimpressio nervi trigt-
curved and farms the tentoria] notch (indsum tentarii). The brain mini), at the apex of the petrous part of the temporal bone, the
stem passes here, dura mater separates into two layers. These layers form the trige-
4. The diaphragms sellae is a process which roofs the sella minal cavity feetmm tngemnak) in which the trigeminal ganglion is
turcica. The hypophysis ties under it. In the centre of the dia- lodged,
phragma is on opening pierced by the infundibulum on which the
hypophysis is suspended.
rtidlamiis
Septum pdluci'Jum ..
Gyms cinguli - J
*** pinealls
IS j B L - Splfnluni
I cnrp'orls callosl
Adriesiointfrthaliimira _ 1 ^ _i|M-3*- — — '~V "."erubrL inagna
rpl4S pineak
(jimnissuca
posterior
mis triniymuj
kqtireshierus Mtebrl
y
Corpus mam til a re
—-Mprlulla spinails
Mtdulla oblongata
Trachea
The sinuses of the dura mater of the brain are as follows 8. The inferior petrosal sinus (sinus petrosus inferior) emerges
(Figs 796, 797, 804). from the cavernous sinus and lies between the clivus of the occipi
1. The superior sagittal sinus (sinus sagittalis superior) is situ tal bone and the petrous part of the temporal bone, in the groove
ated on the bulging side of the superior margin of the falx cerebri. for the inferior petrosal sinus. It ends in the upper bulb of the in
It begins at the crista galli, stretches to the back on the midline, ternal jugular vein.
grows larger gradually, and ends in the transverse sinus (sinus trans- 9. The network of the basilar sinuses (plexus basitaris) is situ
versus) at the internal occipital protuberance. ated on the basilar part of the body of the occipital bone. It forms
To either side of the superior sagittal sinus, between the layers from merging of several transverse communicating venous chan
of the dura mater, are numerous slit-like spaces called the lateral nels running between both inferior petrous sinuses.
lacunae (lacunae laterales) into which granulations project. 10. The occipital sinus (sinus ocripilalis) lies on the internal oc
% The inferior sagittal sinus (sinus sagittalis inferior) runs on cipital crest. It emerges from the transverse sinus and divides into
the inferior margin of the falx cerebri into the straight sinus (sinus two channels which embrace the lateral borders of the foramen
rectus). magnum and end in the sigmoid sinus. The occipital sinus anasto
3. The transverse sinus (sinus transvtrsus) lies in the groove for moses with the internal vertebral plexus (plexus venosus vertebrate in-
it on the occipital bone. It is the largest among all of the sinuses. ternus).
Curving round the mastoid angle of the parietal bone, it is conti The confluence of sinuses (confluent sinuum) is a venous dilation
nuous with the sigmoid sinus (sinus sigmoideus). The last-named de which forms where the transverse, superior sagittal, straight, and
scends in the sigmoid groove to the jugular foramen and is contin occipital sinuses merge. It corresponds in position to the eminentia
uous with the upper bulb of the jugular vein (kitbus venae jugularts cruciata (eminentia cruciformis) of the occipital bone.
superior). The dura mater of the brain is separated from the arachnoid
The sinus drains two emissary veins which are connected with mater by capillary slits containing a small amount of cej-ebro spinal
the external cranial veins. O n e is in the mastoid foramen, the Quid.
other lies on the floor of the eondylar fossa of the occipital bone, The dura mater of the brain is innervated by the mcumgeal
in an inconstant and usually asymmetric posterior condyiar canal. branches of the trigeminal and vagus nerves, the sympathetic
4. The straight sinus (sinus rectus) lies on the line connecting nerves arising from the periarterial plexuses (of the middle menin-
the falx cerebri with the tentorium cerebelli. Together with the su geal artery, vertebral artery), and from the cavernous plexus, by
perior sagittal sinus it ends in the transverse sinus. branches of the greater superficial petrosal nerve, and the otic
5. The cavernous sinus (sinus cavemosus) is named so due to the ganglion; intertruncal nerve cells are sometimes present with hi
presence of numerous septa which lend it the appearance of a some nerves. Most nerve branches of the dura mater follow the
cavernous body. It lies on either side of the sella turcica. On trans course of its vessels, with the exception of the part in the region of
verse section it is triangular and has three walls—superior, exter Lhe tentorium cerebelli where, in distinction from other areas, the
nal, and internal. In the superior wall lies the oculomotor nerve dura/mater is poorly vasculariaed and most of the nerve branches
(nervus oculomotorius), below lies the trochlear nerve (neruus trochha- pasi on it independently of the vessels.
ris). The lateral wall lodges the first branch of the trigeminal nerve, The first branch of the trigeminal nerve, the ophthalmic nerve
the ophthalmic nerve (nervus opkthalmicus). The abducent nerve (nervus opkthalmicus) sends small branches to the dura mater in the
(nervus abducent) stretches between the trochlear and ophthalmic: region of the anterior cranial fossa, anterior and posterior areas of
nerves. the calvaria, as well as to the falx cerebri as far as the inferior sagit
The internal carotid artery (arteria carotis internet) with its sym tal sinus, and to the tentorium cerebelli (the nerve to the tentor
pathetic carotid plexus (plexus taroticus) passes in the sinus. The su ium jramus lentariif). The second and third divisions of the trigemi
perior ophthalmic vein (vena aphthalmim superior) empties into the nal nerve, namely, the maxillary nerve (nervus maxillaris) and the
cavity of the sinus. The right and left cavernous sinuses communi mandibular nerve (nereus -mundibulans) send the middle meuingeal
cate in the anterior and posterior parts of the diaphragma scllae branch (ramus meningeus medius) and the nervus spinosus (ramus
via the intercavernous sinuses (sinus mtercavernosi). The large sinus meningeus nervi mandibularis) to the dura mater in the region of the
formed in this manner surrounds the hypophysis cerebri lying in middle cranial fossa, to the tentorium cerebelli, and the falx cere
the sella turcica. bri. These branches are also distributed in the walls of the adjacent
fi. The sphettoparietal sinus (sinus sphenoparietalis) is paired. It venous sinuses.
stretches medially along the posterior margin of the lesser wing of The vagus nerve sends a meningeal branch (ramus meningeus
the sphenoid bone and ends in the cavernous sinus. nervi vagi) to the dura mater in the region of the posterior cranial
7. The superior petrosal sinus (sinus petrosus superior) is also a fossa up to the tentorium cerebelli, and to the walls of the trans
continuation of the cavernous sinus. It lies on the superior border verse and occipital sinuses. Besides, the trochlear nerve (nervus
of the petrous part of the temporal bone and connects the caver trochkaris), the glossopharyngeal nerve (nervus glossopharyngeus), the
nous sinus wjth the transverse sinus. accessory nerve (nervus accessorius), and the hypoglossal nerve (tier-
Bulbus olfacturius
Lobus front*lis
i j N . oplinis
Ctetema chlasmatls
A. cjrolls hifern
Aiqchnoiden ence-pha
(partly removed) Hypophysis
■A. rojnmunlcans
posterior
orpus mamiJiare
N. oruloiiiolorius-" T'/^SF'j^ Oisierna interpcdunculari!
{incomplettly opened)
9-N. trljjerninus
Pons •
—V, eerebrl inferior
N. hypoglossus
A. vertebralis
Cerebellum
Medulla (iblorigat
m hypoglossus) may take some part in the innovation of the dura in**™ rt- , u
mater of the brain. a t t e r y - t h e mastoid branch (ramus ma^deus crime* ocvf>iialis);
hthaln,ic
The dura mater is supplied with blood bv b r ^ r h e , ii i ^f °P " t e y - t l * anterior ethmoidal artery fcr-
(1) fa* the m^iHary J S j S L ^ ^ X S ^ Z r l Z 1 ^ ^ * " * * ' ***** ""»* 2 * *
^ ^ S f r 0 n 7 , e vertebral r n r ^ C : J ^ S T S ? ^ ^ ^ * * " * * * *
branch fr a w ( w «WM«»|i a r f c w ntrttbmlu); (3) from the occipital
\
Splenium carports
Fornij callosi
^ 1 *
Plexus choriotdeus
V. cerebrl magna
Septum peltucidum .'
Genu corporis ■• ^ - ^
callosi - t3
Fissura transversa
Thalarnus —. cerebri
Lamina tectf
Peclunculus cerebri
Aditus ad
aquatductum cerebrf Ventrlculus quartua
A. cerebrl anterior
('is terra cbtasmatls Cerebellum
N, oprfcus
Cisterns Irtterpeduncularis
A. carotls Inttrna''
Hypophysis
Arathrtotdei
N oculomotorlus' /
A basilans (cut) '
Cisterna cerebtdomedullirt!;
799. Arachnoid mater and pia mater of brain (arachnoidea etpia mater encephali); medial surface
( % ) ■
(Sagittal-median section; an area of the arachnoid mater m die region of the medial surface of the hemisphere is removed.)
The spinal arachnoid mater (arachnoidea spinalii) (Figs 79$, the arachnoid and pia mater of the spinal cord. These are more Or
79+), like the spinal dura mater, is a sac encasing the spinal cord less large cavities, particularly in the anterior and posterior parts,
quite freely. Between it and the dura mater is a space of capillary- with a transverse measurement of up to 1-2 cm. They are filled
like slits—this is the subdural space (cavxm subduraU). with cerebrospinal fluid (Uquor cerebrospinalis).
The subarachnoid spaces (cave suhaTachnoidealia) form between The arachnoid mater is connected to the dura mater in the re
gions where die spinal nerve roots penetrate the spinal dura mater and pia mater by means of special ligaments called the ligamenta
(see above). It is connected with the spinral pia mater by numerous denticulata. These are connective-tissue membranes, 2 0 - 2 5 in
fine connective-tissue bands which Form, particularly in the poste number, which lie in the frontal plane on either side of die spinal
rior part, the subarachnoid septum. cord and run from the pia mater to the inner surface of the dura
The arachnoid mater is also connected with the spinal dura mater.
T H E A R A C H N O I D MATER O F T H E BRAIN
T h e arachnoid mater of the brain (arachnoidta ewepkali) degree, on the sides of the transverse sinus, as well as tiext to other
(Figs 798, 799, 802) is covered, like the spinal arachnoid mater, by sinuses the arachnoid mater gives rise to processes of various size.
endothelium. It is connected to the dura and pia mater of the These are the arachnoid granulations (granulatuntei arachttoideaUs)
brain by epi- and subarachnoid connective-tissue trabeculae. Be which enter the dura mater and together with it penetrate the in
tween the arachnoid mater and the dura mater is a slit-like subdu- ner surface of the cranial bones or the sinuses; the bone tissue be
ral space filled with a small amount of cerebrospinal fluid. comes indented in these areas due to arachnoid granulations leav
The external surface of the arachnoid mater is not generally ing small depressions called the granular pits (foot&lae granui&rcs),
fused with the overlying dura mater. In some places, however, the number of which is particularly great close to the sagittal su
mainly on the sides of the superior sagittal sinus and, to a lesser ture of the skull-cap.
. .. , Corpus callosum
Sulcus corpons callosl . Fnrnin
cerebri anterior
Sulcus drigull.
A. cerebri anterior
Fissiirs
paTleloocdpitalis
/
A. cerebri anterior''
Sepliiin pellucidum''
A. .: ■ rl :i: ■ ..;! i:■: n i ; r
Sulcus cekarinus
Cotrimissura A. cerebri posterior
anlerio Corpus plneale
Lamina termtrsalls
Lamina letti
Chtasma opttcum Pedimculus cerebri
A. cacotts intcrra Adhesio irtterlhalamk'a
I \
RcceSSUS frtfjrldlbull ' I A. cerehri posterior
A, Communicans posterior t o r p u s raamillire
801. Arteries of brain (arteriae cerebri); right hemisphere; medial surface {%).
The inner surface of the arachnoid mater faces the brain. It is (5) along the superior surface and genu of the corpus callo-
intimately fused with die pia mater on die bulging parts of the gyri s u m - t h e eisterna corporis callosi (BNA);
but does not follow it into the depths of the sulci and fissures. The (6) on the floor of the transverse fissure of the cerebrum, be
arachnoid mater, therefore, bridges the gyri, and where it is not tween the occipital lobes of the hemispheres and the superior sur
fused with the pia mater the subaraehnoid spaces (cava subaraeknot- face of the cerebellum—the eisterna ambiens (BNA); this eisterna
dealta) are left. has the appearance of a canal and runs on the sides of the cerebral
The subaraehnoid spaces communicate throughout the whole peduncles to the tectum or the mid-brain;
surface of the brain, as well as the spinal cord. In some areas these (7) under the middle cerebellar peduncles and to the pons—
spaces are cjuite large and are railed the subaraehnoid cisternae the eisterna lateralts pontis;
(riiUrnae svbaracknoideales) (Fig, 800), The cistemae are lodged: (8) in the region of the basilar sulcus of the pons—the eisterna
(1) between the cerebellum and medulla oblongata^the cere- (medialis) pontis.
bellomedullary eisterna (asiema cerebcllojnedullaris); The sabarachnoid cavities of the brain communicate with each
(2) in the lateral sulcus of the cerebrum —the eisterna of the other and with the brain ventricles via the median and lateral aper
lateral sulcus (eisterna fossae lattrelis cerebri); tures of the Fourth ventricle.
(3) between the cerebral peduncles — the interpeduncular eis The eerebrospinal fluid is collected from different parti of the
terna (cislerna interpeduncularis); brain in the subaraehnoid space. The fluid outflow is effected via
(4) between the oplic chiasma and the frmital lobes of the the perivascular and periiieurai slits and the above-mentioned
brain —the chiasma tic eisterna (tisttma chiasmatis); arachnoid granulations into the lymphatic and venous channels.
Ililllllhllll
V. ecnissarisi
!•_■'■' SuhfiiiiUHji'm'- vein*
of head
— Camilla
extema
! J^Cnnniila1:nnt'S
S; urii.-iii rji.i.-nks
Pura mater _
Granulations
Pia mater
-Cavum
ubara^hnoidtale
Arachnnidefl
The spinal pia mater (pia mater ipinaiis) (Figs 793-795) is median suture. The Iigamenta denticulata which arise from the pia
somewhat thicker and stronger than that of the brain. It fits closely mater between the anterior and posterior roots and are attached to
to the external surface of the spinal cord and dips into its anterior the dura mater, fasten both membranes to each other.
The pia mater of the brain (pia mater amphdi) (Figs 798-802), Penetrating into the transverse fissure of the cerebrum and the
in distinction from the two membranes described above, is inti horizonta! fissure of the cerebellum, the pia mater is stretched be
mately adherent to the brain matter and dips into all sulci and tween the parts by which these fissures are bounded and closes the
fissures; only on the projecting parts of the gyri it is fused closely cavities of the diird and fourth ventricles posteriorly.
with the arachnoid mater. The pia mater of die brain is connected The choroid plexuses (plans dwrioutei) and the telac choroideae
with the surface of the brain less intimately than the spinal pia ma (which are described in the sections dealing with the lateral, third,
ter. and fourth ventricles) arc connected with the pia mater of the
The blood vessels embedded in it connect it with the brain brain.
and, according to some authors, merely a narrow slit known as the The pia mater of the brain is innervated mainly by nerves aris
epicerebral, or subpial, space separates it From the brain surface. ing from plexuses which accompany the internal carotid and verte
The perivascular spaces separate the pia mater from the vessels bral arteries. It is supplied with blood by the branches of these ar
and thus form their sheaths. These spaces communicate with the teries.
subarachnoid space.
The nerve fibres which are components of nerves are the pro
The living organism functions according to the principle of re cesses of nerve cells differing in morphology and function; (a) mo
flex response and is a unique system capable of autoregulation. tor cells lying in the anterior grey columns of the spinal cord or ,n
This is accomplished by input of information from the perceiving the motor nuclei of the cranial nerves in the brain stem; (b) sen
nerve apparatuses, its processing, and transmission of regulating sory cells forming the ganglia of the spinal nerves (ganglm ^naha)
signals to the periphery. The peripheral nervous system provides or those of the cranial nerves; (c) autonomic nerve cells lying tn
the structural basis Tor information input and ttansmiss.on. From the lateral grey columns of the spinal cord, in the ganglia of the
the periphery the information arrives to the centres of the spinal
sympathetic trunks, or in the nerve ganglia of the interorganic Or
cord and brain along the afferent, sensory nerve* (Mm sensma),
intraorganic autonomic plexuses.
and from the centres it is transmitted to the periphery along the
The nerve fibres are therefore subdivided into motor, or effer
efferent, motor nerves (nervi motorieus).
ent among which autonomic (vegetative) fibres arc distinguished,
The peripheral nervous system consists of nerves ans.ng from
and sensory, or afferent, _
the b r a i u - t h e cranial nerves (mwi Bttwfcg, nerves arising from The motor nerve fibres innervate the somatic muscles, in which
the spinal e o r d - t h e spinal nerves (mtni spinaUs), and nerve cells they terminate by motor endings.
located beyond the ranges of the central nervous system. The sensory nerve fibres begin by a variety of receptors in all
Each nerve is an aggregate of the processes of nerve cells.
body organs and tissues and convey impulses from them to the
Some groups of nerve fibres are surrounded by a connective-tissue
central nervous system.
sheath which is called the perineurium. Its processes penetrate be The fibres of the autonomic (vegetative) nervous system (sym
tween individual nerve fibres to form the inner connective-msue pathetic and parasympathetic) stretch to the internal organs, blood
membrane called the endoneurium (Fig. 805). vessels, skin appendages (hair, glands), to the muscles, etc. (see The
The whole nerve is surrounded by connective tissue forming
Autonomit Nervous Sjutem).
the epineurium. According to the type of fibres prevailing in them, the nerves
A nerve fibre consists of a nerve cell process (an axis cylinder, are jrrouped into motor, sensory, mixed, and autonomic (vegeta^
or axon) which is composed of neurofibrils running throughout its tive) The nerves appear on the brain surface as motor or sensory
length and surrounded by the axoplasm. In some nerves the axon roots. The motor roots are axons of motor cells lying in the spinal
5, surrounded by a myelin sheath which is covered by the neun- cord and brain, the sensory roots are axons of nerve cells of the
lemma; in others the axon is covered by neurilemma only. The spinal ganglia (or ganglia of the cranial nerves).
fibres of the first type are called myelinated, or medullated The The fibres of a motor nerve reach without mtemipt.on the or
myelin sheath, however, is not continuous but mterrupted in
gan which they innervate.
places by nodes in the region of which the axon is covered only by
The sensory nerve is formed distal to the sensory (cranial or
neurilemma. The fibres of the second type are called unmyeh-
spinal) ganglion, so that its fibres running from the ganglion to the
nated. Or nonmedullated. .
periphery are the dendrites of neurons lying in the ganglion.
The myelinated fibres constitute the main mass of the cranial
The motor fibres are only adjacent to these ganglia. The sen
and spinal nerves. The unmyelinated nerve fibres are found for the
sory and motor fibres stretching from the ganglia to the periphery
most part in the autonomic (vegetative) nervous system (postgang-
form a mixed nerve (see Tht Spinal Naves).
lionic fibres), and among fibres of some sensory pathways (e.g. Running to the periphery, the mixed nerves unite, exchange
those of pain sensibility).
Sulcus olfactorius
Bulbus oliactori N, olfactorius (tractus
olfactorius) (!)
Trattus olfactorius Chfasma opticum
radix sensoria*
Pons
Pedunculus-
cefebrlljaris
tiled! us
S'. facialis (VIO
Oliva - N. Intermedium
Pyramid (medullae
ot>1ong;itae>—""" M vestibulocodilearisfVlll)
N, glossepttai'yngeus
N. accessorius (XI)
Medulla spinalls N. hypoglossus (X11J
,N. opticus
Falxceiebri
rA. t'.iwis interns
Butbits olfactorius—
Diaphragma sellae
InfurulibuluitK. laxilhiris
Sinus
intertavcrnosus jbducens
■N. mantlihitlarfs
Sinus cavernos
N. trigeminus
p!exus basilans
N. facialls
Dura mate
enwphal ^N.vesl.ibulo-
Vv. mefilngeac—
mediae cochlearis
Sinus pdros
Inferior
■N, hypoglcssus
Sinus petr "-■ [
superlo
^ **- ^™ tiff?-
Sinus sigm Wffi ^Suk'iis -.inns sigmoi<iei
K j ^ p ' ^ N . accessorius
Mty ^Medulla oblongiita
irat?^—Sulms sinus fransversi
I^F-Coilfluens sinuutn
y
t s i n u s sagittalis superior
Sinus rectus
804 Inner surface of base of skull with cranial nerves passing through it; superior aspect (%).
805. Innovation and blood supply ofn^ve trunk (schematic representation) (after
W
l^outeT epirceuriuiu
-outeT epineuriuin V
2-innertpineurium
-inner epineuriu™ fiQtcrfa«icuI»r
(iotcrfawicular tisau:)
tisane) 6—internal cpioeural ato
iZ'"^.?"™'*' neurovajcular
™*™l*TplexuipJ~ui
J— panfatKicular neurovastulsr ftttm 111L—- lamellar
|»nre lblrbodies
bodie,inifl perineurium
™„.,^..„
3 — penneurjuiu
fi —perineural aeurovascular plej,„s IS-origin of twig from bundle to sheaths of nerve
+ — endaneurium
9—endoneuta] neitrovucular plexus 13-WJseh and nerve, penetrating into epuieurium
5 - M t e m a l epintura] neurovajcukr p l n u j
10-laraellar bodie* in epinetirium
T H E CRANIAL NERVES
The cranial nerves (ncr* cranioUs) are linked anatomically
™inly with the brain stem b which their nuclei are located The pass through the foramina of the base of the skull (Fig 804) to di
cranial nerves emerge on the b a s e of the brain (Fig. 803) and then - d e mto terminal branches ^ h i n g the regions which they inner-
Tiaclus olfflctorlua
R. nasalis Intertills
D. elhnioldalls
Nn. olfaclorll snteiforta
N_ optlcus a
Sinus sphenoidalis-
Flsaura N. fiasopalatlnus
orbllslls superior
Nn. paktlnl
major el m f n o r e s ^ j .
N. paialinus mafor
Lamina lateralis
processus ptcrygoidei
Palatuin mo Ik'
The 12 pairs of cranial nerves arise from the brain. They are as 11. The accessory nerve (nervus accessories) (XI).
follows. 12. The hypoglossal nerve (nervus hypoglossus) (XII).
1. The olfactory nerves (nervi olfadorii) (I). The first pair of cranial nerves, the olfactory nerve (nermts vifac-
2. The optic nerve (nervus optieus) (II). # torius), arises from the telenccphalon; the second pair, the optic
3. The oculomotor nerve (nervus oatlomoiorius) (III). nerve (nervus opiicus), from the diencephalon; the third and fourth
4. The trochlear nerve (litmus trochlearis) (IV). pairs, the oculomotor and trochlear nerves ( i n w ocukvwtorius et
5. The trigeminal nerve (nervus trigtminus) (V). nervus trachltaris), from the mesencephalon; the fifth, sixths, sev
6. The abducent nerve (nervus abducent) (VI). enth and eighth pairs, the trigeminal, abducent, facial, and audi
7. The Tacial nerve (nervus facialis) (VII) (the sensory root of the tory nerves (nervi trigeminus, abducent, facialis et vestihulocotkharis),
facial nerve [nervus infermediusj). from the metencephalon; the ninth, tenth, eleventh, and twelfth
8. The auditory nerve (nervus vesiibulococktearis) (VIII). pairs, the glossopharyngeal, vagus, accessory, and hypoglossal
9. The glossopharyngeal nerve (nervus glossopharyngeus) (IX), nerves {nervi glo.fsopkaryn.geus, vagus, atxessorias et hypoglossus), arise
10, The vagus nerve (nervus vagus) (X). from the myetencephalon.
Nerv>
bulbos oJfactori Isthmus gyri
CoHCil. cingult
:-■:!:: 511]
Corpus mfiinltUre
Nn. Fimbrla hippocampi
olfactorii
Fibres from urttus
<; to corpus mam ilia re
W * Oyrus dentatus
'Gyrus paraliippoearnpalis
Concha. > l
UnCiiS
iiasali" media ' * LobuB lemporalis
\ A re a of cortical olfactory
Concha I analyser
nasalls inferior Stria olfactoria
Before leaving the cavity of the skull t h e cranial nerves are Ibl- t h e brain and skull, and the regions of ^ r i b u t i o n of the main
lov.ee! by the meninges. branches are shown in the T a b l e o n p p . 163-167).
T h e location of the cranial nerves nuclei, die sites of exit from
T H E OLFACTORY NERVES
Bulbus oculi
Bulbus olfactorius
Fissura opticus
longlmrtinalis cereh-i— — —;
Tractus olfaclorhis
i ^ Chiasnia upticum
Sukus latei-p]is
Trlgormm olfartorium
Substantla perforate
Hypophysis-^ aulerior
Trattus opticus
Infurulirjuluni ■
Tuber cinereiim —I —
i N. oculotnotorius
Corpus mamillare - 4 | M
Substantla Pedunculiis
perforats oosterior— M cerebri
Fossa
inter peduncular!:-
Corpus gerricuiatuiti
laterals
Substantla c i l g r a - ^ ^ ^
^ - C o r p u s genlcutatum meddle
Nucleus ruber-""" Aqueductus cerebri
"■ Pulvinar
Teelum mesertcephali
808. Optic nerves and optic tracts; inferior surface of brain (%).
(Most of the frontal lobes and pons are removed.)
olfactory striae (striae olfadoriae): the lateral, intermediate (or mid The medial olfactory stria runs to the medial surface of the
dle), and media] striae, whose fibres run different routes to the cor hemisphere, under the rostrum of the corpus callosum. After that
tical end of the olfactory analyser—die uncus of the hippocampal some of the fibres pass into the septum lucidum (septumpelfaadum)
gyrus. and then on the fomix and the fimbria of the hippocampus to
The lateral olfactory stria is the largest. It runs backwards and reach the uncus; the rest of the fibres stretch in the medial longi
laterally and ends in the cortex of the uncus sending on its way tudinal striae (stria/: longitudinals! mediates), and then on the splenial
some fibres to the amygdaloid nucleus (corpus amygdatoidettm) gyrus (gynisfasciolares) and dentate gyrus (gyrus dentatits) also to the
(Fig. 807). uncus.
Some fibres or the intermediate olfactory stria terminate on the The nervi terminates, made up of several nerve fibres stretch
neurons of the interior perforated substance (subslantia pwjorata ing between the dura mater and the periosteum, sometimes run
anterior) of the same side. The other fibres pass in the anterior parallel and medial to the olfactory tracts. They begin in the mu-
commissure to the opposite side to end there also in the anterior cosa of the olfactory region of the nasal septum, pass through a
perforated substance. The neuronal axons of the perforated sub foramen of the cribriform plate, and reach the medial olfactory
stance pass rnrough the lamina of the septum lucidum into the for- stria by several roots.
nix and then reach the uncus along the fimbria of the hippocam
pus.
T H E O P T I C NERVE
The optic nerve (nervus opticus) {second pair) (Figs 803, 804, terna nervi optici) which is formed by the pia mater of the brain.
808, 809) is a nerve of special sense, Its fibres begin from the gang- Slit-like intervaginal spaces (spatia intervaginalia ntrvi optici) sepa
lionic cells of the retina of the eye and pierce the choroid and rate the internal sheath from the external sheath of die optic nerve
sclera to form the intra-orbital part of the optic nerve. After pass (vagina externa nervi optici) formed by the arachnoid mater-and dura
ing through the fatty body of the orbit (corpus adiposum orbifue) the mater. Arteries and veins pass in the intervagina! spaces (Fig,943).
optic nerve stretches through the common tendinous ring (anulus Each optic tract curves round the lateral surface of the cerebral
tendintus commanis) into the optic foramen (canalis opticus) (the sec peduncle and terminates in the primary subcorticai visual centres,
ond part) and leaves the orbit to enter the cavity of the skull (third which are represented on both sides by the lateral geniculate body
part). In the region of the optic groove (svkus ckiasmatis) of the (corpus genkulatum lattrak), the pulvinar, and the nuclei of the su
sphenoid bone partial decussation of the fibres of the optic nerves perior quadrigeminal body (nuclei coUUuli supenoris tecti mesence-
occurs, which is called the optic chiasma (diiasma optUum). pkali).
The lateral part of each optic nerve fibre stretches further on Fibres arising from the cells of the lateral geniculate body and
its own side.
the pulvinar stretch through the posterior limb of the internal cap
The medial part crosses to the opposite side where it joins the sule into the hemisphere, form the optic radial ion (radiatio optica),
fibres of the lateral part of the optic nerve of this side to form the and end in the cortex of the media! surface of the occipital lobe
optic tract (tractus option). j along the sides of the calcarine sulcus (sulats ealcarinus).
Thus, the right optic tract contains fibres from the right halves Fibres which arise from the superior quadrigeminal bodies run
of both retinae, the left optic tract—fibres from the left halves. to the nuclei of the oculomotor and other cranial nerves as well as
The optic nerve is surrounded by an internal sheafh (vagijia tn- in the tectospinal tract (tractus tectospinalis).
T H E O C U L O M O T O R NERVE
The-^oculomotor nerve fwraw aculomotorius) (third pair) 1. The superior branch (ramus superior nervi oculwnotarii) is
(Figs 803, 804, 808-810) is a mixed nerve. Its nuclei lie in the teg- smaller and runs on the lateral surface of the opric nerve; it divides
menLum of the cerebral peduncles, on the floor of the aqueduct of into two small branches which approach the levator palpebrae su
the mid-brain at the level of the superior quadrigeminal bodies
penoris muscle and the superior rectus muscle.
(see Figs 771, 772).
2. The inferior branch (ramus inferior nervi ocuUmoiorii) is
The group of nuclei of the oculomotor nerve includes the dor- Stronger and at first lies, like the upper branch, lateral to the optic
soUteral nucleus (nucleus doriolateralis), the ventromedial nucleus nerve. In the orbit the inferior branch divides into three small
(nucleus ventromedialis), the unpaired caudal central nucleus (nucleus branches: the medial one runs to the medial rectus muscle; the
caudahs czntralis), and paired autenomic (parasympathetic) acces
middle, shortest, branch innervates the inferior rectus muscle; and
sory nuclei (nuclei accessorii).
the lateral, longest, branch passes on the inferior rectus muscle to
The oculomotor nerve appears from the depths of the brain the inferior oblique muscle. In addition, the lateral branch gives
matter next to the anterior border of the pons, between the cere rise to the motor root of the ciliary ganglion (radix oculomotoria)
bral peduncles, in the region of the interpeduncular fossa (fossa in- which is formed nf axons of the parasympathetic nucleus cells, and
terpeduncularis). Then it runs forwards, lies in the fissure between stretches to the ciliary ganglion (ganglion dliare) (Figs 809, 811).
the posterior cerebral and superior cerebellar arteries, penetrates Besides the motor fibres described above, the oculomotor
the dura mater, passes in the superolateral area of the cavernous si
nerve contains sympathetic fibres which pass from the sympathetic
nus lateral to the internal carotid artery, and enters the cavity of
plexus surrounding the internal carotid artery and arc called the
the orbit through the superior orbital fissure.
internal carotid plexus (plexus caroticus internus), and sensory fibres
Before entering the orbtt, the oculomotor nerve divides into su arising from the ophthalmic nerve (aervus ophthalmkus) which is a
perior and inferior branches. division of the trigeminal nerve (nervus trigeminus).
Pulvlnar
Lobus temporal Is ' Sybcortical visual centre
Nucleus kntiuularh ' / i n pulviriar
Tlialairiu F o r n i j i (partly r e m o v e d )
Nucleus caudatus
/ .Rsdiatlo optics
^.Subcorticiil visual centre
* i n corpus
Lobus frorrtatisx gcniculatum lateraLe
Sukus calcarinus
Lobus ocdpitalis
Chtasms optlcum-.
Butbus ( v i i i i ...
N, ppficns
Ganglion ic cells ^
in retina A r e a striata (area o f
visual analyser
Nn. dliares breves—,T— in cortex)
—-Cerebellum
SubcorticaJ visual centre
in colliculus superior
Ganglion c i l i a r e / /
Colliculus superior
TractuS o p t i c u s ' Fossa rhomboidea
N. oeuktmotorius' /
A x o n s o f nucleus / Tractus irctospinsks
accessor ius (autonomicus)^ tt. o c u l o m o t o r i i
passing in i in mcscncephakin
n. o c u l o m o t o r i u s , Medulla oblongata
to ganglion ciliare - Thalamus (cut)
Fibres connecting
colliculus superior
w i t h nucleus accessor!us
(autoTuimicus)
n, o c u l o m o t o r i i
The trochlear nerve (turvus trockleans) (fourth pair) (Figs 803, fissure between the temporal lobe and the cerebral peduncle. Then
804, 810, 811) is a motor nerve. The nucki of the trochlear nerves it runs forwards, pierces the dura mater, and passes in the lateral
lie in the raid-brain, on the floor of the aqueduct, at the level of wall of the cavernous sinus. After that the trochlear nerve enters
the inferior quadrigeminal bodies (see Figs 771^72), the orbit through the superior orbital fissure over the common
The trochlear nerves appear from the brain matter behind the tendinous ring, runs next to the ophthalmic nerve, above the ocu
inferior quadrigeminal bodies, on either side of the frenulum veli. lomotor nerve, and then slightly medially to reach the superior ob
Each trochlear nerve curves round the lateral side of the cerebral lique muscle (musadus obliquus superior).
peduncle. The nerve emerges on the base of the brain from the
^W^^^^^ktK . supratrochlearis
M, obliquus superior
1 SupraorbitaliR
CjLmduEa lacriTTitilis
M. levator palpebrae
Bulbus olfactories
N. l&crimsHs
rectus superior
N. fronlalis
N. Innliiearis
( - ♦ - D u r a mater
encephali
TntujifJIblilum —
N. optilbalmicus
Dorsum seilae
S^'~-=l-fc-Sinus pcfrosus superior
N. oculoirotorius
N. maxlllftris N. mandibulflris
/N. supraorbltalis
N. optic us
I ;ni inn crlbrosju.
R. sympathicus
ad ganglion qjliare-* —■ —
U+*.* x oculornotoria
TRamus cmiimunicans
N. liicmnalii .cum 11. nasociliari
N. frontalls —*£j
N. trochlearis-
A. carotis Iqleina
. Hypophysis
Plexus cavernOsus
N, M]l!|ll|>ii]i:ic ..h:
Dorsuin sellae
r\'_ maixillaris
T H E TRIGEMJNAL NERVE
The trigeminal nerve (nervus trigemmus) (fifth pair) (Figs 803, the nucleus is not clear to date: some authors consider it to be mo
804, 81U-82!f!) is a mixed nerve. It has a motor and sensory nuclei tor, others —sensory.
(sec Figs 771, 772). The trigeminal nerve appears on the base of the brain by two
The motor nucleus of the trigeminal nerve (nucleus motorius parts (roots) - sensory and motor—from the depths of the pons
nervi trigemini) lies in the posterior part of the pons in the eminen- where the middle cerebellar peduncle (pedunculus cerebellaris medius)
tia medialis tn front of the nucleus of the abducent nervt. From arises, Both parts stretch forwards and laterally into the slit be
the aspect of the floor of the fourth ventricle (fossa rhomboidea) it is tween the layers of the dura rnater. The trigeminal cavity (tuvum
projected medially of the locus coeruleus. trigeminale) forms here along the course of the sensory part be
The processes of the cells of this nucleus descend to form the tween the layers of the dura mater. It is located Ofl the trigeminal
motor part (root) of the trigeminal nerve (portio minor [radix mo- impression (impressio nervi trigemini) on the apex of the petrous part
toris.} nervt trigemini). of the temporal bone.
The sensory nuclei are as follows. The cavity lodges a relatively large (measuring from 15 to
1. Tli e superior sensory nucleus of the trigeminal nerve (nu 18 mm in length) trigeminal ganglion (ganglion trigeminaU) whose
cleus sensonvs printipalis [superior} nervt trigemini) is located in the concavity faces posteriorly, and convexity anteriorly,
posterior pan of the pons lateral and to the back of the motor nuc The trigeminal ganglion is an aggregate of nerve cells. Their
leus in the locus coeruleus. It is composed of cells on which termi afferent processes form the sensory part of the trigeminal nerve
nate the ascending fibres of the sensory pan (root) of the trigemi (portio major nervi trigemini s. radix senstnia) while the processes
nal nerve (portio major [radix sensoriaj nervt trigemini) running from which run to the periphery form the sensory fibres of all branches
the trigeminal ganglion (ganglion ingeminate). of the trigeminal nerve.
2- The nucleus of the spinal tract of the trigeminal nerve (nu The anterior, convex, border of the trigeminal ganglion gives
cleus trachts spinalis nervi trigemini) is elongated and stretches in the rise to three main branches, or divisions, of the trigeminal nerve.
posterior parts of the medulla oblongata to the superior cervical The first division, the ophthalmic nerve (nervus apktkalmicus) leaves
segments of the spinal cord at the gelatinous matter of the poste the cavity of the skull through the superior orbital fissure; the sec
rior horn. The descending fibres of the sensory root of the trigemi ond division, the maxillary nerve (nervus maxillaris) leaves the skuJJ
nal nerve terminate in the cells of this nucleus. These fibres form through the foramen rotuudum; the third division, the mandibular
the spinal tract of the trigeminal nerve (tradus spinalis nervi trige nerve (nervus mandibularis) leaves the skull through the loramen
mini). ovaie.
'&. The mesencephalic nucleus of the trigeminal nerve (nucleus The motor part of the trigeminal nerve {portio minor nervi irt-
tractus mesencepkalid nerm trigemini) ascends along the pons and gemini s. radix motoria) curves round the trigeminal ganglion medi
mid-brain to the posterior white commissure. The cells of this nu ally and runs to the foramen ovale to be a component of the third
cleus accompany the tnesencephalic tract of the trigeminal nerve division of the trigeminal nerve.
aftradus mesencephaliais nervi trigemini). The functional character of
T H E OPHTHALMIC NERVE
The ophthalmic nerve (nervus ophtkalmicus) (Figs 810> 811-81b', After entering the orbit the ophthalmic nerve divides into
819) is a sensory nerve and the most highly located and smallest three main branches.
division of the trigeminal nerve. It runs anterosuperiorly, pierces I, The frontal nerve (nervus frontalis) is the thickest and passes
the lateral wall of the cavernous sinus and receives a small sym forwards directly under the roof of the orbit and divides into three
pathetic branch from the internal carotid plexus- it then stretches main branches.
lateral to the abducent nerve and inferior to the tnichlear nerve to (a) Tlie supratrochlear nerve (nervus supmtrocklearis) passes me
leave the skull through the superior orbital fissure. dially over the trochlea of the superior oblique muscle (musculus ob-
Before leaving the skull, the ophthalmic nctve gives off a small liquus superior), anastomoses with a branch of the infratrochlear
branch which innervates the dura mater in the region of the ttn- nerve (nervus infratrochlearis), pierces the orbicularis oculi muscle
torium cerebelli; this is the nimus lentorii nervi ophthalmici, or and the corrugator muscle of the eyebrow (musculus corrugator super-
the nerve to the lenlurium (Fig. 810), alii), and ends in the conjunctiva ami skin ol the upper eyelid, the
>J. nasociliaris
R, eornrnijnicans cum n. Tiasodliar N. fronts l b
QariKli™ ciltare
G l a n i | 11.1 lacrlmalis
A. cerebrt anterior
N . ophthalniieuii R. l i t e r a t i ! It Hi|iraurWtali5
Pedunciikis cereuri N
A. carotrs Interim
R. mcfliali.i n. siiprao]Willis
Pans
N. s u p n t r o r h i t s r i s
Nil, pt*?JgopsUftW
N. lnfratrochl earls
Ganglion trii*mina|p^j
N. peirosus m a j o r ,
N- pelrosips p r o f w i d u s ,
ladix oculomoturia
Rr. alveolares
A, o c d p i i a l i s — ^ j superJotcs anterior?!
Rr. a l v M l a r e s R. alveolarts superior m^dlus
superfnres p o s t e r i t i e s —Pifxus deritslls superior
A. temporalis Rr. dentales superiores
superficialis(cuLoff)
A. maxillaris' W— HT. g i n g i vales superiores
l^N. lingualis
A. auricularis posterior-"■
Plexus cervlcalls
A, lingi
A, caralis communis
Ansa cervka
A, thyroidea superior
812. Nerves of head; right trigeminal nerve (nervus trigeminus); anterolateral aspect (]/2).
( P a r t o f t h e b r a i n , m a x i l l a , a n d m a n d i b l e are r e m o v e d , )
skin of the root of the nose, the lower part of the forehead, and in medialis) which passes through the frontal notch and ends in the
(he lacrimal sac, innervating these regions. skin of the forehead.
(b) The supra»orbital nerve (nervus supra-orbitalis) is the thick 2- The lacrimal nerve (nervus laaimalis) runs along the lateral
est branch. It passes forwards lateral to the supratrochlear nerve wall of the orbit and ends in the skin of the lateral angle of the eye
under the roofof the orbit and divides into two branches: a lateral and the upper eyelid.
branch (ramus laltralu) which passes through the supra-orbital On the way, the Lacrimal nerve gives off a communicating
notch and branches Out in the skin of the forehead, reaching the branch with the zygumalic nerve (ramm communicans cum neroo zygo-
parietal and temporal areas, and a thinner medial branch (ramm matko) which innervates the lacrimal gland.
3. The nase-ciliary nerve (nervus nasodliaris) is the third, most nervate the mucous membrane of the anterior part of the nasal
deeply lying branch of Lhe ophthalmic nerve. It runs in attendance septum;
to the ophthalmic artery forwards and medially between the supe
(2) the lateral nasal branches (rami nasales latemles) which end
rior rectus muscle and the optic nerve, stretches between the supe
in the mucous membrane of the anterior part of the lateral wall of
rior oblique and medial rectus muscles, and gives off the following
the nasal cavity;
branches.
(3) the nasal branches of the anterior ethmoidal nerve (torn na-
(a) T h e infratrochlear nerve (nervus infratrochkaris) stretches satts nervi etkmoidalis anteriorisj which innervate the skin on the tip
forwards on the medial wall of the orbit under the superior oblique of the nose.
muscle and ends in the skin of the medial angle or the eye and the
(c) The posterior ethmoidal nerve (nermts etkmvidalis posterior)
root of the nose, first uniting with the branches of the supratroch-
enters the posterior ethmoidal air cells through the posterior eth
lear nerve (nervus suprafrocklearis). T h e infratrochlear nerve inner
moidal foramen (together with the artery and vein of the same
vates also the lacrimal caruncle and the lacrimal sac.
name) and innervates die mucous membrane of these cells and the
(b) The anterior ethmoidal nerve (nervus tthmoidalis anterior) en mucous membrane of the sphenoidal sinus.
ters the skull through the anterior ethmoidal foramen (together
(d) The long ciliary nerves (nerui cilUtres longi) are two or three
with the artery and vein of the same name). It lies under the dura
small branches miming medial of the optic nerve. They reach the
mater in the anterior cranial fossa. Running forwards, the anterior
eyeball, unite with the short ciliary nerves (nerm dliares breves) aris
ethmoidal nerve passes through die cribriform plate of the eth
ing from the ciliary ganglion (ganglion ciliare) and innervate the
moid bone into the cavity of the nose, gives off a thin branch to
choroid and sclera.
the mucous membrane of the frontal sinus, and divides to form the
(e) The conununieating branch with the ciliary ganglion (ramus
following branches:
Eommmicans aim ganglione aliare) can be double and even triple, It
(1) the internal nasal branches (rami namles iaterni) which in runs forwards to the superoposterior angle of the ciliary ganglion.
T H E MAXILLARY NERVE
R. lateralis n. supraorhitalls
A. frontalis
M, rnandibuiarls
N. snails plerygoideK
{Radix facial is)
A. spheTiopaliilina
Nn. palatini
major et minor
A. maxiHans'
FJ_ alveolarea f f^/a'!
superiwes poslerlores J W"
Aa. alveolares j /
superlores poaleriorea ; / /
R. zygomatiewtacialis
A. buccalis
814, Skin branches of infra-orbital and mental nerves (second and third divisions qftrigem
(specimen prepared by A.Mirontsova).
(Photograph of specimen from the aspect of the subcutaneous fat; for contrast, a piece of black silk has been placed undei
1 —IIHSSl u i m n i i 7 — iiirnlal nerve in rrjrimi of mental foraintr
2 —inlra-m+ikal nerve in rtition of Lllfrn-f>rhital foramen 8 - Irfi and righ't connections «E medial branches of rcicnktl
'A - lateral branches of infra-orbital nerve ctjiniTiutncalinfi with nerves
branches of facial nerve 9 —mental nerve (slightly reflected downwards)
4 medial branches of infrx-orbita.1 ntrvca- 111 —branches of facial nerve
5 — left and right 5<me* of overlap of medial branr.hrs "f infra- 1 I — infra-orbital plexus formed by brandies of facial and \n-
tirbital nerves fra-orbital nervrs
fi — OTal fissure
The mandibular nerve (nervus mandibularis) (see Figs 8 1 1 - 8 H , emerges from the skull to its base through the forai
816-819) is a mixed nerve, It is the strongest division (branch) of divides into two main branches—the anterior, predc
the trigeminal nerve. The mandibular nerve is formed by a sensory tor branch, and the posterior, predominantly sen so i
branrh arising from the trigeminal ganjrlion, which unites with the Before dividing into these branches, the man
motor part (root) of the trigemina] nerve. The mandibular nerve sends off a thin nervus spinosus (ramus mtnmgeus n
815. First division of trigeminal nerve in skin of forehead and upper eyelids (specimen prepa
A.Mirontsova). (Photograph.)
(The nerve branches are dissected from the aspect of the subcutaneous fat; for contrast, silk has been placed under the
ne
1 — lateral branch r>f wpflKWtriti! nerve 6 _ n e r v c . f i| e x usin skin of up fit r eyelid
2 - m e d i a l branch nf supra -nrhital nerve 7 - c ™ muni cation of branches o f t i V m i n a I nerve with
S —branch of supra-Lnithlcar nerve bWocVa of facial nerve
+ - » k i n nf rig-hr upper eyelid 8-branches of facial nerve
5 — skin of left upper r j r l i r l
Hi), which returns into the cavity of the skull through the foramen 4, The buccal nerve (nervus buaalis) is quite thick an
spinosurn to innervate the dura mater of the middle cranial fossa. sensory nerve in this group. 11 usually passes between thi
Three or four short twigs originate from the posterior surface or the lateral pterygoid muscle, stretches forwards on the li
the mandibular nerve and run to the otic ganglion (ganglion ati- face of the buccinator muscle, and ends in the skin an
cum). membrane of the cheek; it also innervates the skin of th
The anterior branch gives off the following nerves. the mouth. At the site of its ramification it has branches i
1. The nerve to the masseter (nervm massttericus) which runs eating with those of the facial nerve.
laterally and sends one or two thin branches to the mandibular The Following nerves arise from the posterior brand
joint, and then passes through the mandibular notch to the medial 1. The nerve to the medial pterygoid muscle (nervi
surface of the masseter muscle which it innervates (Fig. 818). dens medialis) begins from the medial surface of the
2. The deep temporal nerves (ntrvi temporalts profundi), two in branch, passes to the medial pterygoid muscle and inn
number (a smaller posterior and a larger anterior nerve), stretch Along the way it unites with another two small branch
laterally into the slit between the lateral pterygoid muscle and the from the otic ganglion:
infra temporal crest (crista infralemporalis), turn upwards onto the (a) the nerve to the tensor palatj muscle (tiervus tensori
medial surface of the temporal muscle and branch out in its iini) innervates the soft palate;
depths (Fig. 817). (b) the nerve to the tensor tympani muscle (nervus It
3. The nerve to the lateral pterygoid muscle (tttrvus plerygoideus paid} ascends to the back and innervates this muscle.
tateralis) is short and usually arises together with the buccal nerve, 2. The auriculotemporal nerve (nervus auriailotempo
It runs to the medial aspect of the lateral pterygoid muscle and in mixed nerve. It contains sensory and secretory fibres \
nervates it proach it from the otic ganglion. The nerve originates by
Verter frontalis
Rjateralis
N. supraorbftaiis
R, medialls
Ganglion IrLgemihalc N supratrochlearis
N. monrtiblilifis
K , Lig. palpebrale mediate
N. pterygoldEus laleratii
A. ntentfigea media
A. msutiltarfsj
V ophthalmitus
M, pterygoklnis lateral is , J
—N rnaailtails,
Pnrus KUlUciis extemus J Rr. palpebrales inferiors
N. aurK'uIoicriipuralis^ ]
n. tairaorbttalti
N, meatus aciisiici extern! _.] L N. Infraorbitniis
Communicating branches Rr. nasales extern!
n. infraorhitalis
between rt- facialis and M. tevator labii
n. auriculotemporalis ~* ~ superloris
N. facialis-. Ri. labiales superiores
A . auricularis rt, Infraorhitalis
posterior ( r e m o v e d ^ - 3 H
R. muscularis from
11.1'ai-ialislonnlipasfriL'i^ M b *$■- r.hrirda [ympden
M. [>Lm'£_rfjkkMJS i r n -w- r r i: i ^ *Y' B M |
N. buCCTlii
A. carol is e x t t ' r n a - j g j
Ductui piirotldeus
M. tSjgastrkus (venter p o s t e r i o n J B
N. inylohyotdeus - ^ H N. aiveolaris Inferior
Gang!imi su!>rnaiidibulure„^BB M. buccinator
N. lirigitaUs
R. muscularis from Rr. llrgitales
plexus cervicalis to btngfion siiblinguale
m, sternodeidomastoidcus _ Rr, subllnguales
M. stcmocleidomasitoidcuf. - Gtandula. siibilngual.is
(drawn aside) JM, myluhyoldeus
R. muscularisfromn, accessorius ^_--~' '--M. digastrltus (venter anterior!
to m. stemodeidomastoideus -*A. Jaciatss.
RT, iubmandibularcs >•■*"" T__ n UngLialTs Olandula submandibularis
A, oceipttalis " Os hyoideum
N, accessorius'
nf. hypoglossus "-V, facialis (removed)
M. thyrnbyoidetii
A. carotin esterna
Plexus rervicails
" * * ■ ^ ,
A, transversa coll
W M. omohyotdcus
M. trapej.iLJ.s/" "-: ~* ■il (venter superior)
Nn. suprsciaviLutares -^ ^ "*-»■ V. jugularis anterior (removed)
M. scaknus anterior "~"A. sjprascapularis
V. traiiversa colli - - V . brachiocephalica
Plexus hrachlalts ' — — M . sternoclcidomastoideus
I N. phrenicus ^ (cut and reflected)
j V. subelivia
V . jugularis extema (removed)
816. Nerves of head and neck; right side viewed slightly from front {%).
(Part of the temporal, sphenoid, frontal, and zygomatic bones and the right half of the mandible are removed.)
817. Nerves of right temporal muscle (specimen 818. Nerves of right masseter muscle
prepared by A.Mirontsova). (Photograph.) (specimen prepared by A.Mirontsova).
(Medial surface uF muscle,)
(Photograph.)
I porterior intramuscular branches (of temporal nerw] (Medial surface of muscle.)
J—nioVtte intTPTrtiiicubT hraii-chcs I —main intramuscular trunk of nerve to m»sseter
" w intrannusnilai' branches 2—posterior intramuscular branches
of temporal mutcte 3—anterior intramuscular branches
+—ueep layer of roassetrf- muscle {reflected)
5—superficial layer ot~ unssracier mustle
N
8. c o m m u n e c m n. B J S o d l i . r ^ -icontalis; N
"P11^5
N. ocidomotorius
N 1lil50Lill3flS
NS. plerygopalatlnU
N. ophttialnikus
N. nanaHs plerygoirlei ]>',
i Radix iacialis ) •**>ij*^ upraOrbltalis
N. tnaJillaris "Yip
N. petrusus profundus ^ . ;' Rr. raediales n. supraorbitalls
t^, inandLbulaTis^
clllarc-
R. anasrornoticus
cum si. lacrimilis
— -"1^. synnpalhLCLjs ad
ganglion ciliare
Radix
oculomotor] a
N. zygomatlcus
N. itifrBoitltalls
8. alveolarls superior
medlus
Rr. alvEolares
superiors
(WHrlores
"vM. riasopalatinus
. * * N . palaiinus major
^Plexus denudis superior
Ganglion pterygopalaiinum
JtSr. alvcolares superiores
P"" ~. posteriori
" --. ^ N n . palatini major et minor
N. petrosus majoi
~"-.N". tensoris weli
palatini
M o t o r root
A. meningea media'' J>«
Ganglion geriiculi .^ "-»Rr. sub1lrigual«s
N tenSurtS tympanl * " ~~- Ganglion
N. glnssnpbaryngeus'' suhlinrjuale
K
R. cotrtrrjafiicara cum plexu tympanici N. mentalis
/ Plexus dentalls
N, petiosus minor'1 '' / / / ' inferior
t'■ / / / •> ,x v "\\ \ \ v
Gang3ion submnndlbularc
N. atiricidotemporalis
Sympathetic root ' j , ' ^ \ \ v, \ \ ^ R. pharyngeus
\ N \ \ ^PICKUS maitillaris eitermis
/
N. lacialls'' / / \ , \ \ Rr ^landularcs
N K. .sympath. ad garigl. submatto.
Chorda Ivinpai i f ?
X ^■• v - —--
v. \ A- facials
*S, lirigjaiLs' ^
X X "" rJ- alveolarls inferior
>J. palatrnus minor
'-S. -s ^ A tarotis externa
PkxuS caioticus ifjlertltJS
""""-- ' ■ A ciratis interna
'~-A. carotls communts
Nn. cstoliri ejtleml
819 Trigonal mm and autononic Relative) ganglia of head; right aspect (semischematical
s
representation).
■SO. Nerves of dura mater of brain (specimen 821. Nerves of dura mater of brain (specimen
\prepared by D.Sigalevich). (Photograph.) prepared by D.Sigalevich). (Photograph.)
fcompletely stained dvtta mater in the region of the middle (Area of completely stained dura mater in the region of the middle
cranial fossa.) cranial fossa.)
1 — nirrirrigcaJ hraneh of maxillary nerve
BCJ1 ttl maxillary DCTVt 2 — iriitJrllr rTHTiiriFfsi] artery
artery
iurface nf the mandible. Then it approaches the mylo- and lower lip; it often sends one or two twigs to the mucous mem
le, ramifies in it, and sends a small branch to the ante- brane nf the lower lip,
«rf the digastric muscle (musadux digastriais) (Fig. 822). 4. The lingual nerve (ncrvus iingualisj is a sensory nerve. Hav
c inferior alveolar branches (rami alveolares inferiors) arise ing originated from the anterior border of the mandibular nerve it
interior denial nerve for the whole length of the segment runs, like the inferior dental nerve, first on the medial surface of
i the mandibular canal. The branches communicate to the lateral pterygoid muscle, and slightly distatly penetrates into
mfrrior denial plexus (plexus dentalu inferior) which gives the slit between the lateral and medial pterygoid muscles (in front
types of branches: of the inferior dental nerve), Here the lingual nerve receives the
r inferior gingival branches (rami gingimles inferkms) in- chorda tympani (a branch of the facial nerve) which enters it from
in'rig the gums of the lower jaw; ihe back at an acute angle. After that the lingual nerve arches
r
Ae Inferior dental branches (rami dentalts inferiares) running downwards and forwards on the medial surface of the mandible,
M h r Mandibular teeth; passes above the submandibular gland and approaches the inferior
Mental nerve (nervm mmtalis) is the terminal branch of surface of the body of the tongue to send end branches into its
dental nerve. After emerging from the mental foramen depths.
On the way the lingual nerve gives off the following branches:
(a) the branches to the oropharyngeal isthmus (rand isthmi fau- (rami tonwtunkantes cum nerve hypoglasso), two or three in number,
dum); these are several small branches stretching to the mucous arch forwards on the lateral surface of the hypoglossus muscle to
membrane of the palatojdossal arch and the tonsil; join the trunk of the hypoglossal nerve;
(b) the branches to the submandibular ganglion^ these are two (e) the branches to the tongue (rami UnguaUs) are the terminal
or diree short twigs composed of their own sensory fibres and branches of the lingual nerve. They run on the inferior surface of
secretory fibres brought here by the chorda tympani; the tongue, penetrate into its depths, unite, and ascend to the mu
(c) the sublingual nerve (newus suUingualis) arises from the an cous membrane to innervate its anterior two thirds (the tip, bor
terior surface of the lingual nerve and innervates the sublingual ders, and dorsum of the tongue), and send twigs to the filiform and
gland, the mucosa of the floor of the mouth in the region of the fungiibrm papillae. At the junction of the root and body of the
sublingual fold, and the raucous membrane of the anterior parts of tongue the rami linguales unite with the lingual branches of the
the lower gums; glossopharyngeal nerve (rami linguales ntrvi glossopkarytigci).
(d) the communicating branches with the hypoglossal nerve
T H E ABDUCENT NERVE
The abducent nerve (nervus abdutens) (sixth pair) (see Figs 803, groove between the pons and the pyramid of the medulla oblon-
804, 810, 811) is a motor nerve. Its nucleus (nucleus nervi abductniis) gata.
lies in the posterior part of the pons. From the aspect of the floor The abducent nerve runs forwards, penetrates the dura mater,
of the fourth ventricle the nucleus is projected in the posterior re and enters the cavernous sinus in which it stretches close to the lat
gion of the emineiilia medians—in the facial colliculus (colliculus eral side of the internal carotid artery. After leaving the sinus, the
facialis) slightly medial and dorsal to the nuclei of the facial nerve nerve enters the orbit through the superior orbital fissure, pierces
(see Figs 771, 772). the common tendinous ring (anulus tmdineus communu), and runs
The fibres which arise from the neurons forming the nucleus of under the oculomotor nerve to reach the lateral rectus muscle of
the abducent nerve run forwards, penetrate the pons throughout the orbit (mvseulus rectus lateralis) which it innervates.
its thickness, and emerge on the inferior surface of the brain in the
T H E FACIAL NERVE
lacrimal nucleus (see The Vagus Nerve). The axons of the cells of
The facial nerve (nenius facialis) (seventh pair) (see Figs 803,
804, 822-825) is a motor nerve. Its nucleus (nucleus nervifacialis) is this nucleus compose the main bulk of the sensory root of the fa
situated in the central part of the pons in the reticular formation cial nerve.
slightly to the back and lateral of the nucleus of the abducent The facial nerve emerges on the base of the brain together with
nerve. From the aspect of the Door of the fourth ventricle the nu the nervus inteniiedius. Further on both these nerves together with
cleus of the facial nerve is projected lateral to die facial colliculus the auditory nerve (nervus vestibulocockkaris) {eighth pair) enter die
(colliculus facialis) (sec Figs 771, 772). internal auditory meatus via the porus acusticus interims of the pe
The processes of cells which form the nucleus of the facial trous part of the temporal bone. There they unite and run into the
nerve first run dorsally, arch round the nucleus of the abducent canal for the facial nerve through the facial nerve area (area mrvt
nerve, and then form the genu of the facial nerve, stretch veutrally, facialis). At the geniculum of this canal the facial nerve is thick
and emerge on the inferior surface of the brain at the posterior ened by the ganglion of die facial nerve (ganglion geniculi).
border of the pons above and lateral to the olive of die medulla ob- The facial nerve follows all the curves of its canal, leaves the
longata. petrous part of the temporal bone through the stykimastoid fo
The facial nerve itself is a motor nerve, but after it is joined by ramen, and stretches into the depths of the parotid gland to divide
the sensory root (nervus intermedia*) formed of taste and secretory into the main branches.
fibres, it acquires a mixed character. In the petrous part of the temporal bone the facial nerve gives
The nucleus of the sensory root, the superior salivary nucleus off the following nerves.
(nucleus salivatvrius superior), is autouomic and lies slightly to the 1. The greater superficial petrosal nerve (nervus petrosus major)
back of and medial to the nucleus of the facial nerve, behind the begins from the ganglion of the facial nerve (ganglion geniculi) and
Dura mater
R, tnenlngsus medius
N. petioaus proiundus A. mcnlngea media
N. mandibularis
(anterior branch)
Ganglion pteryg'opalatiiium.
R. meningcus
(n. mandibularis)
Radix motoria
RT. IBUBIBC posteriory n. trigemini
superiors lalerales
Radix sensoria
Nil. oHflflorii ti. trigemini
822, Right spkenopalatine ganglion (ganglion pterygopalatinum) and otic ganglion (ganglion
oticum); inner aspect (%).
(Sagittal section through anterior parts of the skull and oblique anteriorly tilted section through the posterior parts; the nerves and
vessels of the dura mater are located in its depths; part of the nasal mucosa is removed.)
i \ Rr. temporales
Venter frontalls
N. snprinrbitalis
1 (r. lateralis)
W/ ,M. orblcularls oculi
R. mediulis n. supraorbitalis
\A \
/■
N. supratrochlearis
N. tnfratrochlearis
(1 ■
' \
\—R, zygomattcotcmporalis
N,: auricula- | '//< JA n. zygomaticf
teitnporalia —.1
f&t.—-R- zygomatlcofacifllls
/i ,-V^Vi D. zygomaticl
■ H ^ D k ^ M . levator lab 11
R, occlpitali* ^■X superiorly
HEB^^--\- ^ »_.■ |J urijalis cxternus
n. t-llii!L(>Ui;iii:-
N. occlpHslis ma
"''^B^kib ^fc-~N. Infranrbitalis
-Rr. nasales extern!
n. infraarbitalis
N, eccipitalls '"'"'"-^ffljrrl c—ML zygomaticus major
/ ■ - ■ :
£^- .^e
'Rr, labiates supertores
N. f a u a l i s . - ^ H
R. 1lgastricus-^M
, - V
R, stylohyotdeus 4
Rr. iVgotnatict n. facialis
' M, buccinator
Glandula p a r M i s - j M
N. meittalis
N. auricularis Triagnus^B
M. depressor labii
inferioris
s \
Rr. buccales n. fatbits M, depressor anguli nris
R. colll n. f*811ls>^
N. transversus colli
,1
^ H
M. itiasseter
I
M. stemocleidomastoidein
R. marginalia mandihul.ie
Platysitia
membrane of the anterior two thirds or the tongue and stretch to the brain stem and terminate there in the nucleus of the
in the chorda tympam to the ganglion of the facial nerve tractus solitarius (nucleus tractus solitarii) (a nucleus in common
gesiatli). T h e central processes of the cells of this ganglion with the glossopharyngeal nerve}.
T H E A U D I T O R Y NERVE
EW auditory nerve (nervus oestibulocoMearis s. nervus octavrn) lateral (most of the fibres) and of the same side. Fibres which begin
-
pair) (see Figs 803, 804, 825, 826) is a nerve of special in this nucleus ascend together with the lesser part of the fibres of
insisting of two divisions differing in function; the vestibu- the ventral nucleus as well as with die fibres of the dorsal nucleus
(ptrs vesiibularis ntmi octavi) which carries impulses from (neuron II) to form the lateral lemniscus (lemniscus lateralis) on
apparatus represented by the semicircular canals of the either side; die lemniscus terminates in the subcortical auditory
and the cochlear nerve (pars cockharis nervi vestibulococh- centres —the inferior quadrigeminal body (coUiculus inferior laminae
wf *hkfa conducts impulses from the spiral organ of the coch- tertae) and the medial gcniculate body (corpus genkulatum mediale).
The last-named gives rise to new fibres which pass through the in
i W nuclei of the auditory nerve (nuclei nervi vcstibulocochlearis) ternal capsule to the auditory area of the cortex—the middle part
■ the brain stem between, the pons and the medulla oblongata. of the superior temporal gyrus.
the aspect of the floor of the fourth ventricle they are pro- The vestibular nerve (purs vesiibularis nervi octavi) begins from
m the area vesiibularis (lateral angles of the floor} (see Figs the vestihular ganglion (ganglion vestibuhiTc) situated in the internal
2). O n the inferior surface of the brain the auditory nerve auditory meatus (meatus acusticus internus). T h e ganglion is sub
lateral to the olive of the medulla oblongata by its two divided into two parts: a superior part (pars superior) and an infe
A c vestibular and cochlear nerves. rior part (pars inferior); its cells are bipolar.
peripheral fibres of the cochlear division originate from The peripheral processes of the cells forming the vestibular
ganglion (ganglion spirale cochleae) (neuron I). The peri- ganglion stretch to the receptor cells of the saceule (samilus), utri
processes of the spiral ganglion cells begin in the spiral or- cle (utricufas), and the membranous semicircular canals (canales se-
fmfgxmm spirale) which is the sound appreciating apparatus micirtulares). The central processes are components of the vestibu
t The Organ of Hearing), lar nerve.
mitral processes of the spiral ganglion cells form the O n emerging from the internal auditory meatus the fibres of
(pars cocklearis nervi vestibulocachUaris) which emerges the vestibular nerve dip into the depths of the medulla oblongata
petrous part of the temporal bone through the internal medial to the inferior eerebellar peduncle and divide into two, as
meatus and poms acusticus internus and enters the brain. cending and descending, branches which terminate In the vestibu
of the cochlear nerve terminate in the dorsal and ven- lar nuclei; (1) the medial vesdbuiar nucleus (nucleus vesiibularis me-
nuclei {nuclei cochleares dorsalis et vtntralis) (neuronII). dialis); (2) the superior vestibular nucleus (nucleus vesiibularis
arising in the dorsal nucleus pass on the floor of the superior); (3) the lateral vestibular nucleus (nucleus vesiibularis latera
«mJride in the striae rnedullares and then dip into the lis), and (4) the inferior vestibular nucleus (nucleus vesiibularis infe
V cross to the opposite side, and ascend to reach the rior). Fibres arising in the superior nucleus run in the inferior eer
auditory centres, ebellar peduncle to the cerebellum in which most of them
originating in the ventral nucleus dip into the brain terminate in the cells of the nucleus globosus and nucleus fastigii.
terminate on the cells of the dorsal nucleus of the cor- The vestibular nuclei also communicate with some of the cranial
(nucleus dorsalis carpark traperj>idei) of the contra- nerves and with the spinal cord.
■** glowopharyngeal nerve (nervus glossopkaryngeus) (ninth dorsal nucleus of the glossopharyngeal nerve (nucleus dorsalis nervi
>{«<* Figs 803, 804, 827, 832) is of a mixed character. It con- glossopkuryngei). The last two arc autonomic nuclei. The first two
wotor, sensory, gustatory, and parasympathetic fibres. and the fourth nuclei are common to the ninth and tenth (the va
^ » c k i of the glossopharyngeal nerve (nuclei nervi glosso- gus nerve) pairs of cranial nerves (see Figs 771, 772).
pm^G*) are located in the posterior parts of the medulla oblon- T h e nuclei are projected on the floor of the fourth ventricle in
• K t - These are: (1) a motor somatic nucleus ambiguus; (2) a sen- the following manner: the motor nucleus —in the depths of the
«■*■ fc^fcw of the tractus solitarius (nucleus tractus solitarii); (3) the posterior part of the medulla oblongata in the region of the vagal
* ™ fafivaiy nucleus (nucleus salivatorius inferior), and (4) the triangle; the sensory nucleus —in the posterior part of the medulla
oblongata in the reticular formation, lateral to the sulcus limitans; The tympanic nerve gives rise also to the
the autonoinic nuclei —in the depths of the posterior part of the (a) small tympanic branches to the m
medulla oblongata in line with the sulcus limitans, in front of the panic membrane and to the air cells of the
nucleus ambiguus. (b) the branch to the pharyngotympamc
The gloss opharvngeal nerve appears on the inferior surface of nervi glossopharyngei);
t h e b rain by four to six rootlets behind the olive, below the emer (c) small branches to the Fenestra vestibd
gence of the eighth pair. It runs laterally and Forwards and leaves cochleae.
the skull through the anterior part of the jugular Foramen. In the % The communicating branch with suriesi
region of the foramen the nerve is slightly thickened by the supe vagus nerve (ramus communicant cum ramo
rior ganglion (ganglion superius); after leaving the jugular foramen II. Branches arising from the trunk of
it is again thickened by the inferior ganglion (ganglion inferius) neive.
which is lodged in the petrosal fossa (fossulapetrosa) on the inferior 1. The pharyngeal branches (rami pharntp
surface of the petrous part of the temporal bone. get), three or four In number, begin from ti
The central processes of the sensory cells of these ganglia nerve where it passes between the external and
stretch on the rootlets of the glossopharyngea] nerve to its sensory teries. They stretch to the lateral surface of th*
nucleus; the peripheral processes run as components of the there with the pharyngeal branches of the vagq
branches. The motor fibres of the nerve arise from its motor nuclei; also arrive here from the sympathetic trunk)
passing to the periphery they only adjoin the sensory nuclei, as it geal plexus (plexus pkaryngeus).
happens in the spinal ganglion (ganglion spinak) of the spinal cord. 2. The branch to the carotid sinus (ramus
From the base of the skull the nerve descends between the inter sopharyngei) (one or two), a thin branch enti
nal carotid artery and the internal jugular vein, then arches forwards
rotid sinus (sinus caroticus) and the depths of
and slightly upwards and enters the root of the tongue thickness.
mtis caroticum).
Along its course the glossopharyngeal nerve gives off the fol
3. The branch to the stylopharyngeus (i
lowing branches.
tyngei nervi glossopharyngei) stretches to the mm
L Branches arising from the inferior ganglion. enter it.
1. The tympanic nerve (nervus tympanicus) arises from the infe 4. The tonsillar branches (rami tonsillara
rior ganglion, enters the tympanic cavity, and stretches on its me arise from the main trunk where it passes
dial wall. There the nerve ramifies and forms the tympanic plexus These are short branches (three or five in n
(plexus tympanicus) in the mucous membrane of the middle ear. The to the mucous membrane of the pharyngo
next segment of the tympanic nerve, which is a continuation of the tonsil.
plexus, leaves the tympanic cavity through the hiatus for the lesser 5. The lingua] branches (rami linguales nem
superficial petrosal nerve (hiatus canalis nervi petrosi minorii) as the the terminals of the main trunk. They penetrate
lesser superficial petrosal nerve (ntmus petrosus minor) (before that root of the tongue and ramify to form
it is joined by a communicating branch jramus communicant} from twigs. The end branchings of these nerves
the greater superficial petrosal nerve). On the surface of the pe and terminate in the mucosa of the posterior
trous part of the temporal bone the nerve fits into the groove for it in the region between the anterior surface of th*
(sulcus nervi petrosi minoris) and leaves the cavity of the skull vallate papillae of the tongue (see Fig. 979).
through the sphenopetrosal fissure (fissura spkenopdrosa) to reach Before reaching the mucous membrane
the otic ganglion (ganglion oticum). their contralateral companions and branches of
These three parts —the tympanic nerve, the tympanic plexus, (from the trigeminal nerve) on the midline of tl
and the lesser superficial petrosal nerve—connect the inferior The sensory fibres of the glossopharyngeal
ganglion with the otic ganglion. in the mucous membrane of the posterior third
The tympanic nerve communicates with the facia] nerve (with vey taste stimuli through the peripheral nuclei
its branch, the greater superficial petrosal nerve) and the sympa ryngea] nerve to the nucleus of the tractus solita
thetic internal carotid plexus (plexus caroticus internus) by way of the also arrive here along the fibres of the chorda i\
caroticotympanic nerves (nervi caroikoiympanici) which approach gus. The stimuli reach the thalamus later and
the tympanic plexus. to the region of the uncus (Fig. 828).
St|uania remporalis
wV^Eminerttta arcuata
Pars cochtearis .
(n. veatibutocochloaris) V j
A. menlilgea mtciia
1
^
SiriUS .■!:'.■■ ■■■■■■■■: -M-.
N . facialis
N, inlcrnietiiiis
J ars petrosa \ Dura mater
\ enceplial i
A . r a r o t l s interna
Purus at-iistlcus internus
N. vestibiilococlilearis 1
Ganglion vestihulare
N. facialis
Pars vostibtiians
( n . nctavi)
V "M'rocessus stylgtdeus
T H E VAGUS NERVE
The vagus nerve (nervus vagus) (tenth pair) (see Figs 803, 804, of the vagus nerve, is lodged in the anterior parts of the medulla
•-" r 1 -8-/4; i> ol a mixed character because it contains tnmoi oblongata deeper than the dorsal nucleus and is projected on the
mmi *en»ry fibres and fibres of the autonomic system. The vagus floor of the fourth ventricle medial to the vagal triangle. It is also a
has three nuclei in common with the glossopharyrigeal nucleus of the glossopharyngeal nerve,
they are situated in the medulla oblongata (see Figs 771, 3, The nucleus nf the tractus solitaries (nucleus trachis solitarii)
is sensory and projected on the floor of the fourth ventricle slightly
L The dorsal nucleus (nucleus dorsalis nzrvx vagi) {autonomic) lateral to the sulcits limtlans; it is located far to the back of the
■ the medulla ob Ion gat a lateral to the nucleus of the hypo- nucleus ambiguus. ll is common to the vagus, glossopharyrigeal,
; it is projected on the floor of the fourth ventricle in and itUcnnedius nerves.
of the vagal triangle. The vagus nerve emerges on the inferior surface oi the brain
i The nucleus ambiguus, the ventral (somatic) motor nucleus by 10-15 rootlets from the depths of tlie medulla oblongata be-
Lubu.s iemparalis
/ CapsjLa IntrrriLT
Lobus occipitulis
Nucleus caudcitus
SukitL- eslcarinus
Thalamus
Corjtns
geniciilatiitn mediate '
Thalamus (partly removed) ~"~.
Oolliculus inferior
Corpus KtiHculalum laterals " " " (subcortical
Traciuj o p t t o w " S* i' auditory centre)
Nucleus », oculomotorll ** ^W
PcduraculLis certbrl y ~ Ltaratscus lulorisUs
F i b r e s o f l e m n i s c i j s lateralis Nucleus n. iruclilcarls^ - Cerebellum
Connecting n u c l e i cochleares __ — " ~ I J ~ ~ I Nucleus lemnisci
w i t h c o r t i c a l centres — — lateralis
Of I he s a m e side v « l , M s r . s superior
Nucleus veslibularEs lateralis
Car h lea
Pars vesiibularis fn. oetavi)
Oanfilion ^pirale •* ^ ^ ^ r v " " Ffisciculu^ longitudinal is mediali*
Vest [twin in \\ v \ v v V \ " - v . ^"""i.Nucleus cochleare vt'tur.ilK
Caualcs / \\ v* 'SLV v V i ■"-^ Nuclei vi'sllbularei
scmiclrculares. * i " ^ J i\ \ \ *\ ^ Y ~"*V ^Traclns vestitiuluspirialis
ostei \ \ ^\ \ X ^ F a s c i c u l u s rOflgifcrftJMliS medialis
Ganglion vestt briar* \ \ \ \M
Pars ccrblearis Nucleus caichlearis dorsalis
(n. ociaYl)
Pars veslibuhris la. aclavtj
hind the olive. It runs downwards and laterally and leaves the skull In the region of the inlet of the thorax, the vagus nerve lies be
together with the glossopharytigeal and accessory nerves between tween the subciavian artery (behind) and the subciavian vein (in
which it lies. In the region of the jugular foramen the vagus is front).
thickened by the superior ganglion (ganglion superius nervi vagi); After entering the thoracic cavity, the left vagus nerve (nervus
1.0-1,0 cm distally is another, slightly larger thickening, the infe vagus sinister) lies on the anterior surface of the arch of the aorta,
rior ganglion (ganglion inferius nervi vagi). while the right vagus nerve (nervus vagus dexter) —on the anterior
In the space between these ganglia the vagus is approached by surface of the initial segment of the right subciavian artery. After
the accessory branch (ramus interni nervus accessorii). Descending still that both vagus nerves deviate to the back, arch over the posterior
lower, the vagus nerve stretches in the neck on the posterior sur surface of the bronchi, and approach the oesophagus; there they
face of the internal jugular vein to the inlet of the thorax (aperture ramify to form several large and small branches and lose the char
tkoracis superior), in the groove between this vein and first the inter acter of isolated nerve trunks (Figs #34, 906).
nal carotid and then the common carotid arteries running medial These branches of the left and right vagus nerves stretch on
to it. the anterior (mostly those of the left nerve) and posterior (predom
T h e vagus nerve, the internal jugular vein, and the common inantly those of the right nerve) surfaces of the oesophagus to form
carotid artery are invested in a common connective-tissue sheath the ocsophageal plexus (plexus esophageus).
to form a neurovascular bundle on the neck. At the oesophageal opening of the diaphragm (hiatus esopha-
"Return rnejeticephali
Cerebellum
Jr Nn. temporals [irolmidi
A. max Minns
N. buccalis
f Gan^lCTI superljs
N. giosso- ■M, pterygoltteus laleralis
pharyngeus
Ganglion inferius N. alveolaris inFerior
N. ling jails
l'li>yii.s vt:rlul.ir,i?is - . . . _ ■ „ M. blK'cinator
N. glossupharyng^us
Ganglion inJerjus n. v*gi 4
Rr, llngunles
Radices (JoTsa I
liypoglossjs
tin, Jiiii .n
iH. genlogloisus
TruncHS sympathies -
Gallglicm [huTackum I -
Truncus brachioceprifllicus
N, laryngcus recufrens — —■'
A, 5ilt>clavia
Untus — j j *
Traiuti niweiicfphali
" ^ Pathway connecting nucleus
fasciculi solitarii with ihalamus
Nucleus sensoritis superior n. trigprnlni
-Fossa rhombciitlta
■Nucleus trscluS sofititfi
'• ^ ^HW^N, ,rl8fminus
^ 7*SsT"~MeduLla obloniliita
Fibres of general sensation v
(from n. lingualis) — = , -. *■ vV
glussuphas'vngeLjs
Gustatory fibres of %,
chorda tympan \ \
\ - ^ ^ U .
* Gartgl ion infer ins B. vagi
Gustatory fibres of &
n. glossopharyngous Ganglinn inferius n. glossopharynjjri
I Ganglion gcritcuH
Gustatory fibres of n. vagus
gees) the anterior arid posterior vagal t r u n k s {trunci vagaUs anterior In the a b d o m e n the anterior and posterior trunks send
el posterior) form, respectively, from the branches of these plexuses branches to the abdominal organs and the cneJiac plexus.
and enter the abdominal cavity together with the oesophagus, Both Along; its course each vagus nerve is divided into Four parts;
the posterior and anterior vagal trunks have the left and right va (1) the cephalic part, (2) the cervical part, (3) the thoracic part,
gus fibres in their composition. (4-) the abdominal part.
T H E CEPHALIC PART
T h e cephalic part of t h e vagus nerves is the shortest. It extends per bulb of the j u g u l a r vein (bulbus venae jugularii superior) to the ju
to the inferior ganglion (ganglion inferius) and gives off the follow gular fossa, and enters the mastoid canaliculus (canalicalus mastni-
ing branches. deus). In the depths of the petrous part of the temporal bone the
1. The meningcal b r a n c h (ramus meningeus nemi vagi) arises di auricular branch exchanges fibres with the facial nerve and leaves
rectly from the superior ganglion, runs into the cavity of t h e skull, t h e petrous part via the tyrnpanomastoid fissure (jissura tympuna-
and innervates the dura mater (the transverse a n d occipital venous mastoidea). T h e n it divides into two branches which appear behinrl
sinuses). the external ear near the outer end of the bony part of the auditory
2. T h e a u r i c u l a r branch (ramus auruularh nervi vagi) arises for meatus. O n e of the branches unites with the posterior auricular
the most part from the superior ganglion or lower, from the nerve nerve (from the facial nerve), the other innervates the skin on the
trunk, stretches to the back, runs on the lateral surface of the u p posterior wall of the external auditory meatus..
commumcans
cum plexu lympanico^ N. pttrosus majc
ErainentlB anmsta \ N. pelrosus minor
N facialis N \ I M. tensor tympant
R. tubae /
/ S srPk'xus tarotlcus
S „ interims
\. carols inlerna
acu^ticus exiemus
Osttam pharyngeum
tubae aucMlvje
Processus mastoldeus
829. Right facial nerve (nervus facialis) and tympanic nerve (nervus tympanicus) (%).
(Position of these nerves in the petrous part of the temporal bone.)
Tbe communicating branch with the glo.ssopharyngeal 5. The communicating branch with the accessory nerve is the
conmunkatti cum nervo glussapkaryngeo) is a communica- accessory branch (ramus interims nervi accessorii). This is a rather
the superior ganglion of the vagus nerve and the infe- strong twig which becomes a component of the vagus nerve be
of the glossopharyngeal nerve. tween the superior and inferior ganglia. Besides, the vagus nerve
superior communicating branch (running From the su- sends small branches to the accessory nerve.
i) with the superior cervical sympathetic ganglion.
T H E CERVICAL FART
cervical part of the vagus nerves stretches from the infe- 2. The communicating branches with the hypoglossal nerve.
to die site of origin of the recurrent laryngeal nerve 3. The pharyngeal branches (rami phaiyngei ntn>i vagi) often
fa_pqjmi rtairrms) (Figs 832-834). The following branches branch off from the inferior ganglion, but may arise at a lower site.
| K iram this part of the vagus nerve. There are two of them, a larger superior and a smaller inferior
TW inferior communicating branch with the superior cer- branch. They pass forwards and slightly medially on the lateral
■mjpfltfhrtk ganglion. surface of the internal carotid artery and unite with the branches
of the glossopharyngeal nerve and branches of the sympathetic vagi), two or three in number, arise from the t
trunk to form the pharyngeal plexus (plexus pht&yagtw) on the nerve slightly below the depressor nerve. They ran
middle constrictor muscle of the pharynx (musatlus wnstridar pkar- mon carotid artery, the branches of the righi
yngis tntditti). Branches arising from this plexus innervate the mus of-the innominate artery (fruncus brachiocephaliats),
cles and mucosa of the pharynx. The superior branch also sends vagus running in front of the arch of the aorta,
nerves to the levator veli palatini muscle and the musculus uvulae, cardiac branches unite with the cardiac nerves
4. The superior laryngeal nerve (nervus laryngetts superior) be sympathetic trunk and, on approaching the heart,
gins from the inferior ganglion, descends on the internal carotid nents of the cardiac plexus. Branches of the d
artery, receiving on the way branches from the superior cervical arrive here.
ganglion and the pharyngeal plexus, then runs forwards and di 7. The recurrent laryngeal nerve (nervus la\
vides into two branches before approaching the lateral surface of ginates from the main trunk at the level of the si
the larynx: the right and at the level of the arch of the aorta
(a) the external laryngeal nerve (ramus externus nervi latyngei su- curving round the inferior periphery of these vt
perioris) innervates the laryngeal mucosa, part of the thyroid gland back, ihc recurrent laryngeal nerves ascend into
as well as the inferior constrictor muscle of the pharynx (musculus tween the trachea and oesophagus, their terminal
constrictor pkaryngit inferior) and the cricothyroid muscle (musailta ing the larynx.
cricotkyroideus); it often unites with the external carotid plexus Along its course the recurrent laryngeal nervt
(plexus zarottats externus); following branches (Fig. 833).
(b) the internal laryngeal nerve (ramus interims nervi laryngei Stt- (a) The middle cardiac branches are nuino
perioris) stretches together with the superior laryngeal artery, thicker than the upper branches. Running to die I
pierces the thyrohyoid membrane, and sends branches to intiervate the other cardiac branches of the vagus nerve and
the mucous membrane of the pharynx (above the rima glottidis), the sympathetic trunk and also contribute to the
epiglottis, and part of the mucosa of the root of the tongue. It gives cardiac plexus,
rise to the communicating branch with the recurrent laryngeal (b) The tracheal branches (rami tracheales J1CT71 !■
nerve (ramus communicant cum nemo laryitgeo inferiors)* tis) arise right after the middle cervical branches a
5. The depressor nerve (reducing arterial pressure) (nervus de anterior surface of the lower trachea. On the wai
pressor (BNAJ) begins from the trunk of the vagus nerve and is the the sympathetic branches and approach the
uppermost cardiac branch. It passes through the inlet of the thorax plexuses.
(apertura tkomtu superior) into the cavity of the thorax and receives (c) The fiesophageal branches (rami esopkaga)
a twig from the superior laryngeal nerve. In the thorax it sends phagus.
some branches to the arch of the aorta and the cardiac plexus to (d) The inferior laryngeal nerve (nervus
provide for their baxoreceptive sensibility. terminal branch of the recurrent nerve. O n its
6. The upper cardiac branches (rami cardiaci superiares nervi two branches: (1) the anterior branch innervating i
A, rnaxllbris
V. jugular/s Intern,
N. glossopharyrgejs
t A . facialis
N. camtktis Interims—^ -
(divided)
Nerve branch to ^ * — I
glomus caroticum
^^^^^^^'S^i^^^t^f^m^^^
Mryteno.d, the thyroarytenoid, thyroepiglottic, vocals, and arye-
glottidis The motor fibres innervate the posterior cricoarytenoid
Wlottic muscles; (2) the posterior, or the communicating branch
and the transverse arytenoid muscles.
i t h the internal laryngeal n e r v e (mmus communicant cum ramo la-
(e) The connecting branch between the recurrent Iarvngeal
ijm&c inter™) which U a branch of the superior laryngeal nerve.
nerve and the inferior cervical ganglion (ganglion tmmffarsaam
rhe posterior branch contains motor and sensory fibres. The last-
(stdlatumj) of the sympathetic trunk.
named reach the mucous membrane of the larynx below the rima
The thoracic part of the vagus nerves extends from the site of
1. The lower cardiac branches (rami cardiaci infmorti nervi r/agij
origin of the recurrent nerves u p to the point where the vagus
arise below the origin of the recurrent laryngea] nerve and enter
nerves pass through the oesophageal opening in the diaphragm (hi-
the cardiac plexus behind the aorta.
**w tsophageus). In the thorax the vagus nerve gives rise to the &>}.
lowing branches (Figs 833, 834, 906). 2. The tracheal branches (ramifrachealesnervi sagi) are several
quite strong twigs running to the trachea. On their way they unite
with the trachea! branches of the recurrent laryngeal nerve and The branches arising from this plexus unite, ente
with branches of the sympathetic trunk to Form the plexus of the the lungs together with the bronchi and vessels, ami
pulmonary parenchyma.
trachea.
5. The oesophageal plexus (plexus esophegeus>
3, The thoracic cardiac branches (ram cardiaei tkoradd nervi
many nerves differing in diameter which arise fi
vagi) arise below the origin of the recurrent laryngeal nerve, run
nerve below the root of the lung. Along their
downwards and medially, unite with the lower cardiac branches,
with one another and with branches of the four <
send twigs to the hilum of the lung, and enter the cardiac plexus.
thoracic sympathetic ganglia to form a plexus
4, The pulmonary branches (rami bronchioles nervi vagi) divide
whole lower part of the oesophagus and sending
into thinner anterior branches (four or five) and numerous
its muscular and mucous coats.
stronger posterior branches.
6. The branches to the pericardium are thin t
The anterior and posterior pulmonary branches unite with the
its anterior and posterior walls, On their way they
branches of the three or four superior thoracic ganglia of the sym
branches of the oesophageal and pulmonary ptero:
pathetic trunk to form the pulmonary plexus (plexus pulmonalu).
The abdominal part of the vagus nerves is represented by the The remaining part of the anterior vagal trunk
anterior and posterior vagal trunks (truna vagtdes anterior et poste the anterior periphery of the lesser curvature of tl
rior) (Figs 834, 912). They run on the anterior and posterior sur sends numerous anterior gastric branches ^rami
faces of the oesophagus and enter the abdominal cavity either as nervi vagi) to the anterior surface of the stomach.
solitary trunks or as several branches. The gastric branches of the anterior and posteria
unite in the subserous coat of the stomach with the
In the region of the cardia the posterior vagal trunk sends
here along the left gastric artery and form the ant
some twigs which are called the posterior gastric branches (rami
rior gastric plexuses.
gastrici posteriori nervi vagi) to the posterior surface of the stomach;
The coeiiac branches (ram uHaci nervi vagi) i
the trunk itself deviates to the back and downwards, and retro
the posterior vagal trunk and contribute to the S
grades to form the coeiiac branches (rami cdiari nervi vagi) which
eacfc
coeiiac plexus; as branches of this plexus they rea
stretch along the course of the left gastric artery to the coeiiac
abdominal organs ("see The Coeiiac Plexus). The
plexus (plexus celiacus).
among them are the renal branches (rami renoles ne
The anterior vagal trunk unites in the region of the stomach
run among the coeiiac branches and enter the renal
with the sympathetic nerves accompanying the left gastric artery
renalis).
and gives off one to three branches which pass between the layers
of the lesser omentum to the liver; these are the hepatic branches
(rami hepatici nervi vagi).
The accessory nerve (nervus accessorius) (eleventh pair) is a mo the cranial roots. There are four or five of them foi
tor nerve (see Figs 803, 804, 827). There are two nuclei of the ac or cranial root of the accessory nerve (radix cranialii
cessory nerve (nuclei nervi accessorii). One is the nucleus ambiguus The rootlets arising from the lateral white coin
(the cranial nucleus of the accessory nerve). Fibres arising from cord between the anterior and posterior roots of the
this nucleus form the cranial portion of the accessory nerve which are the spinal roots. They unite to form the spinal
emerges on the base of the brain from the groove of the medulla cessory nerve (radix spinalis nervi accessorii) which
oblongata behind the olive. ters the cavity of the skull through the foramen :
The second, spinal nucleus (nucleus spinalh nervi accessorii) lies in In the skull both groups of fibres unite into a
the posterolatcral part of the anterior (grey) horn of the spinal the accessory nerve which leaves the cavity of the
cord for the distance of the upper five or six cervical segments. with the ninth and tenth pairs) through the jugutai
The rootlets emerging from the medulla oblongata are called divides into two branches,
Apex Jii:JL;iJ;iL-
V, JugularlS tmerna
N glossopharyngeus _
G a n g l i o n [nfrj-jus — J|
n, vagi
N. liyniifflussns — i ^ l l K j
111
N. bryngtUS Superior-.^!
cardiaeus cervical is
M . levalor stapu]3t-.J|
mperioi
N, larvngeus fecurrens
Cardiac us inferior
A. vertebra
Communicating branch
Plexus bractifalis between a, depressor [BN A]
A, carotis cummunis dexte*_ and n. laryngeus recurrent
M . scalerius anterior —,
A. suhclavla dMtra~
"—-A. csrotls communis
stnistra
Costa [ — .
R. cardliaais
Truneus brachlocephaJIc J S i ' inferior
Arcus aorta*
Aorta ascendens — ~
V . cava superior —
Trunctis pulmonaiis""
— — *" «B
1. The accessory branch to the vagus nerve (ramtts interntis ticrsi supplies the muscle and in its depths communicates with the
accessor!;) approaches the vagus and becomes part of it; this branch branches of the cervical plexus (third cervical nerve). After that
contains more fibres of the cranial part. the nerve emerges about half way down the lateral border of the
2. The branch to the sternocleidotmastoid muscle (mmiu exter- stemocleidomastoid muscle into the region of the posterior tri
nus ncrm acussorii) descends and at the angle of the mandible devi angle of the neck and runs under the trapezius muscle which it in
ates to the back to run under the stemocleidomastoid muscle; it nervates.
T H E HYPOGLOSSAL NERVE
The hypoglossal nerve (nerota hypoglosstts) (twelfth pair) is a (e) communicating branch with the second cervical loop;
motor nerve (see Figs 803, S04, 831). (f) communicating branch with the lingual nerve of the tri-
The nuclei of the hypoglossal nerve (nuclei nemi hypoglossi) lie germnal nerve.
in the middle of the posterior part of the medulla oblongata. From In addition to the communications, the hypoglossal nerve gives
die aspect of the floor of the fourth ventricle they are projected in off the following branches.
the hypoglossal triangle (trigomim nervi hypoglossi) (see Figs 771, 1. Branches co the dura mater of the brain originate in the re
772). gion oT the hypoglossal canal and pass to the walls of the occipital
The hypoglossal nerve emerges From the brain matter by sinus.
10-15 rootlets from the groove between the pyramid and olive of 2. The superior root (branch) of the ansa hypoglossi (ansa cer-
the medulla oblongata. The rootlets unite into a single trunk which pttsBsl contains fibres both of the hypoglossal nerve and those of
leaves the cavity of the skull through the hypoglossal canal, de the first cervical loop which communicates with the hypoglossal
scends between the vagus nerve and the internal jugular vein, nerve (see above).
curves round the lateral surface of the internal carotid artery, pass Tliis root descends on the anterior surface of the internal jugu
ing between it and the internal jugular vein. Then it crosses the ex lar vein next to the branches from the first, second, and third cervi
ternal carotid artery in the form of an arch which loops down cal nerves forming the ansa hypoglossi (ansa (eroicalis) (see The, Cer
wards, runs under the posterior belly of the digastric muscle and vical Plexus).
under the stylohyoid muscle in the region of the submandibular The ansa gives rise to branches running to the muscles of the
triangle, and enters the muscles of the tongue to innervate them. infrahyoid group: the stemohyoid, omohyoid, sternothyroid, and
Along its course the hypoglossal nerve sends branches by means of thyrohyoid muscles.
which it communicates with the other nerves. The size of the ansa is determined by the length of the superior
These communications are as follows: root: the shorter the root, the longer are the branches extending to
(a) communicating branch with the superior cervical ganglion the muscles below the hyoid bone.
of the sympathetic trunk; 3. The terminal branches of the hypoglossal nerve (rami lin-
(b) communicating branch with the superior ganglion of the guatts nervi hypoglossi) stretch to the undersurface of the tongue and
vagus nerve; innervate both its intrinsic and skeletal muscles (the superior and
(c) communicating branch with the lingual branch of the va inferior longitudinal, vertical and transverse muscles of the tongue,
gus; the hyoglossus, genioglossus* and styloglossus muscles) (Figs 835,
(d) communicating branch with the first cervical loop; 836, 837).
Ganglion
Inierius n, vagi
Ganglion inferlus n, vagi
Choana —\
N. glossopharyngeus ■
Ganglion cervlcale superius
N. hypoglossus Pharynx (opened)
Isthmus fauclum
VT. pharynge-ae
fe. Ilnguafes n. glossopharyngel
Epiglottis
N. laryngeus superior
V, Jugularls interna
N, vagus sinister ■
Adllus laryngis
N. laryngeus Inferior
Esophagus M. vagus dexter
Glandula ihyroldfia Truncus sympathies dexter
V. Jugtjlarls Interna sinistra r-A. enrolls communis dextra
A. etrotls comrtiLJiis slnistra
& r ,.
Trachea ■ V ^ - UangJlcm cervlcale medium
reeurrens A. thyroldea Inferior
4 Cupula pleurae
.--; i A. subclavta dextra
Ganglion cervico-
1 "Si thoracicum (stellalum)
". larvngeus
recurrent
rygos
^ * ~ N , vagus
bronchioles
Vv. pulmonales
■—Esophagus
A- carpus externa
*»-PiexHS cervtcalls
Ganglion
cervlcale supetijs
truna symptthkJ "
A. laelshs
A. carotls interny -M
Plexus brachlallS
Ganglion cervlcothoraclcum
Truncus sympathicus (cervicaJ part} Istellatiiml
A. subdavla
Osta \
N. cardlacus cervitaHs medins
Arisa subclavla-^
,— N'n. cardiac! Inferlores
N. vaeus — ,
Areas aortae
laryngeus Tecarrert*
Rr, cardiaci from n. vagus R. anastomotioa
between n. vagus and
trunt'UK aympath
Rr cnmnjgrticmfei
N. Inlercosta
Pulmo- sinister
~Truncus syropat
(thoracic part)
Diaphragm a
V. cava inierlur
Pancreas
Rr.gastrlcl anleriorc
Veiitrk'uius—■ — :
The olfactory nerve (I) forms from neuronai fibres of the olfac sory nerve. The hypoglossal nerve (XII): the meg
tory (ethmoid) fossa. The optic nerve (31) is an aggregate of fibres from the cells of the nucleus in the floor of the few
of the retina! cells. The oculomotor nerve (III) is formed of fibres The nerves develop most intensively after ti
arising from the inferior parts of the mid-brain. The traehlear The amount of connective tissue in the nerves
nerve (IV) forms from fibres emerging from the isthmus rhom- and a myelin sheath forms round the nerve fibre*
bencephali. The trigeminal nerve (V): the sensory fibres grow from Myehnization is one of the age-related pec
the cells of the trigeminal ganglion, the motor fibres arise from the This process is not uniform in its course in diffe
nucleus lying in the basal lamina of the brain. The abducent nerve the motor nerves become myelinated, then Lhe n
(VI) is formed of fibres originating in the base of the posterior at last the sensory nerves. This applies both t o l l
cerebral vesicle. The facial nerve (VII); the sensory fibres originate nal nerves.
from the cells of the ganglion or the facial nerve (ganglion geniculi), There is evidence that the cranial nerves
the motor fibres derive from the cells of the nucleus of the facial tion successively, namely, that by the time of
nerve situated is the basal lamina or the medulla oblongata. The nerve has the most developed myelin sheath, hi
auditory nerve (VIII) fibres arise from the cells of the vestibular of nerve function determines to a certain nteajtur d
ganglion and the spiral ganglion of the cochlea. The glossopharyn- the myelin sheath formation. Such a process a
geal nerve (IX) is formed from several sources: the sensory part nerve whose fibres are intensively myelinated in r.
forms from the superior and inferior ganglia of the glossopharyn- birth. It is believed that after birth the myelin
gcal nerve; the motor part—from the nucleus ambiguus; the secre process goes on and reveals a certain succession
tory part—from the inferior salivary nucleus. The vagus nerve (X): the motor and sensory nerves: motor—the facia
the sensory fibres arise from the cells of the superior and inferior ducent nerves, the third division of the trigemii
ganglia of the vagus; the motor fibres—from the nucleus ambi- lomotor nerve; sensory—the auditory nerve,
guus; the parasytnpathetic fibres—from the dorsal nucleus of the divisions of the trigeminal nerve, the vagus, gk
vagus. The accessory nerve (XI): the motor fibres form from the the optic nerves.
cells of the nucleus ambiguus and the spinal nucleus of the acces
autonomic ganglia of the head are part of the autonomic (2) the greater superficial petrctsal nerve (nervuspetrosus major),
e) nervous system. They consist of celis belonging mainly a parasympathetic rootlet which is a branch of the facial nerve
il> parasympathetic part. These ganglia are situated along the containing fibres of its sensory root (nervus intermedius);
of the trigeminal nerve and communicate with it by (3) the deep petrosal nerve (nervus petrosus profimdus), a sym
branches; though the ganglia are not components of the pathetic rootlet arising from the internal carotid plexus.
they are nevertheless described together with it. T h e auto- T h e two last-named nerves approach the sphenopalatine gang
:
K ^ g ^ a °f t h c head are approached by twigs of sensory, pa- lion from the back, enter the pterygopalatine fossa through the
hctic, and sympathetic character which are called root- pterygoid canal, and fuse into a single nerve of the pterygoid canal
(nervus canalis pterygoideus jradht fawdis]),
T W fibres of a parasympathetic rootlet terminate on the cells Branches arising from the sphenopalatine ganglion:
these ganglia. T h e postganglionic fibres of these cells form to- (1) the orbital branches (rami orbitahs gangliones pierygopalatini)
with the sensory and sympathetic fibres the peripheral contribute to innervation of the mucous m e m b r a n e of the sphe-
of the ganglia. noidal sinus and the posterior air cells of the ethmoid bone.
T h e nerves originating from the ganglia are called branches. (2) the superior posterior nasal nerves (nervi nasales posteriory
carries sensory and motor, sympathetic and parasympathetic superiores) emerge from the pterygopalatine fossa lodging the
sphenopalatine ganglion via the sphenopalatine foramen and
T h e following five autonomic ganglia are distinguished in the penetrate into the cavity of the nose in which they are named as
head: ( t ) the ciliary ganglion (ganglion, ciliart) (see Figs 8 1 1 , 812); follows in accordance with their topography:
CQ d»e sphenopalatine ganglion (ganglion pierygopalatinum) (see (a) the short sphenopalatine nerves (lateral) (rami nasales poste-
R p 812, 813); (3) the otic ganglion (ganglion oticum) (Fig. 822); riores superiors laterales) innervate the m u c o u s m e m b r a n e of the
f f l the submandibular ganglion (ganglion submandibulare) (see posterior parts of the superior and middle nasal conchae and the
Kg. 816); (5) the sublingual ganglion (ganglion sublingrtale) (see corresponding regions of the superior and middle meatus;
Kg- 816). (b) the short sphenopalatine nerves (medial) (rami nasales poste-
L T h e ciliary ganglion (ganglion ciliare) is elongated and riores superiors mediates) innervate the m u c o u s m e m b r a n e of the u p
thghfly depressed. It lies deep in the orbit between the lateral rec- per p a n of the nasal septum;
• muscle and the optic nerve in the thickness of t h e Fatty tissur (c) the long sphenopalatine nerve (nervus nasepalatimu) runs
-surrounding the eyeball. forwards and downwards between the periosteum of the vomcr and
T h r e e nerve rootlets enter the posterior bordeT of the ganglion: the mucous m e m b r a n e of this region to the incisive canal, pass
(1) the sensory root of the ciliary ganglion (ramus communicans through it, and terminate in the mucous m e m b r a n e of the anterior
o n mwa nasociliari), a sensory branch running from the ophthal part of the palate (Fig. 822);
mic nerve; (d) the pharyngeal branch of the sphenopalatine ganglion (ra
(2) the m o t o r root of the ciliary ganglion (radix oculomotoria), a mus pharyngeus ganglii pierygopalatini) runs slightly downwards and
parasympathetic branch from the oculomotor nerve; to the back and ends in the m u c o u s m e m b r a n e of the superolateral
(3) the sympathetic root of the ciliary ganglion (ramus sympa- surface of the choauae and the lateral surface of the pharynx in the
ad ganglion ciliare), from the internal carotid plexus. region of the pharyngeal opening of the pharyngotympanic tube.
Branches arising from the ciliary ganglion: the short ciliary 3. T h e palatine nerves unite with ganglionic branches from
(nervi tiliares breves) 1 5 - 2 0 in number originate from the an the maxillary nerve (nervi pierygopalatini), and pass through the
terior border of the ganglion and run forwards to the posterior sur- palatine canal and the greater and lesser palatine foramina to the
Eace of the eyeball. They unite here with the long ciliary nerves mucous m e m b r a n e of the nose and palate. They send two
fatnialiares longi) arising from the nasociliary nerve; together they branches:
pierce the sclera and stretch between it and the choroid. T h e long (a) T h e greater palatine nerve (nervus patatinus major) emerges
and short ciliary muscles innervate the coats of the eyeball, the through the greater palatine foramen (foramen palatinum majus)
cornea, the ciliary muscle, the sphincter and the dilator of the pu- and innervates the mucous m e m b r a n e of the soft and hard palate
Pfl- and the gum of the u p p e r jaw. Its terminal branches communicate
II. T h e sphenopalatine ganglion (ganglion pterygopalatinum) is with the long sphenopalatine nerve (nervus nasopalatinus).
triangular and lies in the fatty tissue which fills the pterygopalatine Passing into the palatine canal, the greater palatine nerve gives
fossa. rise to the nasal branches (rami nasales posteriores inferiores laterales)
Nerve rootlets approaching the sphenopalatine ganglion: which innervate the m u c o u s m e m b r a n e of the middle and inferior
(1) sensory ganglionie branches of the maxillary nerve (nervi meatus of the nose, inferior concha, and maxillary sinus.
pierygopalatini); (b) T h e lesser palatine nerves (nervi patatini ntinores) emerge
from the lesser palatine foramen (foramen palatinum minus) and in oval and slightly depressed. It lies under the lingua
nervate the posterior parts of the soft palate mucosa and the tonsil. the submandibular gland.
III. The otic ganglion (ganglion otkum) is oval and lies on the Its roots are as follows:
medial surface of the mandibiilar nerve at its exit from the fo (1) the sensory root—short twigs from the li
ramen ovale. (2) the parasympalhetic root—fibres from th<<
The roots of the ganglion: which approach the ganglion as components of |
(1) the sensory root arises from the auriculotemporal nerve lingual nerve.
(branch of the niandibular nerve); The fibres of die sensory and parasympathetic
(2) the lesser superficial petrosal nerve (nervus pttroius minor) the communicating branches with the lingual ne
(parasympalhetic rootlet) is a branch of the glossopharyngeal cantes cum nervo linguali);
nerve; (3) the sympathetic root of t i e suhmandibuUr i
(3) the sympathetic root is a branch of the plexus meningeus sympathicus ad ganglio sKbm.andihuia.re)— twigs from
uiediufs which surrounds the middle meningea) artery. rounding the facial artery.
Branches originating from the otic ganglion: Branches arising from the submandibular
(1) the communicating branch with the auriculotemporal (1) the glandular branches (rami glanduiara I
nerve (ramus communicate cum rtervo aurieulottmpmrali) which carries dibularis) innervate the submandibular gland and
secretory fibres to the parotid giand; (2) the pharyngeal branch — a twig terminaiiam^,
(2) the communicating branch widi nervus spinosus (ramus glossus muscle and the superior constrictor musck
commvmcans aim ramo metiingeo neroo mandibularis) is a twig running (3) branches running from the ganglion to
to the dura mater of the brain together with the meningea) branch and penetrating together with it the tongue thic
of the niandibular nerve; in its mucous membrane;
(3) the communicating branch with the chorda tympani (ra (4) branches originating from the subn
mus communieans cum chorda tympani); and communicating it with the neuro-gangli
(4) communications to the muscular branches of the niandi sends branches to the submandibular and subhrtf
bular nerve: (a) the nerve to the tensor tympani muscle (nervus the sublingual ganglion.
tensoris tympani); (b) the nerve to die tensor palati muscle (nervus V. The sublingual ganglion is the smallest ai
tmsow uili palatini); (c) the nerve to the medial pterygoid muscle; in the head and lies on the lateral surface of the
(5) communications to die sensory branches of the niandibu The sublingual ganglion has roots in com
lar nerve: (a) the buccal nerve (wrens buccatis); (b) a branch to the mandibular ganglion, It receive* the sublinpual
dura mater of the brain. branches from the lingual nerve.
IV. The submandibular ganglion (ganglion submandibular e) is Branches arising Trom the sublingual gang
lingual gland.
III Oculomotor Nucleus ii. Nucleus acces- Central grey matter of Sulcus oculomotorius Fissura orbitalis su- Superior, medial, and
oculomotorii sorius tegmentum at level of pedunculi cerebri perior inferior rcctus mus
superior q uadri genii- cles, levator pafpebrac
nal bodies superioris muscle, in
ferior oblique muscle
IV Trochlear Nucleus n. Central grey matter of Behind tectal lamina Fissura orbitalis su Superior oblique
trochlearis tegmentum at level of on either side of fren- perior muscle
inferior quadrigemi- ulum veli and curving
lial bodies round cerebral pe
duncle
Trige initial Nucleus mo- Posterior part of pons, Anterior surface of Nervus oplithalmi- Skin of forehead,
torius ii. tri in cminentia medialis, pons at junction with CUS — fissura orbita bridge of nose, upper
ge mini medial to locus coeru- middle cerebellar pe lis superior eyelid, eyeball, lacri-
leus duncle nial gland, lacrimal
sac, mucous mem
brane of nasal cavity
and sphcnoidal sinus,
dura mater of brain
Nucleus SCil- Posterior part of pons,
sorius superior lateral to and behind
n. trigemini motor nucleus in re
gion of locus coeru-
leus
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Vrif Auditory Nuclei vestib- Posterior part of pons Behind the pons, be- Porus acusticus in- Ampullae of semicir
(a) Vestibular ulares media- in region or vestibular tween it and olive of temus cular canals, utriculus
ucrvc Ms, lateralis, area medulla oblongata and sacculus
(pars ves- superior et in
tibularis) ferior
(b) Cochlear Nuclei coch Spiral Organ
nerve leares ventralis
(pars et dorsalis
coch leans)
The Cranial Nervts (continued)
There are 31 pairs of spinal nerves (nervi spinales) (Figs 838, Most spinal ganglia are lodged in the inter*!
868) which are distributed as follows; the lower lumbar ganglia lie partly in the venebn
(1) cervical nerves (nervi cmttcales) (C^-Cg), eight pairs; ral ganglia, except for the last one, lie in the vt
(2) thoracic nerves (nervi thoradd) ( T h ^ T h ^ ) , twelve pairs; durally. The spinal ganglion of the coccygeal
(3) lumbar nerves (nervi lumbales) (l^-Lg), five pairs; dural space. The roots of the spinal nerves and
(4) sacra] nerves (nervi saerales) (S1-S5), five pairs; can be studied when the vertebral canal is op
(5) coccygeal nerves (nervi cotcygeus) (Coi-Coj), one, rarety two nants of the arches and articular processes are 1
pairs. All the spinal nerves, except for the first
Each spinal nerve (see Figs 732, 868) is a mixed nerve and and die coccygeal nerves lie in the region of the
forms by fusion of two roots belonging to it: (1) a sensory, or pos ramina; those lying most distally and contrit
terior root (radix dorsalis nervi spinalis) and (2) a motor, or anterior tion of the cauda equina are also situated paid
root (radix ueniralh nervi spinalis). Each root is connected centrally canal. The first cervical spinal nerve (Cj) passes I
with the spinal cord by means oT rootlets of the spinal nerves (Jila ital bone and the first cervical vertebra; the eigti
radiculario, ncrvorum spinaliv.-m). The posterior root is connected with nerve (Ce) lies between the seventh cervical
die spinal cord in the region of the posterior lateral snlcus (suktts vertebrae; the fifth sacral (S5) and the CO
lateralis posterior medaliue spinalis) by means of the rootlets of the through the sacral hiatus (hiatus sacralis).
posterior root (fila radieularia radios dorsalis); the anterior root is The spinal nerves are mixed in character;.
joined to the spinal cord in the region of die autcrolatera) sulcus the vertebral canal each nerve runs for a short 1
by the rootlets of the anterior root (fila radicularia radicis veatralis). diately divides to form the anterior primary 1
The posterior roots are thicker and contain a spinal ganglion and die posterior primary ramus (ramus dorsd
(ganglion spinale). An exception is the first cervical nerve whose an motor and sensory fibres (see Fig. 903). Bv me
terior root is larger than the posterior one. The root of the coccy- eating branch (ramtu communicans), which some I
geal nerve contains no ganglion in some cases. be the third ram us of a spinal nerve, each spin;
The anterior roots do not have ganglia. At the site of formation the corresponding ganglion of the syinpatheti
of the spinal nerves the anterior roots simply run next to the spinal trunk itself.
ganglia (usually in a groove on their medial surface) and are con There are white and grey communicating
nected to them by means of connective tissue. mer carry preganglionic (myelinated) fibres
The roots unite to form the spinal nerve lateral to the spinal lateral horns of the spinal cord and are
ganglion. branches are found running from the eighth
The roots of the spinal nerves pass first in the subarachnoid second or third lumbar [L^-L3] spinal nerves),
space and are invested, directly in the pia mater. The ligamentum nicating branches carry postganglionic (c
denticulatum runs between die anterior and posterior roots in the fibres From the ganglia of the sympathetic
subdural space. The three meninges invest closely the roots ap cord; they are darker (grey) in colour.
proaching the intervertebral foramina, fuse with one another close Each spinal nerve gives rise to a branch
to the spinal ganglion and are continuous with the sheath of die dura mater; it is called the meningeal branch 1
spinal nerve (see Figs 79H, 794). spinalis) and contains, in addition, sympathetic
The roots of the spinal nerves stretch in die subarachnoid geal branch is also known as the recurrent ne
space From the spinal cord to the intervertebral foramen in the fol ters the vertebral canal via the intervertebral
lowing manner (Fig. 839): (1) the roots of the superior cervical vides into two branches: a larger branch asce
nerves stretch almost horizontally; (2) the roots of the inferior cer wall of the canal and a smaller descending br
vical nerves descend obliquely from the spinal cord and before en cates with the neighbouring meningeal brand*
tering die intervertebral foramen are one vertebra below the site of tralatera) branches. The anterior meningeal
their origin from the spinal cord; (3) the roots of the upper ten gens anterior) forms as a result. Similar relati
thoracic nerves descend still more steeply and enter the interverte posterior wall of the vertebral canal where the 1
bral foramen approximately two vertebrae below the level of their plexus (plexus meningeus posterior) forms. These |
origin; (4) the roots of the last two thoracic, the next five lumbar, branches to the periosteum, bones, meninges
the five sacral nerves and the one coccygcal nerve descend verti venous vertebral plexuses, and to the artoii
cally to form the cauda equina with the contralateral roots which canal. In the region of the neck, the spinal ne
is situated in the subdural space. After separating from the cauda formation of the vertebral plexus (plexus
equina, the roots run laterally and unite to form the spinal nerve vertebral artery.
while still in the vertrebral canal.
*:— N. ulnaris
N-cutaneus
iruebrachii —
medialis
Rn venlrales
~^-(nn. intercostales 1
N. subcostalis
Truncus sympalhicus
{ganglia lumbalia)^,
N. iliohypogastrlcus
Rr, musculares ^ ^g±.
N. llfolngulnalis-
S,
i—s>
R. cutaneus anterior — mH, fe morale
" " — N . cutaneus
R, anterior femoris posterior
N, obturatorius
R. posterio
~N. ischiadicus
V. aurlcularJs posierlc
Platysma (reflected)
N. otdpitalis
major 3A
Ramus nmrgiiiaNs
rn;indiliulae
A. occipitalis % S
retromaiidlbularls
V. occipital
N. occipitalis
minor
p prior s
| N. trarrsversus
colll
jirguliiris extema
V. jugularis
anterior
Nn. supraclavi
lateralesipostcritire ■'lalvsnu
Nn, SEjpracla-
viculares
medlales
Nil. supnidHwciiliires^.
inrcrmedii -*=-' " '
840. Cutaneous nerves of right cervical plexus (nervi cutanei plexus cervkalis); lateral aspect {%).
(Part of the platysina is removed.)
N. supraurbitalb
R. laterals (branches of n. frontalis
medial is | from n. ophthalmicus n, trigemini)
R, Jygoniattcottmporalis
N. occlpltalis
major (r. posteriorly
n. cervicalis) Yfc
N. transversus colli
(branch of plexus cervicalis)
g
Nn. supradaviculares
(branches of plexus
cervicalis)
841, Distribution of cutaneous nerves of head and neck, right side (semischematical
representation).
« a d s to send branches to these three muscles as well as to the (Cg) is the largest a n d passes initialy between the first a n d second
M K s p m a l i s capitis, longissimus capitis, and rectus capitis posts- cervical vertebrae, t h e n curves round the inferior border of t h e o b
m i n o r muscles. liquus capitis inferior muscle a n d divides into one long; and several
T h e branch r u n n i n g t o the obliquus capitis inferior muscle short branches.
r off a c o m m u n i c a t i n g branch to the posterior primary ramus T h e short branches send twigs to the semispiiialis capitis, sple-
of the second cervical nerve ( Q . ) , O n e branch is supplied to the nius capitis, spleiiius cervicts, and longissimuss capitis muscles.
Je of the atlanto-occipita) joint. T h e long branch is called the greater occipital nerve (nervus o<-
% T h e posterior p r i m a r y r a m u s of t h e second cervical nerve ripitalis major). It perforates the semispinalis capitis muscle a n d the
N, masseterlcus
G million I r l g e m r M t —
N. mandibularis
K, tempuralls profundus'
(n. lrige.mln.us) _ _- - % N. alveoluris inferior
V Branch to m. sterrmthyroideus
W. sternocleidutnastoldeus
J L ^ ^ Z r^a'ter6 Z E S S f f 2 t p
2 T £ TP and the brachiai vh»
" * * * * * * * ■ * — ** * ^
M
—of zfirst5U £ K I 2 « E S 5 3 s *■" "** ™*- -
The lesser occipital nerve (ntrvus ocapitalis minor) (see Figs 841), runs, like the greater auricular nerve, to the posterior border of the
841) originates from the second and third cervical nerves (C a and stemocleidomastoid muscle, winds round it, and passes forward*
C s ), stretches to die posterior border of the stemocleidomastoid in the transverse direction on the lateral surface of this muscle be
muscle, comes out from under it and often divides into two tween it and the plarysma where it ramifies into larger superior
branches which ascend to the back (to the occiput) and ramify be branches (rami sitperiores nervi transversi colli) and smaller inferio
hind and above the auricle in the skin region bordering posteriorly branches (rami inferiores nervi transversi colli). These branches perf
upon the ramification of die greater occipital nerve (nervus oaipita- rate the platysma, ramify in the skin of the side and front of die
Its major) and anteriorly upon the region of the great auricular neck, and extend to the inferior border of die mandible superiorly
nerve (neraui auricularis magnus). and almost to the clavicle inferiorly. The cutaneous nerve commu
The lesser occipital nerve has communications with the greater nicates with die cervical branch of the facial nerve (ramus colli ntrm
occipital nerve, trie greater auricular nerve, and the facial nerve facials) and forms with it the superficial cervical loop.
branches (the posterior auricular nerve and the occipital branch). The supraclavicular nerves (nervi supraclavkulares) (see
The greater auricular nerve (nervvs auricularh magnus) (see Figs 840, 841) originate from the third (fourth) (0a, C+) cervical
Figs 840, 841) is the largest nerve of the cervical plexus. It begins nerve, pass along the posterior border of the stemocleidomastoid
from the third (fourth) cervical nerve (C3 or C»}, stretches to the muscle, emerge from under it slightly lower (ban the anterior ctf
posterior border of the stemocleidomastoid muscle, winds round it taneous nerve of me neck, and lie in the posterior triangle of the
distal to the lesser occipital nerve, and passes over to the super neck under the fascia. After that they perforate the fascia, descend
ficial surface of the muscle. There the nerve ascends forwards to to the clavicle, and separate radially into three groups.
the auricle and divides into anterior and posterior branches. (a) The medial supraclavicular nerves (nervi supradaviculares m
The anterior branch (ramus anterior nervus auricularis magni) is diaks) ramify in the skin of the suprasternal notch and the manub
thinner and ramifies in the skin in the region of the parotid gland, rium of the sternum below the medial part of the clavicle.
lobule of die auricle, and the concave surface of the concha of the (b) The intermediate supraclavicular nerves (nervi supradaritm
auricle. The posterior branch (ramus posterior nervi auricularis magni) lares inlermedii) are distributed in the skin in the region of the m
ramifies in the skin of the outer surface of the auricle and the skin dial part of the deltoid muscle and anterior surface of the ches
behind the ear. and stretch to the level of the fourth rib.
The greater auricular nerve has connections with the lesser oc (c) The lateral supraclavicular nerves (nervi supradaviculares U
cipital and posterior auricular nerves. textiles Iposterioresj) ramify in the skin in the region of the poster
The anterior cutaneous nerve of the neck (nervus transversus parts of the deltoid muscle and the coracoid process of the seal
colli) originates from the second (Q,) or third (C 3 ) cervical nerves, pula.
1. Many short muscular branches arise directly from the ante geniohyoid muscle—by Ci-C^;
rior primary rami of some of the cervical nerves (rami ventraUs ntr- sealenus anterior muscle—by (C+); C5-C7 (C 3 );
cervicalium) (Fig. 909) and supply certain muscles of the scalenus medius muscle—by C7-C s ; (Cj)
head, neck, and back. These are muscular branches running to the sealenus posterior muscle—by C v -C+;
following muscles: (c) muscles of the back:
levator scapulae muscle—by (C^), C s , C4 (C 5 );
(a) muscles of the head:
trapezius muscle—by C 5 -C 4 and branch of accessory nerve;
rectus capitis anterior muscle—supplied by C] (C^);
anterior uitcrtransverse muscles—by C-j-C;,
rectus capitis latcralis muscle —by Q*;
2. The ansa hypoglossi (ansa cervicalis) is made up of mot
longus capitis muscle—by C]-Cj (C+);
fibres of the anterior primary rami of cervical nerves which do w
(b) muscles of the neck:
stemocleidomastoid muscle—by C 2 - C , and branch of accessory contribute to die formation of the cervical plexus. It is formed b
die superior and anterior roots.
nerve;
sternohyoid muscle —by C,-C 3 (C 4 ); ansa cervicalis; (a) The superior root (branch) (radix jramusj superior) consis
omohyoid muscle —by C ^ C j . ; ansa cervicalis; of motor fibres of die anterior primary ramus of the first (and, ie
sternohyoid muscle —by C1-C5,; ansa cervicalis; frequently, the second) cervical nerve, which first join the hyp.
thyrohyoid muscle—by 0 , - 0 ; ; ansa cervicalis; branch of hypo- glossal nerve but then, in the region where this nerve forms i
glossa! nerve; arch, separate from it to form the superior root, and oniy a vq
N. actvssoriiis-^^Hfe
R, ventralls C
844. Right phrenic nerve (l/2) (drawn from specimens prepared by P.E
(Most of the muscles of the neck are removed; the right half of the thorax is opened
bom C(
■MSDM
eh from inferior cervical sympath-
* - - < ?
m trunk of va^uj fitrvc
^ ■ k b n ^ muscle
rf r 4 i ^ m anterior muscle
l rpmcle
tool ■
_ f»rts of the central tendon, at its junction with the some branches,
^ * I B J C nerve to pWiis
I 01 phrenic li^rve
E v e u d s of peri^
^!f^f?"(specimen P " p ^ d b
y P- Evdoki, ph )
- w_«£ ^r P ,;v^;;r,r;l-irtT '
M- obllquus e i t e m us
■ ! ! : v ■ ; - ' . : ■ ! :■■
M. ubltquus
internus
abdonihvJs
N. phrenJfus sinister
848. Nerves of diaphragm; superior aspect (%) (drawn from specimen prepared by
P.Evdokimov).
5. The diaphragmatic branches (rami phenicoabdominaks nervo- (b) branches to the hepatic plexus;
rumpkremcontmj arc as follows: (c) branches to the gastric plexus;
(a) branches which are components oF the right and left infe- (d) branches to the peritoneum, liver, and anterior abdon
rior phrenic plexuses (see The Autonomic Nervous System); the right wall,
plexus is the largest and contains the phrenic ganglion (ganglion
pkrenicum) (see Fig. 921);
anterior (ventral) divisions (divisiones dorsaUs et ventraks). The fossa (fossa supradavicularis major), lateral
trunks Of the plexus stretch in the space between the scalenus mus lower part of the sternocleidomastoid
cles behind and above the subclavian artery. They emerge from the inferior belly of the omohyoid mu
the space into the greater supraclavicular fossa in which they come cervical artery (arietta transversa colli/
close to one another. In a lean person the trunks can be palpated cords of the plexus.
here immediately cranial to the clavicle. The rami forming the The infraclavicular part (pars in/r*
brachial plexus have communicating branches with the sympath lary fossa between the subscapular and
etic trunk and its ganglia—the middle ganglion (ganglion cerckak behind the pectoralis minor and major i
medium) and inferior ganglion (ganglion cervkothwaticum fstella- While still in the supraclavicular f
chial plexus unite to form three cord*
tumj).
Two parts, supraclavicular and infraclavicular, are distin (fasciculus lateralis) situated lateral to d
cord (fasciculus medialis) situated medial
guished in the brachial plexus topographically. The supraclavicu
rior cord (fasciculus posterior) lying behind
lar part (pats supradavicularis) lies in the greater supraclavicular
The supraclavicular part of the brachial plexus (pan supradavi terior portion of the supraclavicular parti
cularis plexus btachialis) sends muscular branches (rami musculares) tothe nerve to the rhomboids fntnm 1
the deep muscles of the neck, and short nerves to the muscles of to the serratus anterior muscle fa
the shoulder girdle.
The muscular branches supplied to the deep muscles of the
THE NERVE TO THE !
neck arise from the plexus branches immediately after their emer
gence from the intervertebral foramina, and run to the following The nerve to the rhomboids (nercui d
muscles: intertransverse, scalenus anterior, scalenus medius, scale on the anterior surface of the levator vaj
nus superior, and longus cervicis. and the scalenus posterior muscle, and
The short nerves: ing branch of the transverse cervical ai
(1) the nerve to the rhomboids (nemtts dorsalis scapulae); lar artery (arttria scapularis descendens;, i
(2) the nerve to the serratus anterior muscle (nervus tkoracicus the scapula where it sends branches i
longus); rhomboid minor muscles and to tt
(3) medial and lateral pectoral nerves {nervi pedotales mediatis et scapulae muscle.
lateralis);
(4) the nerve to the subclavian muscle [JKTTOI subclasius);
(5) the suprascapular nerve (nervus suprascapularis); THE NERVE TO THE SERRATUS |
(6) the sub scapular nerve (nervus suhsutpularis) and its branch,
The nerve to the serratus anterior I
the nerve to the latissimus dorsi muscle (nervus thoraccdorsalis).
gus) (C5-C7; CB) descends on the lateral 1
Branches arising from the anterior portion of the supraclavicu
terior muscle along the axillary line x
lar part of the brachial plexus and those arising from its posterior
depths of the slips of this muscle (Fig. ""
portion are distinguished. The branches originating from the pos
THE MEDIAL AND LATERAL PECTORAL NERVES They descend behind the clavicle and i
The anterior thoracic nerves (C s -C a , Th,} are usually repre tery and vein to enter into the depths of
sented by two trunks—the medial pectoral nerve (nervus pectoralis pectoralis minor muscles; one of the br
mtdtalis) and the lateral pectoral nerve (nervus pectoralis lateralis). lar part of the deltoid muscle.
N. mLisculocutaneus
N. ax I Harts
N. cutaneus
brachll lateral Is ^ ^ H
R. p r o f u n d u s j
n. rarliaUs^jg
R. superficial!5 ul
n. rsdtalls /Mm
N. cutaneus
anlebrachii lateralls-;
gf-N. cutaneus antebrachii
media Its
I R. superflcialls n ulnaris
R. profundus n. ulnaris
850. Brachial plexus and nerves of right free upper limb; anterior aspect (represented
semischematically).
A- carotis in tern a
HJ. {itcessorius v
M occJp]iali£ minor ■
Ansa corvical
R. I : :-.. i !::!Is
M. staknus medlns
M scaleriLis ant
--, .d
N. phrtnlcrus
A. ih^ft
V. Jugula Is Jntcrna
Nn. supraciav cu LITL-- J
H
V. subdavta ^
Plexus brachialts ^ , tfm
A, sube&vlj
V. cephalic^ ^
A.HM J^I-.
"*s ^ 1 M H
Fasciculus
LiArntls -s a
THE NERVE TO THE SUBCl-AVTUS MUSCLE round the neck of the scapula, runs under the spinog
ment (ligamentum transversum scapulae inferius), enters the i
T h e nerve to the subclavius muscle (nermis subdavius) (C % , C s ,
nous fossa, and sends branches to the infraspinatus muscles
C 6 ) is a twig lying in Front of the subclavian artery lateral to the
posterior surface of the shoulder joint capsule (some
lower part of the scalemis anterior muscle and r u n n i n g to the sub
plies the teres minor muscle),
clavius muscle. It often sends communicating branches to the
phrenic nerve which approach the nerve laterally.
THE SUB SCAPULAR NERVE
T H E INFRACLAVICULAR PART
(THE LONG BRANCHES)
T h e infraclavicular part of the brachial plexus (pan infmdavicu- tween the coiacobrachialis, subscapularis, and lati
laris plexus brackidis) supplies long nerves to the muscles and skin muscles (Fig. 852).
of the free part of the upper limb and only one short nerve, the ax- I n the axillary fossa the three cords of the infraclavi
illaiy nerve (tttsmt axillaris), t o the shoulder girdle. of the brachial plexus surround the axillary artery on t i
T h e infrascapular part of the brachial plexus enters the axillary medial, and posterior aspects, only the anterior surface r
fossa in which it lies behind the pectoralis major and minor m u s uncovered.
cles, in front of the subscapularis muscle, and lateral to the serra- T h e axillary vein lies on the anteromedial surface i
tus anterior muscle. At the exit from the axillary fossa it lies be Each cord supplies long nerves to the upper limb.
T H E LATERAL C O R D
T h e lateral cord (fasciculus lateralis plexus brackialis) is formed by (2) branches to the periosteum of the h u m e r u s and
the anterior primary rami of the fifth, sixth, and seventh cervical sule of the elbow joint.
nerves (C5-C7). It gives rise to (1) the musculocutaneous nerve A communicating branch between the musculocw
and (2) the lateral root of the median nerve (radix lattraiis nervi me- median nerves may be often found,
diani) (Figs 838, 850. 852). (3) the lateral cutaneous nerve of die forearm '1
antebrachii lateralis) is the end branch of the must
THE MUSCULOCUTANEOUS NERVE nerve.
T h e musculncutaneous nerve (nervus muscubeutaneus) ( C s - C j ) T h i s nerve pierces the brachial fascia in the bend of
(Fig. 853) stretches downwards and laterally, pierces (not always) lateral to the bicipital aponeurosis, fits next to the a
the coracobrachialis muscle obliquely from top to bottom, and fits descends, and ramifies in the skin of the radial bordei
between the brachialis and biceps brachii muscles. It then emerges half of the palmar surface of the forearm down to the
from under the lateral border of the distal t e n d o n of the biceps T h e following communicating branches occur along
brachii and penetrates the brachial fascia proper in the bend of the of this nerve:
elbow to enter the subcutaneous fat as the lateral cutaneous nerve (a) with the superficial branch of the radial nerve
of the forearm (nervus cutaneous antebrachii lateralis). Jicialis nervi radialis);
O n its way the musculocutaneous nerve gives rise to the follow (b) with the dorsal branch of the ulnar nerve (r&aaa
ing branches: mis nervus ulnaris);
(1) muscular branches (rami mustulares) supplying the coraco- (c) with the medial cutaneous nerve of the forearm
brachialis, brachialis, and biceps brachii muscles; neus antebrackii medialis).
MM Hi
Fasciculus later^lLs
Pit MIS
Fasciculus posterior
brathialjs
■Fasciculus medlars
A. thoraco- n . ,."
R
acromialis ' acrora,a"s' ^ ^ ^ A. thoracoiicrocnidlis
\ R. rleltoideu
*--A. Btrflflfrfs
N- pectoralii lateralis ^,^^m
A- Lhoracka latfr^lii
N mu«vJt>cjlateus
M pectoralis R w
major (cut off) y **
^ . ^ V L . ILTI'.S major
N. axillariS *•
A. aubscapuJarts
Ihoratudorsalis
lalisslmus dorsi
M. brachErtlis —
S53. JVercw and flames of rfciW shoulder girdle and upper arm; anteromedial aspect (%).
The lateral root of the median nerve (radix lateralis nervi medt-
anij forma from the sixth and seventh crania] nerves (C 6 , Cj) and
lies lateral to the axillary artery (see below The Median Nerve).
The medial cord (fasciculus madialis plexus brachialis) is formed brackii medialii); (3) the medial cutaneous nerve of the Forearm (ner
by the anterior primary raiui of the eighth cervical and first thor ous aitaneas antebrachii medidis); (4) the medial root of the median
acic nerves (C„ Th,). It gives rise to; (1) the ulnar nerve (nervus d- nerve (radix medialis neroi medium).
naris); (2) the medial cutaneous nerve of the arm (nerous cutaneous
M . bleeps brachil
N. ulnaris
Septum trite rnnustjul a r t
A. brjtchialis
brachil media!?
N. medlanus
_ - A . collateral is
ulnaris superior
Apciiieurou* m bLcLpitj^ brachit . - A . t o [lateral is
ulnaris inferior
Rarni musculares
n. median!
Ten do m. blclpltis b r a f h i i _
A- brachialis T f
- A . inlcrossea anterior
T e n d u m flexnris di^itoruna
superficial Es
Aa. d i g i t a l s palmaTes
communes
Tendo m. Etexoris
p o i n t s longi v
857. Arteries and nerves of right forearm and hand; palmar aspect (%).
be«perfkiaJ layer oF the forearm muscles, the prrmator teres muscle, and the superficial muscles of the hypothenar are remcived.)
mm
858, Nerves of articular capsule of left elbow joint; uinar 859. Nerves ofrigk ifia
aspect (specimen prepared by E.Strakhova), (Photograph.) profundus muscle (:
-brae Mai is irn;-.i li prepared by G.Pi
2 med [an nerve
3 A 7 Tit-rvc braucLies 10 articular capsule of el (Photo
bow joint (Inner surface QF
nerve brain h to periosteum of huiacnif
1 —muscular branch of ulnar n e T t
nerve trunk to pronatur teree muscle
■■ ''•■ ■'■ •' 11 ■■ of the m n s c J t
S—prfjTMictr tttes muscle (cut and re
2— tvrig communicating iiilraTi]
flected)
median nerves
S^fleito]' carpi ulitarjs muscle
10 — ulecranon 3— muscle tendon
11 —articular capsule of elbow joint 4—muscular branch of median a
12—medial epicondyle the muscle thickness
Ifl—uluamerve
14—triceps brachii muscle
M. bra^hijradjbdiis. - |
A. ulnarL
A. radialls ■
rW flexor carpi utnarfa
M. littOT uarpl radiali
N, ulna its
M. flexor digilorum-1
,Os pjstfurme
-Arms paimans
N. digilalis paSmans
R. a 11 astom fiii c u s
Vagina fibTusa
ii Lgi toru m manUa
M n . d i g l t a l M palmares
prop Hi
Nn. dictates
palmares prupr
1— median nerve
2—abductor pollicis muscle (palled aside)
3 —flexor relinacidum of hand
4—nerve bramdi to abductor muscle
5 — nerve branch to opponeTm potLkis muscle
e ^ o p p o n e u a pollicis muscle
7 — superficial head nf flexor pollicis brcvis
tiLLL«r3r
861. Nerves of left hand; palmar surface (specimen prepared by L.Kiseleva), (Photograph.)
terminal branch (ramus superjiaalis nervi ulna™) and a deep termi
digitalis palmaris preprint) lies on the ulnar border of Lhe palmar
nal branch (ramus projundus nervi tilnarisj.
aponeurosis along the hypothenar muscles, passes on the palmar
A. The superficial terminal branch gives rise to the following surface of the little linger and innervates the skin on its ulnar bor
branches:
der;
(1} muscular branches (r&mi naaeufaret), one or two quite thin
(5) the common palmar digital nerve (ncrvus digitalis palmaris com-
branches which supply the palmaris brevis muscle (sometimes also
munis) is thicker than lhe last-named nerve, lies above the palmar
the other muscles of the hypothenar);
aponeurosis, along the fourth interossecms space (spatium inleros-
(2) the cutaneous branches pierce the palmaria brevis muscle seum IV), and divides into the proper palmar digital nerves (nervi
and innervate the skin in the region of the hypothenar; digitales palmares prnprii) which have two branches:
(3) the communicating branch with the common palmar digi
(a) the proper palmar (radial) digital nerve of the little finger
tal nerve of the median nerve (newus digitalis palmaris commit-
(nervus digitalis palmaris proprius) supplying the skin on the radial
nis HI);
aspect of the little linger;
(4) the proper palmar digital nerve (to the little finger) (nervus
A, ulnaris
A. radialis —
— N. ulnaris
Membrana interossea — -
N. interosseus (
anterior {n.m
A. interossea anterior —
-M. flexor carpi
M- brachioradialis - -
R. dorsal is IT. L
M: pronator quadratus —
R. carpeus pain
R. carpeus palmaris a. r a d i a l i s - r - t L l a. ulnaris
R, palmaris superficial fl. r i l d [ a l i ^ i l J j ] — Os pisiforme
Tendo m. abductoris pollicis long! — R. palmaris n. u
Tendo rm cxtensoris pollicis brevis R. superficial]* ^
M. abductor
M. abductor pollicis _ ^ | — R. muscii!;
Arcus palm
Aa. metaca
R.profundus n. ulriaris
(di
M. flexor pollicis brevis^ M. opponent
M. adductor pollicis -*~^fl| , Rr, must
(divided) to mm, in1.
" Rr. mu:
Mm, lumbricales
Mm, flcxores
superficialis ct
(ten dinc
(b) the proper palmar (ulnar) digital nerve of the ring finger B. The deep terminal branch ,
supplying the skin on die ulnar surface of the ring Hnger and the stretches on the radial aspect of I
skin on the dorsal surface of its middle and distal phalanges. through the base of the musdes fom
The end branches of ihe cutaneous digital nerves give rise to the flexor digiti minimi brevis and aij
lamellared coruuscles (corpusatla lametlosa) and pierces the opponens digiti min
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with the deep branch of the ulnar ai
NERVES OF THE UPPER LIME 199
arteriae ulnaris), a deep space on the palm between the tendons of chii muscle lateral to the basilic vein; then it passes behind the me
the long flexors and the interossei muscles. It arches slightly, al^ dian cubital vein (vena mediana cubiti) and ramifies in the skin of
most following the course of the deep arterial palmar arch, and the ulnar part of the palmar surface of the forearm down to the re
passes towards the thumb. The deep terminal branch gives rise to gion of the radiocarpal joint.
the following nerves: Along its course the anterior branch communicates with the
(1) the communicating branches with the first common palmar branches of the lateral cutaneous nerve of the forearm (branch of
digital nerve of the median nerve (nervus digitalis palmaris commu- musculocutaneous nerve}.
nis I nervi mediant); (b) The ulnar branch (ramus ulnaris nervi cutanei antebrachii me
(2) the articular branches to the articular capsules and perios alis) lies medial to die basilic vein, descends on the ulnar border of
teum of the hand bones; the forearm and ramifies on its dorsal surface with the rami reach
(3) the muscular branches (rami muscular es) supplying the fol ing the region of the radiocarpai joint.
lowing muscles: On its way the ulnar branch communicates with the posterior
(a) the thenar: the adductor pollicis muscles and the deep head cutaneous nerve of the forearm (branch of the radial nerve) and
of the flexor pollicis brevis muscle; with branches of the dorsal branch of the ulnar nerve.
(b) the hypothenar; the abductor digiti minimi, flexor digiti
minimi brevis, and the opponens digiti minimi muscles;
THE MEDIAL ROOT OF THE MEDIAN NERVE
(c) middle group of hand muscles: third and fourth lumbrical,
and palmar and dorsal interossei muscles; The medial root of the median nerve (radix medialis nervi medi
(4) the perforating branches pass through the interosseous an!) originates from the eighth cervical and first thoracic nerves
spaces on the dorsal surface of the hand where they communicate (C$, Th,) and lies medial to the axillary artery (Figs 852, 853),
with the twigs of the posterior interosseous nerve (nervus intcrosseus
antebrackii posterior),
THE MEDIAN NERVE
N. digitalis /
palmaris proprius
Jigftales dorsales'
/
M . extensor poJiicis brevis (tendo)
times two or three in number), inconstantly present, lie in the up terior), between the flexor pollicis fen.
per third of the arm;
fundus muscles, to the pronator qu*
(b) on the forearm with the itlnar nerve (ramm communicant cum It supplies the flexor pollicis \<n._
nervo ulnari) in the depths of the flexor digitorum protundus m dus (the radial part related to the ir
lius-
cle
pronator quadratus muscles,
(c) ou the hand with the superficial terminal branch of the ui- 5. The palmar cutaneous branch
nar nervi* (ramus supajkialis nervi ulnaris) and the superficial branch (sometimes two in number) is a thin
of the radial nerve (ramus supeyficuilis nervi radialis). trunk of the median nerve in (he 1....
2. The articular branches supplying; the articular capsule of tween the tendons of the flexor carpi
the elbow joint and partly the capsules of the carpal joints and muscles. It perforates the aritebraehii
joints of the thumb, index, and middle (ring) lingers on the palmar
of the palm and of the palmar surf a. ■
surface.
thumb.
3. The muscular branches (rami musculares). The median nerve 6. The common palmar digital i
does not give rise to branches on the upper arm (except lor the dian nerve (nervi digitals* palmar es c -
above mentioned communicating branch with the rnusculocutane- anij form as the result of rarmficaliu:
ous nerve), On the forearm the muscular branches arise from the dian nerve. They arise at the level of
main trunk of the median nerve at the level of the medial epicon- retinaculum, lie under the palmar a-p
dyle of the humerus and run to the pronator teres, flexor carpi ra mar arch in the first, second, and u:
dialis, palmaris longus, and flexor digitorum superficialis muscles. give rise to: (a) cutaneous branches,
4. The anterior interosseous nerve (nervtis interossevs [antehra- proper palmar digital nerves (nervi ;.':.
chuj anterior) (Fig. 861) arises from the main trunk of the median (a) the cutaneous branches arc i
nerve at the level of the pronator teres muscle and runs cUstally in neurosis to penetrate into the skin i
Created with novaPDF Printer (www.novaPDF.com)'arteria interossea an palm;
NERVES O F T H E UPPER LIMB
N. cutaneus anlebrachM
posterior
N. cutaneus ultebrachli
Fascia antebrach
R. superflcialis n. radlalls
Retinacj[jm eslensorntn
R commumearts ulnuris
The posterior cord (fasciculus posterior plexus brachialis) is formed posterior part of the deltoid region a* wefl as i i J L f f l
by the anterior primary rami of the fifth, sixth, seventh, and eighth per part and lateral surface of the upper .»
branches may communicate with die postern
cervical, and first thoracic nerves ( C s - C 8 , Th]).
the arm (nervus tutarteus brachii posterior., whin
It gives origin to the circumflex nerve (nervus axillaris) and the
dial nerve, and with the posterior cutaneous n
radial nerve (nervus radialis).
(nervus cutaneus aniebrackii poiiervrr), also a brine
The circumflex nerve (nervus axillaris) (C 5 -C 6 ) (Figs 850, 853, THE RADIAL NERVE
854) is a relatively thick trunk. It lies in the axillary fossa, at its
apex, behind the axillary- artery and on the surface of the tendon of The radial nerve (nervus radittlis) (C=-C*. Thi)
tfie subscapularis muscle. It runs slightly downwards, laterally, and 857, 864-867) lies in the axillary fossa behind the
to the back, and in company with the posterior circumflex humeral At the level of the inferior border of the tendon of d
artery passes through the quadrangular space, winds round the dorsi muscle the radial nerve runs backwards. 1
back of the surgical neck or the humerus, stretches between it and downwards and in company with tile profunda b
the deltoid muscle, and gives origin to the following branches: passes between the long and medial heads of die t
(a) the muscular branches (rami musctdans nervi axillarcs), muscle and fits into the spiral groove (allots w n
several small nerve trunks entering the depths of the teres minor humerus. Then in company with the anterior deseenau:
muscle through its inferolateral surface and the thickness of the of the profunda brachii artery (urteria atllater&Us Tadmla,
deltoid muscle through its inner surface. Among the last-named nerve runs between the brachialis and brachioradialis m i
branches is a group of twigs which are distributed in all bundles of the level of the lateral epicondyle the radial nerve divides into
the deltoid muscle (Fig. 856). Some of these twigs perforate the perScial branch (ramus supeifiaalis) and a deep branch (rawxi }m
muscle and enter the skin. Besides, a muscular nerve may send a jundus).
muscular branch to the inferolateral part of the subscapularis mus Branches of the radial nerve (Figs 854, 863-867).
1. T h e articular branch arises from the main trunk of the r
cle.
dial nerve at the level of the surgical neck of the humerus and a
(b) the articular branches are twigs stretching to the articular
tends to the articular capsule of the shoulder joint.
capsule of the shoulder joint between the capsule and the inner
2. T h e posterior cutaneous nerve of the a r m (nervus tv.tamr*i
surface of the deltoid muscle; they also send twigs to the perios
brackii posterior) arises from the main trunk of the radial nerve h
teum of the humerus.
the axillary fossa, runs obliquely backwards, sometimes penetrat
(c) the upper lateral cutaneous nerve of the arm (nervus cutantiis
ing through the thickness of the long head of the triceps brachii
brachii lateralis superior) stretches between the deltoid muscle and
muscle, pierces the brachial fascia approximately at the level of the
the long head of the triceps brachii muscle (in rare cases it passes
tendon of the deltoid muscle, and ramifies in the skin of the po»-
through the thickness of the deltoid muscle). It divides into as
tcrolateral surface of the upper arm. Its branches may communi-
cending and descending branches which ramify in the skin of the
165. Nerves of right hand; dorsal surface (specimen prepared by V.Bobin). (Photograph.)
1—superficial branch of radial nerve 4—terminal twigs From median nerve passing to dorsal surface of
2—communicating branch between ninai ami radial nerves fingers
H—doireal digital nerves 5—dorsal digital Tierves (from ulnar nerve)
6—dorsal branch of ulnar nerve
•rirh those of the upper lateral cutaneous nerve of the arm nerve in the caualis humeromuscularis, extends in attendance to
u culaneus brackii latcralis superior) which is a branch of the cir- the main trunk to the lateral Intermuscular septum, pierces it and
tex n a v e (nertiits axillaris). the brachial fascia at the lateral border of the brachioradialis mus
. The muscular branches (rami musatlares) in the region of the cle, arid ramifies in the skin on the posterior surface of the distal
r ann are supplied to the three heads of the triceps brachii part of the upper arm and posterior surface of the foreann down to
i t to the anconeus muscle, and quite often to the lateral part the region of the r&diocarpal joint. Its branches may communicate
c brachialis muscle. with those of the medial and lateral cutaneous nerves of the fore
. The muscular branches (rami mwscutarts) in the region of the arm and with the dorsal branch of the ulnar nerve (ramus dorsalis
r joint stretch to the brachioradialis and extensor carpi radia- manus nervi ulnaris) and the superficial branch of the radial nerve.
agus muscles. 6. The superficial branch arises from the maintrunkof the ra
Fhe posterior cutaneous nerve of the forearm {nerrjus tuta- dial nerve in the cubital fossa at the level of the lateral epicondyle
aiebrathii posterior) arises from the main trunk of the radial and lies medial to the brachioradialis muscle. Dis tally it lies lateral
to the radial artery. In the middle third of the forearm the super than the superficial branch and lik
ficial branch deviates laterally and, after passing between the ten trunk at the level of the lateral epicon
dons of the brachioradialis and extensor carpi radialis longits mus supinator muscle, winds round the u
cles to the posterior surface of the radial (lateral) border of the descends obliquely to the posterior
forearm, perforates the antebrachia) fascia slightly above the radio- which it lies under (he extensor digitt
carpal joint. Then the superficial branch of the radial nerve ram superficial and deep extensors; after t
ifies in the skin on the lateral region of the radiocarpal joint and in company with the posterior intert
the lateral half of the dorsum of the hand and fingers (see below) dorsal surface of the wrist.
to form the dorsal digital nerves (nervi digitales dorsales neroi radia The deep branch gives origin to:
lis). (a) the muscular branches (rami n
The superficial branch gives origin to the following nerves: forearm which supply the Following
(a) the communicating branches (rami commutikatites) are small carpi radialis brevis, extensor digito
twigs running to the lateral and posterior cutaneous nerves of the extensor carpi ulnaris, abductor pel
forearm in the region of the posterior surface of the lower third of brevis, extensor pollicis longus* extei
the forearm and the radiocarpal joint; the communicating branch (b) the posterior inter osseous nc
with the ulnar nerve (ramus communieans ulnaris) which connects the thii] posterior) originates between the
superficial branch of the radial nerve with the dorsal branch of the the extensors, then lies on the dors;
ulnar nerve (ramus dorsalis warms ncrvi ulnaris) on the dorsal surface membrane of the lorearm between th
of the hand; licis longus and extensor pollicis br
(b) the dorsal digital nerves (nervi digitales dor sales nervi radialis), metacarpus.
five in number, innervate the lollowing skin areas: the radial and Along its course the posterio
ulnar borders of the dorsal surface of the thumb down to the base branches to the interosscous itiembn
of the nail, the radial and ulnar borders of the dorsal surface of the with the anterior interosscous nerve
index finger down to the middle phalanx, and the radial border of anterior) which is a branch of the me
the dorsal surface of the middle finger, also down to the middle and bone thickness of the dorsal su
and to the articular capsules of the
phalanx.
7. The deep branch (ramus profundus neroi radialis) is larger metacarpophalangeal joints.
r65a. Cutaneous nerves of right upper limb (specimen prepared by N.Samoilov). (Photograph.)
A—palmar surface; B —dorsal surface
- -Th H ), the anterior primary ramus of the twelfth thoracic upper arm and innervate the skin 011 it or communicate with the
TV
« (Th12) ** called the subcostal nerve fnewus mkostalis). The medial cutaneous nerve of the arm.
rater part of the first intercostal nerve (Th,) stretches as a com The subcostal n a v e fnervus .mhtmtalis) (Thit) contributes to the
ment of the braehial plexus; the second (Th2), often the third formation of the lumbar plexus (plexus lumbalis).
lb) and rarely the fourth (Tha) intercostal nerves give rise to in- Each intercostal nerve stretches in the corresponding intercos
costobrachial nerves (nem inleTtnstobrackiales) which pass to the tal space and at its origin lies in front of the external intercostal
N. cut an e us brachii
medialis (branch of plexus
brachialis) — _^_^
N. cutaneus brachii
posterior (branch of /
ii. radialis from plexus brachialis) /
f /
/
N. cutaneus antebrachii
lateraJis (branch of //
Rr. euta
n. muscuTocutaneus
S (branches of nn.
from plexus brachialis).
Rr. cutanei latcrafc
(branches of nn. thora
(pectorales)
N, cutaneus antebracl
medialis (branch of pic
brachialis)
R. palmaris (branch of
n. medianus from plexus
brachialis) ^
K. superficial is (branch of R. cutaneus palmaris (branch of
n. radialis from plexus n. ulnam from plexus brachialis)
brachialis) -:■*-,„
^ R. superficialis (branch of n. ulnaris
from plexus brachialis)
^N. digitalis patmaTls
communls ri, ulnaris
1
V Nn. dlgllales pal mares
communes n. medlanl
Nn. digitalis palmares
proprii (branch of _ - > N n . digitales palmares
n, median us from plexus proprii (branches of n. ulnaris
brachialis) from plexus brachialis)
866. Distribution of cutaneous nerves of right half of shoulder girdle and rig
created with novaPDF Printer (www.novaPDF.com)iar) aspect (semischematical representatk
-Rr. cutanei lateralcs
(from rt. dorsaks nn,
thoracici)
Nn. supiadaviculares
(branches of plexus cervical is)
N. cutaneus brachii
posterior (branch of n. radialis
from plexus brachialis)
R. superficial is man us
ft radialis (branch of
plexus brachialis)
R. Jorsalis
(branch of n. uinaris
from pjtxus |-jF-adii<ilis)— -£—*
\
'. ' \
K
r.- " \
«• f
867. M * * * * * . * ^ nerves of right half of shoulder girdle and right free uPPer lim
Created with novaPDF Printer (www.novaPDF.com)'
ct (semischematical representation).
20 S T H E THORACIC SPINAL NERVES
jMm. intercostales
extern
R. cutaneus anterior i :
muscle covered by the endothoracic Fascia and parietal pleura; the nerves reach the lateral border of the -
only exception is the subcostal nerve which stretches not in the in nis muscle, pierce it, run on the poster;
tercostal space but below the twelfth rib and at the beginning lies a small distance (0.5-1 cm) and then
in front of the quadratic lumborum muscle. Each intercostal nerve nerves give rise to cutaneous brancht
passes between the internal intercostal and intcreostalis intimi wall of the sheath of the rectus nhd ■:
muscles and approaches the costal groove in company with above skin of the corresponding region, while
stretching intercostal arteries and veins. ify in the thickness of the muscle. Tin
The upper six or seven intercostal nerves (Th t -Th 6 -Th;) run catc with each other. The distal parts ■
in the intercostal spaces to the lateral border of the sternum and intercostal nerves form plexuses (Fit;- *■'
ramify in the skin of this region; the lower intercostal nerves ap 1. The communicating branches
proach the costal cartilages and pass through the cartilage of the from one intercostal nerve to the nev
next below rib to penetrate between the transversus abdominis and 2. The muscular branches (rami rh':
Created with novaPDF Printer (www.novaPDF.com)heir direction, the following muscles: leva tores cost a run:.
N. occipltalis
major
N_ occipltalis
minor-,_
\a. intcrcostale;
poster iores
(rr. dorsales)
M. latisslmus d o r s i - ^
Rr. cutanei
ractiiales (fiorti rr,
doi'salcs riri. ^
J
ttu-irariturum) - * " "
Fascia tlioracolumhalis
<
i
» ^ J , CUtafleus
h (bianch ot 7
N. email
(branch of n. rai.
Rr.cutanei later
(branches of nn. inter
Rr. cut an .
Rr. cutanet mcdiales (branches of rr. dorsa
(branches of n. dorsales
nn. thoracieorum) i 1
Nn. clunium super'
(branches of rr. dor
nn.lumbalium:
R.cutaneus i
(branch of n. ilioh
plexus lum
Pedunculum cerebri
Medulla spinalis -|
Ganglion cervieothoracicum ( s t r a t u m )
Gsngtfon tetvicaie m e d i u m ^ y]^. phrenlcuS
M. scalenus anterior-. d
Plexus hracHlalls-
:
■ . ' - ^ _
Clavlciils ^ . ^ T
A.axiliads^ Truncus aymphflticus
Rr communicant
Rr. ciilanei artterlonSS
(pectorales)
N. medlanus
Nn.iittertostales
M. rectus sbdomlnls
N. subcostal is-^
CoruS Tnedullarls
M. lumtalls N, CiitanfUS
bradili media I is
N.illotiypogastrlcu:
KUiolngulnsl!:
Plexus l u m b a l l s - ^ ^ T - -
V. sapriens magna
N. obturatorlus Funkulus spemiatkus
serratus posterior inferior, trans versus thoracis, subcostal, mtercos- eral cutaneous branch (it is a
tales intimi, internal intercostal, external intercostal, transversus plexus).
abdominis, internal oblique, external oblique, rectus abdojiiinis, The lateral cutaneous branches r
pyramidalis, and quadratus lumborum. times the third (Th3) and fourth (Ti
3. The pleural and abdominal branches arc twigs stretching in to the skin of the upper arm as the i
the intercostal nerves and branching oil from them to the costal anterior branch of the lateral cutaut
pleura, the peritoneum of the anterolateral walls of the abdomen, tcrcostal, or subcostal flwsrve (Thl5)
and to the serous covering of the diaphragm periphery. small twigs which cross the iliac eres
4. The cutaneous branches (rami cutanei) arise from the inter of the gluteus medius muscle to rear
costal nerves and form two rows of branches—thicker lateral cu greater trochanter.
taneous branches and thinner anterior cutaneous branches. (b) The anterior cutaneous b n
(a) The lateral cutaneous brandies (rami cutanei laterales [pecto [pectoralis et abdominis]) are the tenr
rals et abdommi*;]). They arise From the intercostal nerves and tal nerves. In the region of the thoi;
along the axillary line pierce the external intercostal muscles on tcrcostal muscles and extend to the
the chest to emerge between the slips of the serratus anterior mus as the rami cutanei anteriores peclt
cle, and the internal oblique muscle in the region of the abdomen. fourth pectoral cutaneous branches
After that eacli lateral cutaneous branch divides into an anterior mary gland and are called the mec]
and posterior branch; both branches innervate the skin of the mammarii mediates nervarum tkotddfon
corresponding regions. wall one of the anterior cutaneous b
The anterior branches of the fourth-sixth lateral cutaneous sis of the external oblique muscle at
branches reach the skin of the mammary gland; these are the lat abdominis muscle, while the other
eral mammary branches (rami mammarii laterales nervwum ikoracico- pierce the anterior wall of the sheath
ritm). cle at its medial border to ramify in
The first intercostal nerve (Thj) does not give rise to a lat the rami cutanei anteriores abdomii
The lumbar nerves (nerai lumbales) (Figs 857, 876), live in num base of the sacrum. Like all the oth
ber, are formed by relatively long spinal roots which pass vertically nerve gives origin to a rrtfenirtgej
in the vertebral canal. The anterior and posterior roots unite to branch, a posterior primary rainus ai
form the spinal nerves which emerge from the vertebral canal via The meningeal branches (rami
the corresponding hiteivettebral foramen so that the first lumbar meninges of the spinal cord.
nrfvc (] ,\ is KjMw^fti thr i\r<it nnrl spmnrl lumbar vertebrae, while The communicating branches ft
Created with novaPDF Printer (www.novaPDF.com) mbar vettebra and the sympathetic trunk,
NERVES OF THE TRUNK
N. cutaneus colli
/• (branch of plexus cervicalis)
/ Nn. supraclaviculares
' (braT)ehen of pfe*us cervical is)
N. cutaneus bracliii
I ateralis superior
h (.branch of n.axillaris
Suam plows brachialis)
The posterior primary rami (ram dorsales nervorum luttibalwm) (b) The lateral branches (rami h
lie between the transverse processes of the lumbar vertebrae, run twigs to the lumbar interspinales at:
dors ally, and each soon divides into a medial (ramus medialh) and a thicker branches to the skin. The lat
lateral (ramus lateralis) branches which innervate the muscles of the posterior primary rami of L l7 L^. L
back proper and the skin of the lumbar and sciatic regions the above-mentioned muscles and il
(Figs 8G9; 870). lumbalis) and descend below the ilia
The posterior primary' rami of the lower two lumbar nerves the gluteal region. They are called tl
(L4-L5) supply the muscles only. terior primary rami of the lumbar 1
(a) The medial branches (rami mediates) are smaller than the Along their course they couiinunica
lateral branches and ramify in the multifidus and the lumbar inter- the skin in the region of the greatei
spinales muscles.
The muscular branches arise from the anterior primary rami of to the quadratus lumborum muscle
the first to fourth lumbar nerves (Lt-Lj.] before the lumbar plexus terior primary rami of the twelfth 1
is formed and innervate the mlcriransvei'se muscles of the lumbar bar nerves (Th }S , L , - ^ ) supply the
«»v'.rtn TL™ T .^W nrisimv FrOiti tbr anterior primary rami of the arising from the anterior prim a ry r:
Created with novaPDF Printer (www.novaPDF.com)nerves (Th12T Lj-U) run bar nerves (Ljv L2) innervate the p
THE LUMBAR PLEXUS
M. iliohypogastricua,
Ji femOfalls
ft. nbturatorlus
N. Illolngul
N. genilofemoralis
R. f emoralis R. genitetis
(from n. genilofeinoralifiy
HIS-(from n. getiitofemoralis)
| p
[ V T " - ^ ^ ' - - K Ciir«llRUS leillOtils posterior
Hr. iiiii.iu-: anteriorcs
f ^ S Rr, cutanei
■liV
1ST peroiteus ^
i tlbulsHs^ comniLiiii^J^ N. Lll-i;i!i.i
N. c-utaneussiLr-ae
(ilbu[grls>profuiidus
me dial is-
N- peioneus
(Tibularl&) superficial!
" - . A . S^phfRUS
surae lateral! s
N. cutancus dorsals
rrtedlalis
N. cutaneus dorsal!*
intermediua
N. culxneuf do/satis
lateral[$
N- ptantarl,H mcdialls
dorsflics pedis
N. pJantoris literati*
875. Lumbosacral plexus and nerves of free part of right lower limb; anterior aspect (represented
semischeniatically).
Diaphragma
N. subcostal Is
Tnmcus sviupjathlcus ^- ^ndl(f^H
M. qufldraini lurofnirirm.
to hypo gastric us
Promiwti
kr. cummuHicrinles
Tr unfits
titinhos;icralJs M. psoas major
M cutaneus temorfs
sacralia luteralis
R. yenitalis
Sjsina i||;a;i t~in. gtflftofemwatjs)
autendr superior ^
-*■ Rr. muKcuiorcs (from plexus
N. ciitaueus lumbalis) t o r n , tllacus
x
f't-ninris lLit«ralJs^I=ti^|,
-—R. iernoralis
(ft gen itofe moral is;
B~"Li£. illguinnle
J - N . femoralis
A, prplumta
Pfexiij sacralis femoris.
f - V . ierniiralls
N. obluratofius \ ——
V femoralis
M. pectineus
(divided) -~-£i;_
A, el v. pruFundae j
N. Sfiphenus — - ^ A (ertioralls
"■ M. sartorius (divided)
Aorta abdominalis
V. cava inferior
A . lumbalisIV
and accompanying veins Ureter
N. cutaneus A. et v iUacae
femoris lateralis_<—« communes
sinistrat
K. iliacus a. iltolumbalis
V. Iliaca
and accompanying veins
Interns
M, psoas maJor_ A. .sacral[s
medians
M. femoral Is
V. profunda lemons
R. muncularis
(to m. vastus latcraUs)^ Rr. muaculares
S
>V: femuralls
Vv. comltantes a,
femoralis ^szH R. cutaneus n. obturatorll
.^_M gracflis
R. muscular is -R- cutaneus n. femoralis
(to m. vastus medialis) MB
_^_A. fernoraUs
M. rectus femoris J
N. saphenus__
Rr, cutanci
ind accompanying veins
— ^ s * R. articularls
N, sapbenus
579. Nerves ofvastus muscles of right thigh (specimen prepared by S.Ostrovsky). (Photograph.)
(The external surface of the muscles is demonstrated.)
(b) the cutaneous branches ramify in the skin of the pubis, up- orts) pass to the skin of the root of the penis, the anterior parts of
er part of the medial surface of the thigh, and the inguinal re- the .scrotum (upper parts of the labia majors in Females). These
ion; brandies may communicate with the genital branches of the geni-
(c) the scrotal (or labial) branches (nervi scrotales /labiaksf anteri- tofemoral nerve.
Nn.perincales Ny
M . transversus ^^ "V M. transversus pfn-f-
N
perinei superficial^ v Nv SUptTlJCijilS
(divided) j \ \
\ \ \<
■
JU-Tuher Iscbladicum
N. dorsal Is
perls — v pudendae
interrsae
■LA pudenda interns
Vv. rectales
N. pudendus—■ """
inferiorcs
v
Aa. rectales inferiores \^ Anjs
is i M . sphlnctfir ant externus
A_ pudenda Interns
Nr. rectales Irfferlores
880. Nerves, arteries, and veins of male perineum; inferior aspect (%).
(The gluteus maximus muscle on the right is divided; the scrotum is reflected; part of the sacrotuberous ligament is removed.)
The genitofemoral nerve fnertms gemtofemoralis) (L,, L J pauses triangle. A twig of the femoral branch may communicate with the
in the depths of the psoas major muscle to its anterior surface and intermediate cutaneous nerve of the thigh (ram aitaneus anterior
extends behind the ureter towards the inguinal region. In the mus- nermfimoTalis) and with the ilio-inguinal nerve;
cle> or on emergence from it, the nerve divides into two (b) the genital branch frttmus gmitalis tarsi gmitofcmomlis) lies
branches —the Femoral (ramus femoralis) and genital (mmus getiita-
on the anterior surface of the psoas major muscle medial to the
lis) branches:
femoral branch but also lateral to the external iliac vessels; it de
(a) the Femoral branch (ramus femoralis nervi gtmtofmoralh) scends into the inguinal canal, passes to the superficial ring, and
stretches lateral to and behind the external iliac vessels (easa iliaca leaves the canal together with the spermatic cord (or the round lig
extenw), at first behind and then in front of the fascia iliaca, and ament of the uterus in females). It then runs into the scrotum,
enters the lacuna vasorum in which it runs lateral to and in front sending on its way small branches to the cremaster muscle, the
(if the rcmora] artery. After that it pierces the fascia lata of the skin or (he scrotum, the dartos muscle (lumca dartos), and the upper
thigh in the region of the fascia cribrosa covering the saphenous areas of the medial surface of the thigh; in females it sends twigs to
opening and ramifies in the skin of this area, Some of its branches the round ligament of the uterus and the skin in the region of the
pass under the inguinal ligament, pierce the fascia lata of the superficial inguinal ring and the labia majora. This branch may
thigh, and are distributed in the skin in the region of the femoral communicate with the femoral branch of the genitofemoral nerve.
881* Nerves of male perineum; left side (specimen prepared by A.Kosov). (Photograph.)
(The left ilium is removed; the urinary bladder arid rectum are opened.)
9— muscular branches oi pudenda! plexus 18—left bulb»-urethra! gland
1—ncruni
10—pfrineal nerve 19—syiupliysis (secondary cartilaginous joint)
I—sacral g^ng'Taa of sympathetic trunk
] 1 —branches of perinea! nerve 20—nerve twig tiom pcrinesl nerve to bulbo-
1—ajittriOT sacral foramina
12—bism'h to prostate urethral glaud
A—branches of syni pathetic trunk to pelvic
13—bianches of perinea] nerve to skin of peri 2] — prostate
plexus
neum 22—dorsal nerve of penis
5—sacral plexus
14—strotum 23—Lrriuarv bladder (opened)
<f—pelvic splanchnic nerve firtm S^ to pelvic
IS—branches at perinea! nerve to serotuun 2+— rectum (opened)
ptcEUS
16—penis 25—pelvic plexus (ventral part).
7 ^pudenda] nerve
8—inferior haeinorrrirtidal nerves 17—branches of dorsal nerve of penis
lateral cutaneous nerve of the thigh (ntrvus cutaneus femoris it descends lateral to the sartorius muscle, pierces the fascia lata,
(L(, t^) emerges from under the lateral border of the and ramifies into some small and two or three larger branches
major muscle, sometimes thruugh the substance or the mus- which reach the knee joint. The branches of the nerve may form
nrrtches on the anterior surface of the iliacus muscle under communications with the intermediate cutaneous nerve of the
sHaca to the anterior superior iliac spine medial to which thigh (ramus cutanens anterior nervi femoralis).
t under the inguinal ligament onto the thigh. On the thigh
1 Vv, puderjdae
internac
Sn rectales inierlores
Nil pcrinenles-^^^M
-;3
A. pudenda I n t e r n a l
J
Vv. pudendae Sflterftae
M- gluteus rnaxlmus
N. pudendus
M, levatrtr arli' A rec tails inferior
Vv. rectales inferlof.es' Fossa Istriiorcctalis
M, sphincter ani extern us
882. Nerves, arteries, and veins of female perineum; inferior aspect (%).
(The glutens maximus muscle on the right, is cut; part of the sacrotuberous ligament is removed.)
or magnus and adductor brevis muscles, and sends muscular An inconstant accessory obturator nerve (Lj, L s , L*) lies at the me
tranches (rand musadares) to the adductor magnus and adductor dial border of the psoas major muscle above the fascia iiiaca,
ninimus muscles. passes through the pectineal line (ptcten osns pubis), and stretches
In addition, the posterior branch gives rise to articular between the iliopsoas and pecttneus muscles where it ramifies
■ranches innervating the articular capsule of the hip joint and sending branches to the peclineus muscle and the hip joint and
tranches to the periosteum of the posterior surface of the femur. communicating with the other branches of the obturator nerve.
884. Nerves of right glutens medius muscle (specimen prepared by N.Rybakina). (Photograph.)
(Medial surface of muscle.)
I —rtervc twi£ arising independently iTom sac
I—superior border of muscle
H— posterior border of muscle ral plexus, and it* branches, in the muscle
HI—distal tendwi of muscle thickness
2—frank of superior gluteal nerve and its ram
IV—antcriurlwrderuf muscle
ifications in the muscle thickness.
main trunk in the false pelvis and run to the psoas major muscle;
The femoral nerve (nervus femorahs) (L t , Lj, Lji L+)
the shorter branches originate from the lateral surface, the longer
(Figs 875-379) is the largest nerve of the lumbar plexus. At the be
branches—from the medial surface of the trunk.
ginning it lies behind the psoas major muscle, then emerges from
2. The nerve of the femoral artery proper branches oft Trom
under its lateral border and stretches in the groove between the
the main trunk of the femoral nerve in the cavity of the pelvis
psoas major and iliacus muscles under the fascia iliaca to the la
slightly above the inguinal ligament, passes together with it
cuna musculorum. Through the lacuna the femoral nerve passes to
through the lacuna musculorum, and runs to the femoral artery
the thigh on which it stretches under the fascia covering the iliacus
immediately below the inguinal ligament. It ramifies in the con
and peelineus muscles in the femoral triangle, lateral to the fem
nective tissue of the walls of the femoral artery and the profunda
oral vessels. Directly in the lacuna musculorum, or slightly distal
femoris artery. One or two branches approach the femur and enter
to the inguinal ligament, the nerve divides into its terminal
it through the nutrient foramina.
branches among which three groups can be distinguished: ante
3, The muscular branches of various thickness and length pass
rior, medial, and lateral.
in the region of the thigh to the following muscles: the sartorius
Branches of the femoral nerve.
1. The muscular branches (rami mtucularts) arise From the (from the anterior and lateral groups of branches), pectineus and
85. Nerves of left glutens minimus muscle (specimen prepared by N.Rybakina). (Photograph.)
] —superior border of muscle 1 —trunk of superior gluteal nerve and its
[I — posit rior border of muse! e branches in musclt thickness.
III—distal tendon a( muscle
IV—ant*ii(.>r border of musdr
«us medialis (both from the medial group of branches), rectus and anteromedial surface of the thigh, reaching the region of the
arms vastus intermedius and vastus lateralis (all from the lat- knee joint Those piercing die sartorius muscle and stretching
il group of branches), and the articularis genu muscle, above its anteromedial surface form communications with the cu
The muscular branches which run to the rectus femoris muscle taneous branches of the anterior branch of the obturator nerve.
KJ branches to the articular capsule of the hip joint; those The other group of branches, likewise piercing the sartorius mus
Etching lo the vastus medialis and vastus lateralis muscles send cle but stretching on its anterolateral surface, form communica
gs lo the articular capsule of the knee joint and the periosteum tions with the branches of the lateral cutaneous nerve of the thigh
the femur. and the femoral branch of the genitofemoral nerve.
4. The intermediate cutaneous nerves of the thigh (rawi cuta- 5. The saphenous nerve (nervus saphenus) is the longest branch
a ■era ftmoratis}, three to five in number, pierce the fascia lata at of the femoral nerve, It originates from the medial group of
■[ levels of the thigh and ramify in the skin of the anterior branches and runs initially lateral to the femoral artery. It then en-
M, gluteus medlus
A. glutea superior^A ^ ■ j ^ ^ V v . glutaie superiors
A. et v. gluteae
Inferiores-*.^
A. pudenda intern a
A- et v.
comitatites M, tiuadratus
n, Ischladlcl--' femoris
A. et v, perforantes
ft^-A.etv. perforates
Rr. musculares^
A. et v, peTforarrtes
M. semltendinosu
M. semtmembranosus-i;
M, bleeps Femoris
A. poplltea-V!
V, poplltea
N. Ubial1s-\
N, peroneus (Itbularls) communes
Fossa poplltea
M. gastroctiemlus
V. saphena parva
■ : . - ; * * ^
cmilmdinosu? muscle
DO; bead of biceps femoris muscle
emiritTTlbT^r^ftii^ muscle
boil head of biceps femoris muscle {on the left)
oniraon origin of posterior group of thigh mus
ks
itrvie (superior) of jernitendinosus muscle
ommunicaiiiig nerve rviig
Kiwe trunk running to semitendinosus musck
:er*e trunk running to short head of biceps
nnoris muscle
ier*t (iEfcriw) of iemitendiito$u* muscle
kieral popliteal nerve
icr*c trunk nmiiinf to long head of biceps fent-
fii muscle
ncdiaJ popliteal nerve
rialk nerve.
ters the subsartorial canal (canalis adductorius) together with the (sometimes more than one) arises from the nerve trunk at the level
Femoral artery and vein and lies in it in front of and lateral to the of the medial epicondyle of the femur; it then pierces or by-passes
artery. After that the nerve passes through die anterior wall of the the tendon of the sartorius muscle, penetrates the fascia and ram
canal together with the descending genicular artery (arteria gem ifies under the skin in the region of the patella and medial surface
descenders) and stretches in the groove between the vastu.s medial is of the knee and upper parts of the leg (above the tubercle of the
and adductor magnus muscles covered by the posterior surface of tibia);
the tendon of the sartorius muscle. Here it pierces the fascia lata of (c) the medial cutaneous nerves of the thigh (rami cutanei cruri
the thigh, penetrates into the skin, and descends on the anterome- mediatis) are a series of thin branches arising from the saphenous
dial surface of the leg down to the foot in company with the long nei-ve along its length and running to the medial surface of the leg.
saphenous vein. Some of them pass into the skin of the anterior and posterior sur
On its way the saphenous nerve gives rise to the following faces of the leg.
branches: The saphenous nerve stretches on the medial border of the
(a) the communicating branches, in the middle of the medial foot, hut its terminal branches fail to reach the skin of the big toe.
surface of the knee joint, with the cutaneous branches of the obtu On uie foot, the nerve forms communicating branches with the
rator nerve; branches of the musculocutaneous nerve (nervus peroneus superfiria
(b) the infrapatellar branch (ramus injrapatellaris nervi sapkenus) lis).
(S3) unite by means of four loops to form the sacral plexus (plexus which passes over the arcuate line of the pelvis flinea terminals)
sacr&lis). The union of the mentioned part of the fourth lumbar into the true pelvis medial to the internal iliac artery to unite with
nerve with the fifth lumbar nerve forms the lumbosacral trunk the first sacral nerve.
(iruncus lumbosacrttlis). This is a rather thick bundle of nerve fibres
The muscular branches are distributed in the following mus lus muscles (which are usually innervated by branches of the
cles; the piriformis, obturator internus (which can be innervated sciatic nerve).
also by the muscular branches of the sciatic nerve), and the gamel-
The superior gluteal nerve (nervus gluteus superior) (L4, Lj, S|) dius and minimus muscles arching forwards, After giving off twigs
(Fig. 886) emerges from the cavity of the true pelvis in company to these muscles, it ramifies in the substance of the tensor fasciae
with the gluteal vessels superior to the piriformis muscle, curves latae muscle.
round the greater sciatic notch, stretches between the gluteus me-
The inferior gluteal nerve {newus gluteus inferior) (L>, S,, S2) of the gluteus maximus muscle. The inFerior gluteal nerve inner
(Fig.886) emerges from the cavity of the true pelvis into the gluteal vates the gluteus maximus muscle and the articular capsule of the
region inferior to the piriformis muscle, stretches under the glu hip joint.
teus maximus muscle lateral to the pudendal nerve and medial to Sometimes it may participate along with other nerves in inner
the sciatic nerve and the posterior cutaneous nerve of the thigh, vating the obturator intemus, gemellus, and the quadratus femoris
and in company with the gluteal vessels ramifies in the substance muscles.
The posterior cutaneous nerve of the thigh (nervtts attaneus fe- emerges from the cavity of the pelvis below the piriformis muscle
wunis posterior) (S,, S a , S3) (Figs 886, 900) initially lies close to the medial to the sciatic nerve, stretches under the gluteus maximus
inFerior gluteal nerve or forms a common trunk with it, then muscle almost on the midline between the ischial tuberosity and
the greater trochanter, and descends on the posterior surface of 2. The perineal branches frami perineahs nervi cutanei femoris
postaioris), one or two, sometimes more in number, originate as
the thigh.
twigs from the main trunks descend, curve round the ischial tuber-
There it lies immediately under the fascia lata in line with the
osity, stretch forwards, and ramify in the skin of the medial surface
groove between the semitendinosus and biceps femoris muscles;
of the scrotum (labia majora) and the perineum, These branches
descending, the posterior cutaneous nerve sends branches which
communicate with the perineal branches of the pudendal nerve.
pierce the fascia for the whole length of the posterior surface of the
3. The cutaneous branches arise from either side of the main
thigh and ramify in the skin oF the posterior, and particularly the
trunk and ramify in the skin oF the medial and posterior surfaces
medial, surfaces down to the skin of the popliteal fossa.
of the thigh. The terminal branches stretch to the skin of the popli
The branches of the posterior cutaneous nerve of the thigh.
teal fossa and may descend on the leg to communicate there with
1. The gluteal branches (nervi cfanium inferiores) (see Figs 870,
the branches of the medial cutaneous nerve of the calf or the leg
900) are small and two or three in number. They originate from
(nervus cutanats surae medialis) which is a branch of the medial
the main trunk, curve round or pierce the inferior border of the
popliteal nerve (nervus tibialis)*
gluteus maximus muscle, ascend, and ramify in the skin of the glu
teal region.
The sciatic nerve (nervus isthiadieus) (Li, L5, Si, S2, S*) quadratus femoris. These branches originate either before passage
(Figs 876, 886, 888) is the largest nerve not only in the lumbosac- of the sciatic nerve through the greater sciatic foramen or in it.
ral plexus but in the whole body and is a direct continuation of all II. The articular branch is a small trunk ramifying in the artic
the roots of the sacral plexus. It emerges through the greater ular capsule of the hip joint.
sciatic Foramen under the piriformis muscle lateral to all the IIL The muscular branches in the thigh arise from the medial
nerves and vessels which pass through this foramen. It then popliteal nerve and run to the long head of the biceps femoris and
stretches between the gluteus maximus muscle and the ge- to the semitendinosus, semimembranosus, and adductor magnus
mellus, obturator intern us, and quadratus femoris muscles al muscles.
most on the midline between the ischial tuberosity and the greater Muscular branches from the lateral popliteal nerve run to the
trochanter. short head of the biceps femoris.
On emerging From under the inferior border of die gluteus IV. The articular branches originate from the medial and lat
maximus muscle, the sciatic nerve lies in the region of the fold of eral popliteal nerves and innervate the articular capsule of the
the buttock (sukus glutens) close to the fascia lata; further down knee joint.
wards it is covered by the long head of the biceps femoris muscle V. The lateral popliteal nerve (nervus peroneus [fibwlamj commu
and lies between it and the adductor magnus muscle. In the mid nis) {U, Lj, Si, S2) (Figs 886, 888, 892), on separating from the
dle of the thigh the long head crosses the nerve. Distally the sciatic main trunk of the sciatic nerve, at the proximal apex of the popli
nerve stretches between the semimembranosus muscle lying me teal fossa turns to its lateral side and then stretches under the me
dial and the biceps femoris muscle lying lateral to it, and reaches dial border of the biceps femoris muscle, between it and the lateral
the popliteal fossa in whose upper angle it divides into a thicker head of the gastrocnemius.muscle, curves spirally round the head
medial branch, the medial popliteal nerve (nervus tibialis), and a of the fibula being covered there only by fascia and skin. Distally
thicker lateral branch, the lateral popliteal nerve (nervus peroiuus the nerve pierces the substance of the initial portion of the pero-
Ifibularis} communis). neus longus muscle, and divides there into two terminal
The division of the sciatic nerve into the two branches may branches—the musculocutaneous nerve of the lower limb (nervus
sometimes occur above the popliteal fossa and even directly at the peroneus fjibularis] superficialis) and the anterior tibia! nerve (nerv
sacral plexus; in such a Case the medial popliteal nerve leaves the peroneus [fibuiarisj profundus).
cavity of the true pelvis under the piriformis muscle, while the lat Branches of the lateral popliteal nerve.
eral popliteal nerve pierces it, For the whole length of the sciatic 1. The muscular branches run into the substance of the short
nerve both branches lie in a common connective-tissue sheath on
head of the biceps femoris muscle.
opening which they are easily separated up to the sacral plexus.
2. The articular branches stretch to the lateral parts of the ar
The companion artery of die sciatic nerve (arteria comiians nervi w-
ticular capsule of the knee joint and the superior tibiofibular joint.
chiaditi) determines the separation of the branches.
3. The lateral cutaneous nerve of die calf of the leg (nervus cu
Branches of the sciatic nerve.
ianeus surae lateralis) arises in the popliteal fossa, stretches to the l
I, The muscular branches ramify in the following muscles: ob
teral head of the gastrocnetnius muscle, pierces the crural Fascia,
turator intern us, gemellus superior and gemellus inferior (both
and ramifies in the skin of the lateral surface of the leg down to the
may also be supplied by twigs from the sacral plexus), and the
region of the lateral malleolus.
N. tibiaUs-—
V. popUtea—
■^W. biceps femorls
A. poplttea -
'--JSJ. peroneus communis
N. cutaneus N. tutaneus surae lateralis
surae medtalls A. et v. genus superiores laterales
r. mustulares
A. et v. genus
superiores medlales
I / M . gastrocnemlus
Tendo m.""
semitendlnosi (caput laterale)
V. tl blahs posterior
-V saphena parva
M. gastrocnemtus' V. tibialis anterior
(caput medlale)
-A tlbia]fs anterior
A. tlbtalis posterior
Arcus tendlneus m
sole! M. soleus
A. et vv. peroneae
A. et vv. tibi ales- (fibula res)
posit en ores
N. tibiaJis
A. tlblalis posterrc>r~Mj
M. peroneus bre vis
Tendo m ttblalisi Mm (mJibularis brevis)
posterior ^ S
A. et vv, peroneae (fjbulares)
Vv. tlbiales posterlore A. maJleofaris lateral is
Vv. malleoiares
laterales'"i Raml calcanei
Tendo calcaneus
888. Nerves, arteries, and veins of right leg; posterior aspect (l/4).
0 Created with novaPDF Printer (www.novaPDF.com) sterior tibia} and peroneal veins are partly removed.)
234 THE SACRAL PLEXUS
4. The sural communicating branch (ramus communicant pero the anterior and then the medial surface of the vascular bundle,
neus {fibularis}) (Fig. 900) may originate from the main trunk or and lies between the extensor digitorum longus and the tibialis an
from the lateral cutaneous nerve of the calf, It stretches on the lat terior muscles in the proximal parts of the leg; in the distal parts it
eral head of the gastrocnemius muscle and is covered by die crural
stretches between the tibialis anterior and the extensor hatlucis
fascia which it pierces to ramify in the skin, and communicates
longus muscles.
with the medial cutaneous nerve of the calf or the leg (a branch of
On passing to the dorsum of the foot, the nerve runs first un
the medial popliteal nerve).
der the superior extensor retinaculum (retinaculum musatlorum extc
5. The musculocutaneous nerve of the lower limb (nervuspero sorum suptrius) and then under the inferior extensor retinaculum
neus [fibularh] superjicialu) (Figs 892, 897) passes between the heads (retinaculum mmculorutn exknsorum. injerius) and the tendon of t
or the peroneus longus muscle and descends, running for some extensor haltucis longus muscle to divide into two branches, one
distance between the peroneus muscles. After passing to the me extending medially and the other laterally, The first is shorter and
dial surface or the peroneus brevis muscle, the nerve pierces the sends most of its branches to the extensor digitorum brevis mus
cmral fascia in the region of the lower third of the leg, and ram cles. The second is a longer branch which reaches the first inter
ifies into its terminal (dorsal) branches—a medial branch (nervus osseous space in company with the dorsalis pedis artery, where it
cutanens dorsalif medmlu) and a lateral branch (nervus culaneus dorsapasses under the tendon of the extensor hallucis brevis muscle to
lis intermedium). gether with the first dorsal metatarsal artery (arteria mttatarsea dor
Branches of the musculocutaneous nerve of the lower limb. salis prima) and divides into two terminal branches which ramify in
(a) The muscular branches (Fig. 893) innervate the peroneus the skin of the dorsal surface of the adjacent sides or the big and
longus muscle (2-4 twigs from the proximal segments of the nerve second toes.
trunk) and the peroneus brevis muscle (1-2 twigs from the trunk
Branches of the anterior tibial nerve.
in the middle diird of the leg).
In the region of the leg:
(b) The medial branch (nervus cutaneus dorsalis medidis) is one (a) the muscular branches supply the fo I lowing muscles; the
of the two terminal branches of the musculocutaneous nerve of the tibialis anterior (three branches entering the upper, middle, and
lower limb. It stretches on the crural fascia for some distance, runs lower parts of the muscle); extensor digitorum longus and extensor
to the anteromedial border of the dorsum of the foot, sends twigs hallucis longus (two branches to each entering the upper, middle,
to the skin of the medial malleolus, communicates here with the and lower parts of the muscles); the extensor digitorum longus and
twigs of the saphenous nerve, after which divides into two small extensor hallucis longus (two branches to each entering the upper
branches. One of them, medial, ramifies in the skin of the medial and lower parts of the muscles) (Fig, 893).
border 0 r the foot and the big toe up to the distal phalanx, and
(b) the articular branch runs to the articular capsule or the
communicates with the anterior tibia! nerve in the first interosse- ankle joint,
ous space. The other, lateral, branch communicates with the termi In the region of the dorsum of the fool:
nal branch or the anterior tibial nerve and extends to the second
(a) the muscular branches (rami musculares) are supplied to the
interosseous space where it ramifies on the adjacent sides of the
extensor digitorum brevis and extensor hallucis brevis muscles;
second and third toes and gives origin to the dorsal digital nerves
(b) the communicating branch runs to the musculocutaneous
of the foot (nervi digitdes donahspedis) (Fig. 897). nerve;
(c) The lateral branch (nervus eut&nens dorsdis intermedia) (c) the articular branches supply the dorsal surface of the artic
(Fig. 897) stretches, like the aforementioned branch, on the crural ular capsules of the metatarsophalangeal and interphalangeal
fascia and runs on the anterolateral surface of the dorsum of the joints of the big and second toes;
foot. After giving off twigs to the skin in the region of the lateral (d) the dorsal digital nerves (nervi digitales ivrsales pedis) are the
malleolus, which communicate with the branches of the sural terminal branches of the anterior tibial nerve; they divide into two
nerve, it divides into two branches, one extending medially and twigs:
ramifying in the skin of the adjacent sides of the third and fourth
(1) the lateral digital nerve (nervus digitalis dorsalis hallucis latera
toes. The other branch stretches laterally, receives a communicat lis) ramifies in the skin on the dorsal surface of the big toe rrom
ing twig from the sural nerve and runs to the skin of the adjacent the direction or its lateral border;
sides of the fourth and little toe and to the lateral side of the little
(2) the medial digital nerve (nervus digtti setundi medialis) inner
toe, forming here a communication with the terminal branch of vates the medial border of the dorsal skin surface of the second
the sural nerve. All these branches are named the dorsal digital toe.
nerves of the foot (nervi digitdes dersaUs pedis).
VJ. The medial popliteal nerve (nervus tibidis) (L.„ L,, Sj, S2,
6. The anterior tibial nerve (nervusperoneus [fibularisj profundm) S ) (Figs 888, 889), being a direct continuation of the sciatic nerve,
a
(Fig. 892) pierces the substance of the initial parts of the peroneus is much thicker than the other branch of this nerve, i.e. the iateral
longus muscle, the anterior intermusctilar septum, and the exten popliteal nerve. It begins at the apex of the popliteal fossa, passes
sor digitorum longus muscle, and stretches on the anterior surface almost vertically to the distal angle of the fossa and lies directlv
of the intermuscular septum lateral to the anterior tibial vessels under the fascia, between it and the popliteal vessels (vasa poplitea).
(vasa tibiaim anterkra). After that the nerve descends and passes to fn front of and slightly medial to the nerve is the popliteal vein
- V . saphena magna
,-V. pophtea
A, et vv.tibJales M, gastrocnemius
anteriores - ^ ^ (divided)
\
4.
A. perortea (fibuJaris)
N, plantarls lateralis
A. plantaris lateralis
Rr caJcanel
889. Nerves, arteries, and vein of right kg and foot; medial aspect (%).
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236 THE SACRAL PLEXUS
7Rete articulate
/ genus
N. peroneus (flbulari
communis
R- (nuscularis-
\ . recurrens lib!alls
N r peroneus (fibularis) anterior
superflcialls
M. extensor
hallueis longus
Septum intermijsculare
Fasda cruris —
N. peroneus (fibularls)i
SLiperficialis—
N. ciutantujs dorsalis
intejfroedlttS-
N. surallsH
Malleolus l a t e r a l i s j
N, peroneus (fibularis)
R. anastomoticus— profandus
N. cutaneus dorsalis
Nn. digitales
late r a i l s - "
dorsales pedi:
A. tiblalis posterior
M, flexor
hallucls longus
3 _ M- flexor dtgitorum
brevis (cut and reflected)
N. plantaris medialjsJl
M. abductor digili
minimi
M. abductor ha] Juris
R. superficial j N.p]amar|S
M, flexor
hallucls longus^ J / I N. digitalis plantaris communis
(from n. plantaris lateralis)
Nn, digitalcs
plan tares communes
(from n, plantaris medialis)
R r calcanci mediates
(from n, tibialis)
Aponeurosis plantaris
V. saptiena magna/
N. plantaris laterals
(r. superficial is)
N, plantari s medlalt:
Rr, cutanei (from nn.
plantares)
- ^ N n , digitales plantares
proprii (from n. plantaris
late ralis)
and little toe S and pass i» the dorsal SU rface of the distal pha
langes; ' of the interossei muscle, on one side and the flexor digitorum lon-
m ™ f e - d the oblique head of the adductor hallucis muscle
m * lateral part forming the proper plantar digital nerve for
on the other. It sends muscular branches to the interossei, second
be Wt t « fnmus diptalupkntarisproprius V) whieh r S m i ( i « in
third, and fourth lumbrical, adductor hallucis, and flexor hailucis
the skm of the plantar surface of the lateral side of the little toe
brevis (lateraf head) muscles.
thu nerve often sends muscular branches supplying the i n t e r e s t
muscles of the fourth intermetatarsa] space and the flexor digit i Besides the named nerves, twigs are sent bv the superficial and
minimi brevis muscle; deep branches of the lateral plantar nerve to the articular c a p s u l c ,
of the m e t a t a r s i joints and the periosteum of the bones and pha-
(c) the deep branch framus prcfundu, nervi piantaris t&tcralis) lies langes, r
m company with iht plantar arch (artus piantark) between the layer
T H E P U D E N D A L NERVE
3. The inferior vesical nerves, like the middle rectal nerves (e) the dorsal nerve of the penis (ntrvm dorsalis penis) (the dor
urute w.th the branches of the hypogastric plexus and stretch to sal nerve of the clitoris [nervus dorsalu ditoridis] in females) (see
the floor ol the bladder and to the sphincter vesicae muscle. F-gS 880-882) is the superior branch of the pudendal nerte ft
stretches m company with the artery supplying the penis (a short
* l h c vagmal nerves unite with the branches of the hyposas-
tnc plexus and stretch to the upper parts of the vagina branch of the internal pudendal artery) on the inner surface of the
inferior ramus of the ischium and the pubis, passes through the
Branches of the e x t r a p d v k (perinea!) part of the pudenda!
nerve. urogemtal diaphragm, runs together with the dorsal penis (cliton-
d*s) artery on the dorsum of the penis (clitoris) and ramifies into
The pudenda! nerve emerges from the cavity of the true pelvis
terminal branches to be distributed in the skin and corpora caver-
^ r o u g h the greater sciatic foramen together with the internal pu-
nosa of the penis down to the glans (the labia majora and minora
dendal vessels fmn PMmda into**} which are medial , 0 it (see
in females).
fT 8 8 0 - 8 8 2 ) . Then it fits on the posterior surface of the i s c h S
spine, c u r v e round it, and returns into the cavity of the pelvis On its way the nerve sends twigs to the deep transverse perinei
through the lesser sciatic foramen below the levator ani muscle and sphincter urethrae membranaceae muscles and to the plexus
cavernosus penis (ditoridis) (see Fig. S82).
T H E COCCYGEAL PLEXUS
The coccygeal plexus (pkxta cnccygeus) (S 4 , §5, C o t , Gbj) lies on
■
: anterior surface of the tendinous part of the coccygeus muscle
d ihc sacrospinous ligament; it communicates with the pudenda!
rve and the terminal segment of the sympathetic trunk.
THE BRANCHES OF
THE COCCYGEAL PLEXUS
1. The muscular branches are directed to the coccygeus raus-
: (the coccygeal nerve [nerous coccygeus J), the levator ant and the
irococcygeus ventrylia (inconstantly) muscles.
2- The anococcygeal nerves (nervi anococtygei). three to five fine
igs, stretch on the anterior (ventral) surface of the coccygeus
iscle, between it and the levator ani muscle, and at the lateral
rface of the apex of the coccyx enter the skin to ramify in the re-
>n of the eoccvx, down to the anus,
_Rr. cutanel
Rami n. cutand crui"ls mediates
surae lateralis.
_ N. saphenus
N. peroneus (fibularis)^
superficialis
Retinaculum mm. extensomm
super lus
N. cutaneus dorsalis
medialis
N. cutaneus dorsalis
In termed! us
Communication between n.
c uta n eus dor sal is —~
lateralis and n. cutaneus
dorsalis intermedius
^ N. peroneus {fibularis)
profundus
Nn, digitaks
dorsaks pedis
898. Nerves ofjlexor digitorum 898a, Cutaneous nerves of right lower limb (specimen
langus muscle of foot (specimen prepared by V.Bezyazychnyi). (Photograph.)
prepared by G.Potapenko). 1—cutaneous branch of obturator ncr"e 5—anterior cutaneous branches
2—subcutanefii™ nerve 6 — obturator nerve
(Photograph.) 3—mrdial cutaneous branches of leg 7—femoral nerve
4— subpalellar branch S—later*] cutaneous nerve tif thieh,
_ N. ilkiinguinalis (branch of
plexus lumbal is)
N. ctitaricusfemoris
lateralis (branch of
plexus lumbalis) ! S
w
Rr. cutanei femoris
aaterioMS (branches of. n,
femoral is from plexus J._ R.eutaneuS (branch of
tumbal is) _ —- r. anterior from
n. obturarorius)
I — - Rr.c«raneitruris mediales
n. sapheni (branch of n. femuralis
from plexus lumbalis)
N. cutaneus dorsalis
medialis (branch o. n. peroneus
N. cutancus dorsalis superfieialis from plexus saec alis)
intcrmedius (branch of n. peroneui
Huperficiaiis from plexus sacra! is)
j N. peroneus profundus
N. cutaneus Ctorsalis / (branch of n. pemneus
lateralis (branch of
communis flWn plexus
n, sura I is from pies JS sacralis)
sacralis)
\
Nn. digitales plafltarc^ _ N. digitalis dorsalis. haMucis
pneiprii (branches of nn. digitales lateralis et n. digitalis
p!a n lares com mimes from dorsalis securnjj medialis
n. plantaris latcraiisl > ^ / S i (branches of n. peronens profundus)
Nn. di.gitale.s pi an tares
prnnrii (branches of nr. (ligitales
planlarcs communes from
n. plimtaris media] is)
899. Distribution of cutaneous nerves of right lower limb; anterior aspect (semischematical
representation).
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NERVES OE THE LOWER LIMB 247
N. cutaneus femons
posterior (branch of
pleXBS sacralis)
R. Cutaaeua (branch of
r. anterior from /
n, Obluratorius) /
(piestis lumbalis) '
Rr.CUtanci Claris
media ks n. saphen N. cutaneous surac medialis
(branch of n. femora lis (branch of n, tibialis
from plexus lumbalis). from plexus sacra lis)
10. Distribution of cutaneous nerves of right lower limb; 901. Distribution of cutaneous nerves of
osterior aspect (semischematical representation). right foot; plantar aspect
(semischematical representation)
Communicating branches are classified into white and grey or third lumbar segments of the spinal cord, the pregangliomc
branches (rami albi et grisei). fibres for the sympathetic trunk ganglia situated above and below
Each white (communicating) branch (ramus albus) is an aggre these segments (i.e. fibres for the region of the neck, lower lumbar
gate of pregangliomc sympathetic fibres connecting the spinal and the whole sacral regions) pass in the sympathetic trunk itself.
cord with the sympathetic trunk, It contains efferent my el mated Each grey (communicating) branch (ramus griseus) unites the
nerve fibres (neurofibrae efferent) which are processes of neurons of sympathetic trunk with a spinal nerve. It contains nonmyelmated
the lateral horns of the spinal cord, passing through the anterior efferent nerve fibres (neuronbrae efferens) of the cells of a sym
root (radix vmtmlis) and connecting the cells of the lateral horn pathetic trunk ganglion, runs into a spinal nerve to become a com
with the cells of the sympathetic trunk, or, after passing through it, ponent of its fibres, and reaches an organ.
with the cells of the prevertebral ganglion of the sympathetic These fibres are called the postgangtionic fibres (neurofibrae
plexus. The fibres, arising from the cells of the lateral horn and postganglionares) and terminate on the periphery.
stretching to the cells of the sympathetic trunk ganglion or to The peripheral part of the sympathetic system is in turn di
those of the ganglion of the sympathetic plexus are called the pre- vided topographically into a cephalic part (pars cephalica), cervical
ganglionic nerve fibres (neurojibrae preganglionures).
part (pars cervkalis)s thoracic part (pars thoratica), abdominal part
Since the lateral horns and, consequently, the intermediotat- (pars abdominalis)f and a pelvic part (pars petvina).
end nuclei, are present only from the eighth cervical to the second
The superior cervical ganglion (ganglion cervicale superius) artery and is distributed along the branches arising from it
(Figs 904, 905) is the largest among the cervical ganglia; it mea contributing to the formation of plexuses surrounding vessels of
sures up to 2 cm in length and up to 0.5 cm in width and is spin the same name:
dle-shaped. The ganglion lies at the level of the bodies of the sec (a) the superior thyroid plexus;
ond and third cervical vertebrae, sometimes reaching the atlas (b) the lingual plexus;
proximally and the fourth cervical vertebra distaljy. (c) a plexus stretching along the course of the facial artery; it
To the back of the ganglion is the longus capitis muscle, in gives origin to one or two twigs: the sympathetic root of the sub-
front—the trunk of the internal carotid artery, and lateral to it is mandibular ganglion (ramus sympaihicus ad ganglion submandibu-
the vagus nerve. The ganglion supplies some nerves and ganglia larej;
with twigs and organs and vessels with nerves. Most of these nerves (d) the occipital plexus;
and ganglia contribute to the formation of various nerve plexuses. (e) the plexus auricularis posterior;
The branches of the superior cervical ganglion. (f) the plexus temporalis superficial is;
1. Communicating branches (rami communkantcs) to the first - (g) the maxillary plexus:
fourth cervical spinal nerves. (h) the plexus meningeus.
2. The communicating branch (grey) with the hypoglossal The descending part oF the external carotid plexus descends on
nerve (ramus communicant cum. neroo hypoglosso). the wall of the external carotid artery to the common carotid artery
3. The jugular nerve (nervus jugularis) (see The Cephalic Part of and forms here the common carotid plexus (plexus caroticus eamit
the Sympathetic Nervous System). nu) which accompanies the artery for its whole distance.
4. Communicating branch with the inferior ganglion of the va At the bifurcation of the common carotid artery its nerve
gus nerve (ramus communicant cum ganglio inferiors nerci vagi), plexus receives fine twigs from the glossopharyngeal and vagus
5. The communicating branch (grey) with the phrenic nerve nerves, which together with the common carotid plexus, take part
(ramus communicant cum nervo pkrenico). in innervating the carotid body (glvmus caroiicum) situated here (see
6. The internal carotid nerve (nervus caroticus internus) (see The The Endocrine Glands).
Cephalic Part of the Sympathetic Nervous System). 8. The cardiac branch of the superior cervical ganglion (nervus
7. The external carotid nerves (nervi carotid externi), two or cardiacus cervicalis superior) (Figs 904-906, 915) arises by two o
three, sometimes as many as six twigs, run from the level of the three twigs from the superior cervical sympathetic ganglion,
stylohyoid muscle to the wall of the external carotid artery. Here usually at its inferior pole. The main cardiac branch descends me
they ramify into still smaller twigs which form the external carotid dial to the sympathetic trunk, in front of the longus cervicis mus
plexus (plexus caroticus externus) around the artery (see Fig. 819). cle and prevertebral fascia, and behind the common carotid artery,
The ascending and descending parts are distinguished in this crossing the inferior thyroid artery (usually in front). Along its
plexus. course the cardiac branch may form communications with the su
The ascending part passes on the wall of the external carotid perior and recurrent laryngeal nerves and with the cardiac branch
Ganglion ciJIare
Glandula
N. octflomolorius lacrimalis
X pangiion pterygopalaiinum
K Intermedium
N. vagus \ *B^f—Glandula
\,£ \ sublingualis
Glandula parolis
Ganglion submandibulare
Ganglion
cervicak s u p e r i u s - - | r J^^GJanduia submandibularis
"A, carolls communis
N. cardiacus * }l~~^ caroticus inlernus
cervlcalis .:■■ H ^ G f a n d u l a thyroidea
superior ,4— Esophagus
TrLtncus
5yni|)athlcus-<^i
Hepar
Aorta
Venlrjculus
M sjjlanchnicus I
major '— _-qL. J ' l c x u s ccli.-iijiis
-
»!-..,.. ^^_*sf-Pancr<.'as
N. sptanchntcasj
minor--^ * Plexus
-
mesenteticus
Rr. c o n i m u n i a i n l e s - * - ^ "' ,■ superior
(Htj^r*—Hntestinum
Plexus crassum
mesenterlcus
inferior *■ ^ l n test In urn
s% tenue
Plexus
hypogastrlcus
Plexus SacratisJU
v
Ulerns
Vesica urinarta
N. pelviCUS-r
Rectum—-T|
of the middle cervical ganglion. After passing into the cavity of the small branches to the walls of the pharynx and trachea and to the
thorax and the superior and then the middle (anterior, according thyroid gland; some twigs run to the common carotid and inferior
to BNA) mediastinum, the right cardiac branch of the superior thyroid arteries. The trunk of this cardiac branch contains collec
cervical ganglion lie's in front of the innominate artery, the left tions of nerve cells or solitary cells.
cardiac branch—in front of the common carotid artery. 9. The pharyngeal branches of the superior cervical ganglion
Both branches pass to the anterior surface of the aorta and pul (rami laryngopkaryngei) stretch to the larynx and posterior wall of
monary trunk and contribute to the formation of the common the pharynx in company with the pharyngeal branches of the glos-
cardiac plexus (see The Nemes of the Heart). sopharyngeal and vagus nerves, and together with them contribute
The cardiac branch of the superior cervical ganglion sends to the formation of the pharyngeal plexus (plexus pharyngevs).
The middle cervical ganglion (ganglion cervkalt medium) 5. T h e cardiac branch of the middle cervical ganglion (nervus
(Figs 904, 906) is oval and much smaller than the superior gang cardiaais cervicalis medius) (Figs 904, 905) arises by several branches
lion. It lies in front of the longus cervicis muscle, at the level of the either from the middle cervical ganglion or directly from the Sym
transverse processes of the fifth and sixth cervical vertebrae, pathetic trunk. It stretches between the sympathetic trunk and the
usually adjoining the inferior thyroid artery anteriorly. Sometimes, cardiac branch of the superior cervical ganglion, first behind the
instead of it there are a few small accessory ganglia. common carotid artery and then at its lateral border, and, after
The middle cervical ganglion (sometimes the intergangliomc passing in front of or behind the subclavian artery, enters the cav
part of the trunk) gives rise to one (sometimes two or three) fine ity of the thorax (the right branch lies at the division of the innom
twigs forming the ansa su be la via (Figs 904-906) which embraces inate artery, the left—at the lateral border of the left common ca
the subclavian artery from front to back and is usually a compo rotid artery, between it and the subclavian artery). In the thorax
nent of the inferior cervical ganglion. both cardiac branches of the middle cervical ganglion take part in
Branches of the middle cervical ganglion. the formation of the common cardiac plexus (see The Nerves of the
1, The communicating branches from communkantes) to the Heart).
fourth, fifth, and sixth cervical spinal nerves; they originate from Along its course the cardiac branch of the middle cervical
the postern lateral surface of the ganglion. ganglion sends twigs to the common carotid and inferior thyroid
2. The oommutticatfitg brunches with the phrenic nerve (in arteries and takes part in the formation or the corresponding plex
constant). uses.
3. The carotid nerves are two or three very fine twigs running The branch also communicates with the vagus and laryngeal
to the walls of the common carotid and inferior thyroid arteries recurrent nerves, as well as with the cardiac branch of the superior
and entering the plexuses surrounding these arteries: the common cervical ganglion forming plexuses with it.
carotid plexus and the inferior thyroid plexus. 6. The thyroid branches are fine twigs which arise sometimes
4. The inferior thyroid plexus gives origin to twigs which ac from the cardiac branch of the middle cervical ganglion and run
company the inferior thyroid artery and enter with its branches the directly into the substance of the thyroid gland. They send small
parenchyma of the thyroid and parathyroid glands. branches also to the parathyroid glands.
THE SYMPATHETIC NERVOUS SYSTEM
253
%/
Canal Is
/cen trails
/ Coramfssura
/ / anterior
grisea
V O r g a n (intestine)
F/brae posiganglionares
903. Course of spinal nervefibresand their communications with sympathetic trunk (diagram).
>_ftfc dtgastrlcus
(venter anterior)
M. r n a s s e t e r - i N. hypoglossus
Ganglion cervlcale supeYlus
truncl sympathlcl
M . stornoclcido-
maKtoideus (cut off) -■§§ ^-N. Isryngeus superior
IKA-IM- thyrohyoideus
M. sptenius c a p i t i s m j ^ -M. sternohyoideus
__> _ - ' ^ f r R . carilirjf.us c m k a l l s superior
■At stcriititlvyroLdeus
N. vagus—!
- N . cardlacus cervicalls Superior
-Truncus syttipsihlcus
-Glandula thyraldea
\—N, cardlacus cervlcalis medlus
Plexus cervlcalis *M. Staienus anterior
-Ganglion cervlcale medium
irunci symnathicl
N. phrenicus^ ''Trachea
M & tsryngieus recurrens
M. scalenus medlus
, Truncus brachlocephallciis
Rr. cardiacl thoracic I
N. cardiac us ce™icaJls inferior
Truncus sympathlcus
_"^gV. cava superior
(reflected)
Esophagus1 Bfc&Plexujs anterio
N. vagus " » j \ ^ dexter
t«,V ^Ventrii;ulu5
\V,r dexter
Nodulus lymphaticus'J
"Hi
Branch to hfltiS pulmonis
N. hypog!ossus
A, carotis Irtterna
Ganglion tnferiijj
n. vagi
Ganglion cervicak
superlus truncl
iaryngeus superior sympathicl
Truncus Sympathicus
Glsndula thyroidea
K ' P J e x u s cervicalls
N. cardiacus cervlcalfs medlus
Trachea
Ganglion Cervico thoracic urn (stellsturr}
N. cardiac us cervicalls Inferior r. communjcatites
Ansa subclavia
A, carotis communis dextra
M. la rynge us rec u rrens -
A. carotis
communis sinlstra
V. cava superior avla sinisira
Arctts aortse ■ f -]M s sympathicas
A. pulmonalis agijs
dextrs
Auricula dextra^ Jaryngeus rec u rrens
— A . puJmonalls sinlstra
Plexus atriorum anterio
r. cardiac! thoracici
Tmricus pulmonails-.
- R r . bronchiales
Aorta
Plexus A[
pW pulmonales
anterior d e x t e r r . f " \ slnlstrae
Sulcus
Inter vent ricu I arts
cordis anterior—
" "~~~-—i^Anterior surface
eritrjculus dexter --.^ of atria
Plexus ""Auricula sinlstra
n ten or sinister
Pulmo sinister (cut off)
s
Plexus posterior sinister
Ventrlculus sinister
1— glostopharyngeal nerve
2 —first cervical nerve
3—sinus branch
i~ inferior ganglion of vagus nerve
5— nerve branches from inferior ganglion of
vagus nerve, w nerve plexus (htercarolid)
in the region of bifurcation of common ca
rotid artery
6—branch of ansa ceivicalis
7—internal carotid artery
8—blanches from vagus nerve to common ca
rotid arltry
9—common carotid artery
10—vagus nerve
11 —phrenic nerve
12 — beginning of subcJavian artery
If!—brachiocephalic trunk
14—external carotid artery
15—mblingual nerve
16—neive plexus (intercartilid) in the region of
bifurcation of common carotid artery
1J—lingual nerve
905a. Nerves of human right common carotid artery (specimen prepared by G.Oleinik).
(Photograph.)
The vertebral gangiion (ganglion vertebrate) (inconstant) lies im 2. The vertebral nerve (nervvs vcrtebralis) is in most cases ac
mediately under the middle cervical ganglion almost at the level of tually the vertebral branch of the inferior cervical (stellate) gang
the transverse process of the sixth cervical vertebra; behind it is lion. It is formed of two small branches accompanying the verte
the freely lying (outside the canal of the transverse processes) part bral artery, Together with the branches of the sympathetic trunk
of the vertebral artery, and in front j» the vertebral vein. they form the vertebral plexus (plexus vcrtebralis) around the artery
The branches of the vertebral ganglion.
1. The communicating branches (rami communicantes) run to
the seventh cerebral spinal nerve.
The inferior cervical ganglion (ganglion cervkotkoracicum fstella- 4. Branches to the subclavian plexus (plexus subclaoius) whose
tumj) (Figs 904, 905) is smaller than the superior but larger than twigs accompany the subclavian artery.
the middle and vertebral ganglia, irregularly quadrangular in Branches to this plexus may also arise from the first thoracic
shape and is often fused with the first thoracic ganglion to form sympathetic ganglion.
the stellate ganglion. 5. Branches to the inferior thyroid plexus whose twigs accom
The ganglion is situated at the level of the transverse process of pany the inferior thyroid arteiy and together with its branches
the seventh cervical vertebra and the head of the first rib; it is an reach the thyroid and parathyroid glands.
irregularly quadrangular plate from which many twigs of various 6. Branches to the vertebral plexus (phxus vertebralis) which ac
size and thickness run in different directions. companies the vertebral artery; they reach the meninges along its
Branches of the inferior cervical ganglion, branches.
1, The communicating branches (rami communicantes) extend to 7. Branches to the plexus accompanying the internal mam
the sixth, seventh, and eighth cervical spinal nerves. Like the mary artery (arteria tkoracica interna).
branches of the middle cervical and superior thoracic sympathetic 8. The cardiac branch of the inferior cervical ganglion (nervm
ganglia, these are postganglionic fibres which stretch as compo cardiacus cervkalis inferior) (Figs 904, 905), arising by several
nents of the peripheral nerves of the hrachial plexus and ramify to branches from the cervicothoracic ganglion or the inferior cervical
innervate the walls of the vessels, the glands, skin, and muscles of and first thoracic ganglia of the sympathetic trunk, stretches (on
the upper limb. the right) behind the subclavian and innominate arteries, and (on
2. The communicating branches with the phrenic nerve (rami the left) behind the aorta to the common cardiac plexus (see The
communicantes cum nervo phrenko). Nerves of the Heart).
'i. The communicating branches with the vagus nerve (r&mi On its way the cardiac branch of the inferior cervical ganglion
communicantes cum nemo vago), some of which pass to the recurrent sends communicating branches to the cardiac branch of the mid
laryngeal nerve. dle cervical ganglion.
M . slcmocleidomastoideus
(divided and: p u l l e d upwards)
A. nccipltaJls J
A- laclalis
I mini,: >>mpathicus G
(cervical part) --JB ► A. lingualfs
M- mylohvoldeus
M . digastric us
Ganglion cervii:a|e medium , J J (part of posterior
venter removed)
Plexus brachialis "* A. th.vroldea superior
Ganglion cervlcothoracicum ' ■ * N . vagus (cervical part)
(steliatuml -V
carotis communis
Ansa surxlavia ^ ^ M Glandula thyroldea
A. subtli thyroldea inferior
N. larvngeus returreni hea
— A. thyroldea irna
Ganglion thoraclcum
trumci SympathlciJ "runcus brachiocephalkus
V. cava superior
V. fntercostalls posterior & vagus (thoracic part)
V. azygos -^Mm
Plexus pulmonalis
A. IntercoStalis Esophagus
posterior j
Rr. communlcantes
Pulmo (pulled to the left)
Djctus
thorar.icLis^JJ
— Diaphragms
—Ventrlcuius
N. splanchnicus major
M subcostall:
Kami gastric I
anteriores
Proncus vagalis poster
N. sr.KHiH'.linii.'.iis rr.in...i — — $j
Plexus celiacustffc
Pancreas ^ L ~
:■ V,
^ S J bcrniazygos
•carotg braiiditsof Fourth thoracic
cpagtttM
* synLpatheLic ^anglimi
f branches of sixth thoracic
:
8a™g'i°"
Mo aortic plexus
■pUTjerve to fiostcrior ocso-
l o p l trunk
i fnm greater splanchnic nerve to
bUJC n e r v e
aic nerve
I trunk
I branch of left va$jus nerve
nerves; branches running to the periphery (to organs, plexuses, times stellate, sometimes irregularly triangular. The first thoracic
etc.) arise from the medial border. ganglion often fuses with the inferior cervical ganglion to form the
The first thoracic ganglion (ganglion tkoradcum prmum) ccrvicothoracic (stellate) ganglion (ganglion cervitotfomrittm [sttlla-
(Figs 906, 907) (see The Inferior Cervical Ganglion) lies behind the turn}), or, less frequently, with the second thoracic sympathetic
subclavian artery, at the level of the head of the first rib. It is some ganglion.
1. The grey communicating branches (rami communicants gri 6. The greater splanchnic nerve (nervus splandinicta major)
st*} arise from the lateral border of each ganglion of the sympa (Figs 906-908) arises by three to five branches from the ante reme
thetic trunk and stretch to the corresponding intercostal nerves; dial surface of the fifth to ninth thoracic ganglia. Lying on the lat
there may be more than two of them, in which case they unite not eral surface of the vertebral bodies, all the branches unite into a
only with the intercostal nerve stretching on the level of the given single trunk (approximately at the level of the ninth-tenth verte
ganglion, but also with the nerves next above and next below. brae) which descends medially to the lumbar part of the dia
% The cardiac branches (nervi cardiari Ikorada) arise mainly phragm. After passing through the lumbar part of the diaphragm,
from the first thoracic ganglion (sometimes also from the second, together with the vena azygos on the right and the inferior vena
or the third, and even from the fourth and fifth thoracic ganglia). hemiazygos on the left, the greater splanchnic nerve enters die ab
Along their course to the heart they have communicating branches dominal cavity stretching for a small distance as a trunk and then
with the cardiac branch of the inferior cervical ganglion as well as becoming a component of the coeliac plexus (plexus celiacus). Along
with the thoracic cardiac branches of the vagus nerve (see The its course the nerve sends small branches to the thoracic aortic
Nerves of the Heart). plexus, to the branches forming the lesser splanchnic nerve, and to
3. The communicating branches with the vagus nerve. the nearlying parts of the mediastinal pleura. The greater splanch
4. The communicating branches with the recurrent laryngeal nic nerve contains solitary nerve cells which form quite often a
nerve. small splanchnic ganglion (ganglion splancknicum).
5. Fine twigs arising from the medial border of the Eve to six 7. The lesser splanchnic nerve (nervus sphnchnicus minor}
tipper ganglia take part in innervation of the vessels and viscera of (Fig. 906) originates by two or three branches from the tenth to
the thoracic cavity.
eleventh thoracic ganglia and usually follows the course of the
Stretching medially, some branches reach the walls of the in greater splanchnic nerve (less frequently together with the sym
tercostal vessels, the vena azygos (on the right) and the inferior pathetic trunk) with which it pierces the diaphragm to enter the
vena hemiazygos (on the left), and the thoracic duct. Other abdominal cavity and ramify into several branches, The lesser part
branches become components of the thoracic aortic plexus (plexus of the branches contribute to the formation of the coeliac plexus,
aortkus tkoradms) which is connected at the beginning with the the greater part become components of the renal plexus (see lite
common cardiac plexus, and inferiorly—with the coeliac plexus Nerves of the Kidneys).
and its derivatives; some of its branches enter the plexuses of the
8. The lowest splanchnic nerve (nervus sphnchnicus imus)
viscera; the oesophageal branches run into the oesophageal plexus
(Fig. 90fi) is an inconstant branch, h originates from the twelfth
(plexus esophagevs), the pulmonary and bronchial branches—into
(sometimes the eleventh) thoracic ganglion, stretches next to the
the pulmonary plexus (plexus pulmonalis).
lesser splanchnic nerve, and becomes a component of the renal
All the indicated branches, lying medial to the sympathetic plexus.
trunk, are interconnected along their course by small branches of The three splanchnic nerves are components of plexuses which
different length and thickness containing small nerve ganglia take part in innervating the abdominal organs; the stomach, liver,
differing in size; these communicating branches are in turn united pancreas, intestine, spleen, and kidneys, as well as the blood and
by small longitudinal branches as the result of which a collateral lymph vessels of the thoracic and abdominal cavities.
trunk is formed (Fig. 919).
:,rtntra]branch
I branch
p ^ d by branches of 1 eft
I tying i n FrOfit of
pjhMj] branch
1 1 ^ polled upwards)
9 S
of the sympathetic trunk (pars abdominath The lumbar part of the syrnpadietic trunk carries three to five,
(Figs 902, 910-914) passes into the abdominal usually Four, oval-elongated lumbar ganglia along its course. The
i lite crura of the lumbar part of the diaphragm and lowest of them is the largest and most elongated and may stretch
__• anterolateral surface of the bodies of the first to beyond the line of the promontory in which case its lower pole ex
tends into the true pelvis.
r TOtcbrae behind the inferior vena cava (on the right
^h*. m * t bicud surface of die aorta (on the left side), and in Branches of the lumbar part of the sympatherie trunk.
^ m trf ife H 1 * " ' vessels on both sides; within the range of the 1. The grey communicating branches (rami tommunicawles gri-
tmmfm imr wrtebrae the sympathetic trunk lies at the medial bor- sd), after origin from the lateral border of each ganglion, lie be
17 ■#' !fc pr-1 major muscle, but in the region of the fifth ver- tween die bodies of the lumbar vertebrae and the first parts of the
_ t , i i « ihghtly lateral to this border. psoas major muscle which they pierce here to run to the lumbar
iew=r» £»e transverse communicating branches pass between nerves.
npathetic trunks For their whole distance. 2, The branches to the coeliac plexus.
Pancryas
Plexus celiacus
Glandula
suprarenalis dextra —
Duodenum
reflected to the left)
Ganglion
A. mesenltfrii;,! superior
aorticoremsi
Plexus mesenleritus superior
Aoria
-l^en sinister
Ganglion ipesentericum inferlus
A, mesenteries interior
Plexus
aorticus abtbmtnalis V. mesenteilca inferior
Plexus rnesenterlcus inferior
fen dexlt-r—
Plexus l i \ pogfSSfitUS superior
V. navn inferior
( N . presai'raiiB)
Plexus bypogastricus
infefior sinister
(Plexus petvinus sinister)
-Duetus deferers
Duct us deferens
-Veslca urlnarfa
910, Nerves and plexuses of organs of abdominal and pelvic cavities; (anterior aspect) (J/^)
(specimen prepared by R.Sinelmkov),
(The peritoneum, greater part of the stomach, small and large intestine, and liver are removed; the stomach, d u o d e n u m , and pancreas are
drawn to the left; the rectum and urinary bladder are pulled downwards,)
911. Hypogastric plexus and dorsal parts of right and left pelvic plexuses (specimen prepared by
B.Smolkina). (Photograph.)
1—ganglia of hypogastric plexus S, 4—dnrsfll parts of left and right pelvic plix-
2— nen't Inniks of hypogaslric plexus
-Plexus yesfcalis
P'eaus sac X
KM, splanchn
SEcrales "*■
Plexus hypo^gstrtc
inferior fpars veritrali
yinphysis pubk-a
Plt-xus rc.tallL- ^ H
Pk'.MiS prosiallfus J ^ H fV dorsali.s penis de.ttcr
N. putlendus &
M. huibocavfrnoRiis - ^
StfdtUlM
912. Nerves and plexuses of organs of abdominal and pelvic cavities; anterior aspect viewed
slightly from the right {%) (specimen prepared by R.Sinelnikov}.
(Part cf the peritoneum, stomach, and .mail and large in.te.tine are removed; the pancreas and right ureter are removed completely)
right kidney
Cfjeliac plexus
ri^ht renal plexus
sympathetic trunk
ritfht reno-aortic nerve
right para-aortic body of luiiabo-aortic pardgaiLg-
lion
7 —branch from sympathetic trunk to inferior mes-
enteric aitd hvpogastric plexuses
9-—ri^ht Ovarian plexus
9—inferior mescntcTic ple-jtus
10— hypogastric plexus
11 — communications between hypogastrk and supe
rior rectal plexuses
12—caudal part of pelvic plexus
]3— interior, middle, and posterior braiitbei of pel
vic pleXUS
1+—anterior primary ramus of third t&Ctfi nerve
15 —pelvic nerves
16 —branches from pelvic plexus to uterus
] 7 —ganglion: c plate of pelvic plexus
I S — m u s c u l a r iitrVCS
19 —branches of pudendal nerve to sphincter ani cx-
temus muscle
20 — posterior v u t ] trunk
21 — superior mcscntcric plexus
22 —superior meseuterfc artery
23 — nerve ganglion at base of Superior nic&enteric ar
tery (superior meaenteric ganglion)
24—intcntieieuteric plexus
25— ftervc twig ta ovarian plexus
W—left para-aortic body of inTnbo-aortic paragan^
Sieo
27— pelvic (sSgiunid) colon
ffl— right ureter
?9 — uterine tube arid ovary
30 — urinary bladder
31 —branches from pelvic plexus to vagiua
J2 — branches of inferior rrctai piexus
913. Abdominal and right pelvic parts of autonomk system (specimen prepared by E.Melman).
(Seveii-month-old human female fetus; the right hip bone and surrounding muscles are removed; the urinary bladder and other organs
of the pelvis are drawn to the left; the sigmoid colon is distended; (he sciatic nerve is drawn to the right,' black silk IS placed under the
nerve trunks.)
V. eava iiiferio
A. uvariga 5 r ^ £ ~ Pw i ion™ n]
/ Colon KlginolclfNjr!
A. iliaca intprnii —*f
N. riypogasiricus dexter —
Ovatium {Jeilrurti
A. iiinbilkniis — ^ , j ^ _
Tuba utcrina dex(ra
Ovartmn smfstruin
Plexti* hvpogaslrir.il?, inferior
I Plexus pelvirais)
N. splandinicus sac rails ^BS-'JH ' 3 t " m uteri
• - T u l i . i uterina sinlslra
Plexus siicrail; Uterus
^ - A . ulerlna
A, pudenda interna —
Branches of plexus hyptigasiricus
inferior to urerus and vagina
A. rpclalia media " ' .— Vagina
914. JVftito and plexuses of organs ofpelvic cavity; anterior aspect (l/t) (specimen prepared by
A.Zhuravlev).
(The pelvic Jsigmoid] colon and uterus with its appendages are drawn to the left; the urinary bladder is cut along the sagittal plane.)
T H E COELIAC PLEXUS
The coeliac plexus {plexus cehafw) with the prevertebral coehac (c) the vagus nerve, communicating with the plexus via its coe
anglia /ganglia csliaca) included in it belongs to the largest aulo- liac branches;
omic plexuses. (d) the first and second lumbar ganglia of the sympathetic
It varies greatly in the number of nerve trunks stretching to it trunk (ganglia lumbalia trund sympathid);
nd the number of ganglia forming it as well as in the shape of its (e) the thoracic aortic plexus (plexus aorticus thoradcus);
irge conglomerate (Figs 910, 912, 913). (f) the phrenic nerve (nervus phrenkus).
The coeliac plexus is unpaired and lies at the origin of the coe- The right and left vagus nerves contribute to the formation of
iac artery, spreading laterally almost to both adrenals. Its upper the parasympathetic part of the coeliac plexus. The greater part of
>arts are connected with the thoracic aortic plexus, the lower the common posterior trunk of both vagus nerves is a component
>arts—with the superior mesenteric plexus. of the coeliac plexus.
The plexus is a complex of sympathetic coeliac ganglia (ganglia A great number of nerve branches arise from the coeliac plexus
iliaca) Of various size and shape which are interconnected by and run in all directions to form secondary plexuses. Nerve cells
neans of many communicating branches differing in length and and the secondary plexuses formed by them are lodged along the
hickness. Among the ganglia of a developed plexus there are two course of most of these branches as well as within them. Some of
argest conglomerates—the right and left coeliac ganglia. the cells form ganglia of various size which extend beyond the
The coeliac plexus receives branches from the following branches, others are scattered as occasional nerve cells in the
lerves: branches.
(a) the greater splanchnic nerve (ntmus splanchnkus major);
(b) the lesser splanchnic nerve (nervus splanchnkus minor) (a
anal! part of its twigs);
The secondary plexuses are paired and unpaired. 1. The hepatic plexus (plexus kepaticus) is mostly formed by
The paired plexuses (Fig. 910). twigs originating from the coeliac plexus. The common anterior
1_ The phrenic plexus accompanies the inferior phrenic ar- trunk of both vagus nerves as well as the right and left inferior
rr*: iu branches unite with the branches of the phrenic nerve phrenic plexuses also take part in its formation (see The Nerves of
[irnetrating into the abdominal cavity. A small phrenic ganglion the Liver).
^mgtwn pkrenicum) lies here on the right side (see Fig. 921). 2. The splenic plexus (plexus lienalis) is derived from branches
Branches from the phrenic plexus stretch to the adrenal and of die coeliac plexus and the common posterior trunk of both va
b e inferior vena cava, and are components of the hepatic and gas- gus nerves (see The Nerves of the Spleen).
trk plexuses. 3. The left gastric plexus (plexus gastrkus) is formed by
!. The suprarenal plexus (plexus suprarenalis) is derived mainly branches of the coeliac plexus and the vagus nerves. The branches
i branches of the closely lying ganglia of the coeliac plexus and unite and stretch in the form of a plexus on the walls of the gastric
ipanies the ramifications of the suprarenal arteries. It re- arteries and ramify at the cardia of the stomach and the lesser cur
some of the branches From the hepatic plexus and the lesser vature (sec The Nerves of the Stomach), and also follow the gas trod u-
odenal artery and its branches (see The Nerves of the Stomach).
mc nerves.
4. The pancreatic plexus (plexus pancteaticus) is derived from
. The renal plexus (plexus mails) is formed by the aortico-
branches of the coeliac, hepatic, superior mesenteric, and splenic
remal ganglia (ganglia aorticorenalia), branches of the coeliac and
plexuses, and branches of the left renal plexus (see The Nerves of the
abdominal aortic plexuses, and, as it is pointed out above, by part
of ifcr lesser splanchnic nerve and the lowest splanchnic nerve (see Pancreas).
Ik . V P H of the Kidneys). 5. The superior mesenteric plexus (plexus mssenterkus superior
4. The testkular plexus (plexus itstmiam) is formed by (Figs 910, 912, 913) is formed by branches of the coeliac plexus
arising from the abdominal aortic and renal plexuses; in and partly by the abdominal aortic plexus. Its main bulk is situ-
n accompanies the testicular artery and reaches the testis; in atcd at the origin .of the superior mesenteric artery. One or two
it stretches in attendance to the ovarian artery and is small superior mesenteric ganglia (ganglia mesentenca superia) are
the ovarian plexus (plexus ovancus) (see The Nerves of the lodged here. Stretching in attendance to the ramifications of the
L
superior mesenteric artery, the terminal twigs of the branches of
"•»■ unpaired plexuses (Fig. 912). the plexus reach the pancreas and the duodenum forming pan-
N. iarv
N. cardiacus cervkalis
superior sinister
N. cardiac
superior dexter
^ Plexus cervicalis sinister
Truricus sympathies dexter
N. phrenlcus sinister
R. Cardiatus cervlcahj superior
M. scalenus anterior
Ganglion cervkaie infe —Trachea
dextrum trunci syinpji
Plexus hTachlalls sinister
Truncus brachloeephallcus
V
- cava st/penor
A
" NwSfcKb sinistra- Vv
Putoionales
dextrae
A
- pulmonaffs dastra t / ' « U s ofrighta t r i u m
Tr
" n c w n^monalls—
Vv
- Pulmonales^-
sJm'strae -*."£. ,
Nervi
nerve foJd
VMtrtadm Sinlster/
mterventricularls
P
posterior
^Vttarfeirtus dexter
«=*
«*<»g.nd siffJlloid c o l o P
the b a c h e s rf the m w l
0f h
; , < ™ ^ - I o n and the de-
^ a
'°"S ** "**** « W
* •7 ^^^ctr^tft^ ^ ^ ^
* " « * * r and feLa] S ^ f i T £ * * ■ ^ » * • «*
tend, between the . u p e r i o r a " S . ° t h c " W w t a d a„rt a and « ,
* W nerv« and ^ ^ J « - - the superior b a T O
- pl«M ^ ^ . ^ - t 1 0 n of the s u p e r i f ) r r e e .
the
P J
' * h , c h " ^ m u n i c t e , with the P*™ which is i t s c 0 „tin U a t i o n ZJX " * * * hypogastric
-4
s
C\ ,-6
. The hypo gastric plexus (plexus kypogastriats superior) The hypogastric plexus receives branches from the inferior
910) lies in the spa.ce bounded superiorly by the site of bi- mesenteric, aortic, and coeliac plexuses, and a few branches from
rJon of the abdominal aorta into the common iliac arteries, la the inferior lumbar and first sacral ganglia of the sympathetic
y—by both iliac arteries, and inferiorly by a line 0.5-1,0 cm trunks.
.- the promontorium. It is a flattened, rather thick, elongated The hypogastric plexus sends twigs to plexuses surrounding
top to bottom nerve plate containing nerve ganglia of various the common iliac arteries and veins, The following plexuses are
ind shape. Many nerve cells are present in the substance of distinguished:
:erve trunks of this plexus (Fig. 911). (a) the iliac plexus (plexus iliaats), right and left, entwines the
tlow the promontorium, at the level of the second-Uiird sac- common iliac artery\
Frtebra, the hypogastric plexus bifurcates to form a longer (b) the femoral plexus (piexm■ femoralii^ right and left, entwines
hypogastric plexus and a shorter left hypogastric plexus. the femoral artery.
irarn -Mrttt
UTr. codiaci
Duclus ctiuledwrhus. (from truncus
vagalis
K. hepatka propria-jju. posterior)
Rr. hepatici
(from plexus
V. portae- gastiici)
Plexus
gasuoduodeiialis
Plexus hepaticus
et a. hepatica conimunis
Plexua hepaticus
A. Uenalis
A . gaslmepiploica sWstra
A, gastroepiplolca dtxtta
Plexus llenali*
Plexus celiacus
Pancreas
920. mm of stomach, porta hepatis, and gall bladder; anterior aspect (%) (specimen prepared
by I.Shapiro).
THE PELVIC PART
OF THE SYMPATHETIC NERVOUS SYSTEM
wcralia trund sympatkid) a n d the terminal unpaired ganglion im-
T h e pelvic p a r t of t h e s y m p a t h e t i c t r u n k (parspdmm trund sym-
p a r . T h e n u m b e r a n d size o r t h e g a n g l i a vary.
paikm) (Fig* 902> 9 1 0 - 9 1 4 ) is s i t u a t e d o n t h e pelvic surface of t h e
A series of t r a n s v e r s e twigs r u n o n t h e pelvic surface of t h e s a c
s a c r u m m e d i a l to t h e sacral f o r a m i n a .
r u m b e t w e e n t h e right a n d left s y m p a t h e t i c t r u n k s a n d c o n n e c t
T h e pelvic p a r t of t h e s y m p a t h e t i c t r u n k h a s t h r e e or four
t h e m . C o m i n g g r a d u a l l y closer to t h e m i d p l a n e , b o t h s y m p a t h e t i c
elongated oval g a n g l i a w h i c h b e c o m e g r a d u a l l y s m a l l e r down-
t r u n k s u n i t e o n t h e a n t e r i o r surface of t h e first coccygeal v e r t e b r a
w a r d s . T h e s e a r e t h e s a c r a l g a n g l i a o f t h e s y m p a t h e t i c t r u n k (ganglia
*) foim a sacral loop in the middle of which lies the ganglion im- muscles of the trunk and lower limbs as well as to the skin glands
par. The sacral and coccygeal ganglia of the sympathetic trunk and dermal muscles,
p w rise to communicating and splanchnic rami. 2, The sacral splanchnic nerves (nervi splancknici sacrales) origi
1. The grey communicating rami originate from the lateral nate for the most part from the medial border of the sympathetic
wtace of each ganglion and run as components of the anterior trunk ganglia and reach the organs of the true pelvis as compo
ximxry rami of the sacral and coccygeal nerves to the vessels and nents of its plexuse*.
H.
The pelvic plexus {plexus kypogastricus inferior s. plexus pelvinus) The pelvic plexus contains the following structures:
(Figs 910-914) is paired; it is a continuation of the unpaired hypo (a) the lower parts of the hypogastric plexus which is continu
gastric plexus (plexus hypogastricus superior). The right and left plex ous with it;
uses lie on either side of the rectum, between it and the hypogas- (b) the sacral splanchnic nerves (rtervk splanchnia sacrahs)
tric vessels, on the surface of the pelvic diaphragm (Ievator ani which originate from the ganglia of the sacral part of the sympa
muscle). thetic trunk (the second and third, less frequently from the first
The pelvic plexus is a plate with a narrow posterior (dorsal) and fourth ganglia);
part which is a continuation of the hypogastric plexus, and a wide (c) the pelvic splanchnic nerves (nervi sptanchniri pdvini s. nervi
rhomboid anterior (ventral) part, The ventral part is situated in a erigentes) arise from the anterior primary rami of die second, third
space bounded laterally by the anterior primary rami of the second and fourth, and less frequently of the Erst and fifth sacral nerves;
and third sacral nerves, dorsally — by areas of the pelvic fascia and they contain also parasympaihetic fibres (see The Sacral Part of the
parietal peritonenm which correspond to the lateral periphery of Parasympathetic Nervous System).
the rectum, and medially and ventrally —by the lateral surfaces of The pelvic plexus gives rise to numerous branches of different
the seminal vesicles in the male or the lateral wall of the vagina in length and thickness which contribute to the formation of the sec
the female. The ventral part, and to a lesser degree the dorsal, con ondary plexuses,
tains numerous nerve ganglia of various size and shape.
for tried by branches of the pelvic and vesical plexuses. Small nerve to form the nervus cavernosus penis major and tiervi cavernosi pe
ganglia are included along the course of its branches. Some nis minores which pierce the tunica albuginea of the penis and
branches of the prostatic plexus communicate with those of the ramify in its corpora cavern osa,
plexus of the vas deferens, others reach the walls of the pro static The corpus cavernosus of the clitoris is innervated by branches
part of the urethra, of the pelvic plexus,
6. The cavernous nerves of the penis (ttervi cavernosi penis) are 7. The uterovaginal plexus (plexus uterovaginalis) is lodged in
situated on the dorsal surface of the penis which they reach after the pa ranted nc fat with its main built situated on the lateral sur
passing through the urogenital diaphragm, They are a continua faces of the uterus and vagina as a paired (right and left) plexus. It
tion of the prostatic plexus branches and some twigs of the ante is a collection of nerve ganglia and branches of various size and
rior primary rami of the sacral nerves. On the dorsal surface of the shape. Its branches descend on the sides of the uterus to the infe
penis the small nerve branches unite with those of the dorsal nerve rior parts of the ovarian plexus (see The Nerves of the Uterus).
of the penis (nervus dorsalis penis) (a branch of the pudendal nerve)
The peripheral part oF the parasympathetic nervous system [testicular], aortic, splenic), the ganglia of the hypogastric plexuses
passes in the trunks of the third, seventh, ninth, and tenth pairs of (pelvic ganglia) with the ganglia of related plexuses of organs of
cranial nerves, and in the trunks of the (first), second, third, fourth the true pelvis.
{fifth) sacral spinal nerves. The numerous collections of nerve cells lodged in the walls of
The peripheral extramural ganglia are as follows: the ciliary the viscera are related to the peripheral intramural ganglia.
ganglion (ganglion ciBaTe), the sphenopalatme ganglion (ganglion The fibres of nerve cells lying in the cephalic and sacral para-
pterygopalatmum), the otic ganglion (ganglion otkum), the subman- sympathetic centres are termed preganglionic (neurofilrae pregm<
dibular ganglion (ganglion submandibulare), the ganglia of the bron glionares); the fibres of nerve cells of the peripheral extra- and in
chial and cardiac extraorganic plexuses, the coeliac ganglia (gang tramural ganglia are termed postgangiionic (neurqfibrae postg&ngtw-
lia celiaca) with the ganglia of related plexuses of abdominal organs nares).
{renal, suprarenal, hepatic, pancreatic, gastric, mesenteric, ovarian
The cephalic part of the parasympalhetic nervous system is in quadrigeminal bodies, and the rhombcncephalic part, whose cen
rum subdivided into the mesen cephalic part, whose centre is tres He in the pons and the medulla oblongata (sec Fig, 902).
lodged in the aqueduct of the mid-brain at the level of the superior
The mesencephalic part of the parasympathetic nervous system nucleus of this nerve and run as components of the motor root of
is Formed of parasympathetic fibres of the oculomotor nerve (nerous the ciliary ganglion (radix oculavtotoria) to enter this ganglion and
ocuhmotorius) which extend to the sphincter of the pupil and the to terminate on its cells; the postganglionic fibres run in the twigs
ciliary muscle. of the short ciliary nerves (nervi ciliares breves) to the above men
The preganglionic fibres passing in the oculomotor nerve origi tioned muscles.
nate from a group pi very small cells in the accessory (autonomic)
The rhombencepbalic part of mis system (see Fig. 902) in ing in the pons and extend as preganglionic fibres in two direc
cludes: (1) the parasympathetic (secretory) fibres of the facial tions:
nerve (navits j'adalis) distributed to the lacrirnal gland, the glands (a) one group of preganglionic fibres passes in the thickness of
of the nasal and palatal mucosa, the submandibular and sublin the greater superficial petrosal nerve (nervus petrosns major) and en
gual glands, the glands of the mucosa of the floor of the cavity of ters the sphenopalatine ganglion (ganglion pterygopalatinum). Some
the mouth, and, possibly, the parotid gland; (2) the parasympath of the postganglionic fibres of the ganglion become components of
etic (secretory) fibres of the glossopharyngeal nerve (nervus gloiso- the zygomatk nerve, and via the communicating branch with the
pharyngeus) to the parotid gland and the glands of the mucous lacrirnal nerve run to the lacrirnal nerve to reach the lacrirnal
membrane of the cheeks and lips; (3) the parasympathetic fibres of gland; the other part of the fibres enters the greater and lesser pal
the vagus nerve to the organs of the neck, the cavity of the thorax atine nerves and reach along them the glands of the nasal and pal
and abdomen, becoming along their course components of sym atine mucosa;
pathetic plexuses. (b) the other group of preganglionic fibres passes in the chorda
1. All parasympathetic (secretory) fibres of the facial nerve be tympani to the lingual nerve (see The Trigeminal Nerve) and then
long to its sensory root (ntruus intermedium). They originate in the enters the submandibular and sublingual ganglia; the postgangli
cells of the superior salivary nucleus (nucleus salivatorius superior) ly onic fibres extend to the submandibular and sublingual glands, the
■ liver
-round ligament of liver
-cystic artery
-porta hepatis
-ItFt part of hepatic plexui
■left pruper hepatic artery
-plexus of hepatic duct
-portal vein
-right part of hepatic plexus
-branches of hepatic plexus to stomach
-right gastric artery
-branches of hepatic plexus to hepatic and bile
ducts
-hepatic plexus
-branches of hepatic plexus to duodenum
-duodenum
-plexus on anterior surface of bile duct
-hepatic plexus (pulled to the right)
-lateral nerve of gall bladder
- medial nerve of jail bladder
-nerve twigs communicating the lateral and me
dial nerves of gall bladder
-nerve hrjucli running mi cystic artery
-gall bladder
-nerve plexus on wall of gall bladder,
925. Nerves ofporta hepatis and gall bladder; anterior aspect (specimen prepared by
I. Shapiro). (Photograph.)
1M1
tver
--■'■'■ bladder
lepatic plexus
plexus of posterior surface of bile duct
luodenum
: :■!< h of posterior nerve of bile duel
■iic duct
'ranch of posterior nerve of bile duct to pan-
neas
snxreas
essel to right lobe of liver from superior ineseii-
cric artery
erve twig connecting plexus of posterior HIT-
ice- of bile duct with superior mesenteric plexus
eive twigs surrounding origin of right hepatic
rtery
upericT mesenteric plexus
.!: i iiiiiiil aorta, (opened)
cpatk plexus
osterior iierv* of bile duct
eive twigs of hepatic plexus
ortal vein
epatic plexus
ranch of hepatic plexus running to liver on pos-
:rior surface of portal rein.
anterior lingual gland, and the glands of the mucous membrane of The postganglionic fibres supply also the raucous membrane of
the floor of the cavity of the mouth. the cheeks and lips, the fauces, and the root of the tongue.
2. The parasympathetic (secretory) fibres of the glossopharyn- 3. The para sympathetic fibres of the vagus nerve arise in tin
geal nerve arise in the cells of the inferior salivary nucleus (nucleus cells of its posterior nucleus (nucleusposterior nervi vagi); as pregang
salwatorius inferior) lodged in the medulla oblongata, and then run lionic .fibres they stretch in the trunk of the nerve and its branches
as preganglionic fibres in the tympanic nerve, and in the lesser su to the nerve cells lodged in the vagus trunk itself and in the extra -
perficial petrosal nerve (nervus petrosus minor) reach the cells of the and intramural ganglia of the organs of the neck, thorax, and ab
otic ganglion (ganglion oticum) in which they terminate in synapses. domen, They synapse on the cells of these ganglia and as post
The postganglionic fibres extend from the otic ganglion via ganglionic nerve fibres run to the organs.
branches communicating it with the auriculotemporal nerve, enter
the trunk of the nerve and along its parotid branches (rami parati-
dei) reach the parotid gland.
5—""
930. Nerve ganglia and intratruncal nerve cells (specimen prepared by R.Sinelnikov).
(Photograph.)
(Area of totally stained specimen of pancreatic-duodenal plexus.)
1 — nerve t^nks 3—fiervr ganglia
2—intiatniucal nerve cells 4—vcss*!s
The submandibular and subiingual salivary glands are sup The twigs running to the upper parts of the subiingual gland
plied with nerves from the submandibular ganglion (ganglion sub- arise from the subiingual ganglion which lies on the outer surface
mandibtdare), the subiingual ganglion (ganglion sublinguah) (see of the gland and communicates with the distal end of the subiin
Fig. 816 and The Trignminal Hmx) and from the so-called neuro- gual nerve.
ganglionic chain, which is a complex of small ganglia and nerve The neuroganglionic chain gives rise to nerves distributed to
trunks connecting the submandibular and subiingual ganglia and the lower parts of the subiingual gland and to the closely lying
crossing on the way the lingual nerve with which it is connected by areas of the submandibular gland.
short communicating branches.
Small collections of nerve cells are included along the course
The submandibular ganglion gives rise to twigs entering the hi- of most nerve twigs supplying both glands,
lum of the submandibular gland.
The heart is supplied with nerves (see Figs 904, 905, 915, 916) All these nerves, on their course to the heart, contribute to the
from three cervical and two to four upper thoracic ganglia of the formation of a single common cardiac plexus in which an extra-
sympathetic trunks, from the cervical and thoracic parts of the va cardiac part (with superficial and deep parts) and an intracardiac
gus nerves and their branches (from the superior and recurrent part are distinguished. Small collections of ganglionic cells and,
laryngeal nerves), and from the right phrenic nerve. quite frequently, a single cardiac ganglion (ganglion cardiaaim) arc
1
Academician V, P. Vorobiev (1876-1937), a renowned Russian
anatomist, author of Atlas of Human Anatovty (in 5 vols., 1938), de
veloped the theory of macromicroscopy and stereomorphology.-
Ed.
Colon transversum
Rr, colici
A- iliocolica
H - Anastomosis between a, colic
media et a, colica sfnUtta
plexus mesenterici
supeHorts
fc — A. colica sinistra
Colon sscendens -Sh
j ^ C o l o n (iescendeti&
Mesenterium (radix) ~ M f l
s - n ^ f t - — A, iiiaca comma
Plexus hypogastricus
I b u m fcul off) _ ——— ~~ superior (N. presacrali:
Caecum "1
J
Appendix vermiform is
^ n . el vasa appendicis
rerraiionnis
Rectum
l—descending colon
2—superior left colic artery and attendant
nerves
3 —sigmoid arteries and veins and attendant
nerve plexuses
4 —pelvic (sigmoid) colon with vessels and
nerves entering its will
5 —superior rectal artery and vein surrounded
by nerve plexuses of the same name
6—rectum
7—vascular and a w e branches running into
the wall of upper part of rectum
i, 9—nerve brandies passing into middle and
lower parts of rectum from ventral part of
pelvic plexus
10—cavity of right half ol urinary bladder
11— vesical plexus
12—ventral part of right pelvic plexus
13—communicating branch between ventral
part of pelvic plexus arid superior rectal
plexus
1<J-—ureter and nerves extending to it from pel
vic plexus
IS—branch connecting ventral part cif pelvic
plexus with superior rectal and sigmoid
plexuses
16—tight hypogastric nerve
17 —hypugasirir; plexus
IS—branches connecting dorsal part of hypo-
gastrit plexus with luinbosacral and infe
rior mesenteric plexuses
19—aortic abdominal plexus
2U —inferior mesemerir plexus
2[—inferior mesenteric artery
22— inferior mesetlterit vein surrounded by
nerves
23—right xidtsey-
933. Inferior mesenteric, aortic (abdominal), hypogastric, and pelvic plexuses (3-year-old child)
(specimen prepared by B.Smolkina), (Photograph.)
The lungs are supplied with branches (see Figs 906-909) from Small collections of ganglionic cells occur along the course of
both vagus nerves and frnm the lower cervical and upper three or the plexus trunks, These collections either form small ganglia or
four thoracic: ganglia of the sympathetic trunks. All of these are scattered inside the trunks.
branches form four interconnected plexuses which He in the hilum The branches of the plexuses enter the lungs in company with
of the lungs and communicate with the tracheal and cardiac plex the bronchi and vessels. Small ganglia lie along the course of these
uses, branches in the lungs.
^ ^ - Nerve plexuses in
Atrigonum vesicae
Ductus deferens
Ductus dexter
deferens sinister- Plexus deferentialis
dexter
Plexus Ampulla ductus
deferentialis sinister'*'
deferentls dextrl
Ampulla ductus x
Vesicula seminalis dextra
deferentls sinistrf' Prostata and its nerves
Vesicuia seminalis sinistra
and its nerves Urethra (pars membranacea)
935. Nerves of urinary bladder and seminal vesicles; posterior aspect (%) (specimen prepared b
R.Sinelnikov).
(Drawing of the specimen with stained nerves.)
The stomach is supplied with branches (see Figs 906, 920, 923) The subserous plexus is a wide-loop network formed by twigs
from both vagus nerves. Descending on the oesophagus, these of various size at the intersection or which lie small ganglia; the
branches eithei- pass directly to the stomach or reach it via the greatest number of the ganglia are found in the region of the lesser
lesser omentum; the gastric branches (rami gastrici) and branches and greater Curvatures.
of the coeliac (sympathetic) ganglia approach the stomach in com The myenteric plexus is connected with the subserous plexus
pany with its arteries. Both groups of branches contribute to the and is also a wide-loop network with ganglia of various size occur
formation of a single common gastric plexus which is subdivided ring along the course of the twigs. The twigs forming the wide
topographically into the anterior gastric branches (ratni gastria an- loops of the plexus are thin in the region of the fundus of the
teriores nervi vagi) lying on the anterior gastric wall and the" poste stomach (Fig.922), slightly thicker in the region of the body of the
rior gastric branches (rami gastrici posteriores nervi vagi) stretching stomach, and are thickest in the region of the pylorus (Fig. 923).
on the posterior gastric wall. The submucous plexus is connected with the myenteric plexus
After penetrating under the serous coat of the oesophagus, the and, just like the first two plexuses, is a network but with a smaller
branches of the vagus and sympathetic nerves take part in the for number of cells.
mation of three plexuses: the subserous plexus (plexus sufaerosus)t Being interconnected, the three plexuses innervate accordingly
the my enteric plexus (plexus; myentericus), and the submucous plexus various elements of the gastric wall.
(plexus submutosus).
The intestine receives branches (see Figs 910-914) from the part of the sympathetic trunks, the sacral plexuses, and the plex
superior and inferior mesenteric plexuses (and via them the vis uses of the genitals). AH the mentioned branches approach differ
ceral and splanchnic branches, and branches of the lumbar ganglia ent parts of the small and large intestine, pass into their walls, and
of the sympathetic trunks), branches from the hypo gastric and pel take part in the formation of the subserous, myenteric, and submu
vic plexuses (and via them the visceral branches from the sacral cous plexuses (Figs 931, 934).
The liver is supplied with branches (see Figs 920, 921, 925, part of the hepatoduodenal ligament; it extends to the right lobe of
926) from the coeliac plexus, the anterior common trunk of the va the liver in the space between the twigs of the portal vein and the
gus nerves, and the right and left inferior phrenic plexuses. Run bile duct.
ning tn the liver these branches contribute to the formation of the The anterior and posterior hepatic plexuses are freely con
hepatic plexus (plexus kepaticus) which is subdivided topographi nected to each Other by a great number of nerve twigs.
cally into an anterior hepatic plexus and a posterior hepatic Nerve ganglia of various size and shape lie along the course of
plexus. the trunks of the hepatic plexuses. There are also many intratrun-
Both plexuses are situated in the thickness of the hepatoduod- cal nerve cells, either in groups or scattered along the extension of
enal ligament and run to the porta hepatis; on the way they encir the trunk. In the liver, the nerve twigs pass in company to the ram
cle the proper hepatic artery and its branches and lie, accordingly, ifications of the proper hepatic artery and portal vein (Fig. 927).
on the anterior (anterior plexus) and posterior (posterior plexus) The common hepatic plexus sends branches to the gall blad
surfaces of the portal vein. der, most of them originating from the right part of the anterior
The greater part of the anterior hepatic plexus extends in at hepatic plexus. In the thickness of the cystic wall, a superficial
tendance to the hepatic artery. Its trunks are relatively thick at the plexus lying in the subserous and connective-tissue layers, and a
beginning but gradually become thinner as they come closer to the deep plexus lodged between the muscular layer and the mucous
liver. At the division of the proper hepatic artery into the right and membrane are distinguished.
left branches, the anterior hepatic plexus separates into two bun Small nerve ganglia and intratruncal nerve cells are present in
dles, right and left, which are interconnected by numerous twigs. the trunks of the deep plexus.
The main bulk of the posterior hepatic plexus lies in the right
Ductus deferens
A, lesticularls-^
Plexus delerentjalis
Plexus testicularis
Plexus pfHTtpiliformis-^-^ ( \ \ V Ai
--Fascia spermatica intema
A. deferenilaHs
Caput epidid\m!dis
Corpus epfdidymidis
Appendix epididyrnidis-M
Ttstis
936. Nerves of right testis; medial aspect (%) (specimen prepared by B.Neigas).
(The tunicae are opened and partly removed.)
tion of the duodenum, communicate, and send twigs to the head of Small nerve ganglia are encountered along the course of
the pancreas. On approaching the wall of the duodenum> some of branches of the posterior plexus of the head of the pancreas.
the branches stretch to the inferior pancreaticoduodenal artery The three plexuses of the pancreas are connected by mean?
and form a plexus around it which accompanies its ramifications. a series of communicating branches.
The spleen receives most of the nerve branches (Fig.921) from branches to the head and body of the pancreas and branches
the splenic plexus and a smaller number from the left suprarenal the stomach which accompany the short gastric arteries.
and left phrenic plexuses. The structure of the splenic plexus varies, which is eviden
In it* initial portion the splenic plexus is a network of narrow associated with the architectural pattern of the vessels.
loops surrounding the trunk of the splenic artery. Further on, Occasional minute ganglia and small intratruncal cells ,
larger and longer twigs can be detected in it which communicate present along the course of the branches of the splenic plexus, p
with one another by means of a series of short branches. ticulariy in its initial parts.
As it stretches to the spleen, the plexus sends numerous
The kidneys are supplied with nerves from the renal plexuses renal artery. It receives inferior branches from the lesser and k
(see Figs 910, 912, 913). The right and left renal plexuses are est splanchnic nerves and sometimes a branch from the first lu
formed by small branches arising from: bar sympathetic ganglion.
(a) the aorticorenal ganglia (ganglia aortkorenaiia); Twigs from the same splanchnic nerves (less frequently frt
(b) the lower parts of the coeiiac plexus; the greater splanchnic nerve) pass to the renal plexus (plexus TO
(c) the sympathetic trunks. lis), by-passing the aorticorenal ganglia.
The aorticorenal ganglion is often paired, in which case a supe Small renal ganglia (ganglia renalia) occur along the course
rior and an inferior ganglion are distinguished. the trunks of the renal plexus. The largest among them, lying ct'
The superior aorticorenal ganglion lies in the upper angle to the root of the ovarian (testicular) artery, stands out.
formed by the beginning of the renal artery and the corresponding The renal plexus is connected with the superior and infer
border of the aorta. A twig runs to it from the lesser splanchnic mesenteric plexuses and the abdominal aortic plexus.
nerve, or, rarely, from the greater splanchnic nerve or the coeiiac The renal plexus gives rise to nerves which run to other orga
ganglion. to the adrenals (plexus suprarenalis), to the ureter (pUxus uretcr
The inferior aorticorenal ganglion is lodged in the lower angle and to the testicular (plexus testiculxris) or ovarian (pUicus ovan
formed by the aorta and the inferior border of the beginning of the
The urinary bladder is supplied with branches (see Figs shape and in tntertruncal nerve cells. The largest ganglion is
910-914, 935) mainly from the vesical plexus (pkxus vesicalis) cated at the opening of the ureter into the bladder; it sen
which is formed on either side of the bladder by branches of the branches to the bladder, ureter, and vas deferens. Some ganglia
corresponding pelvic plexus, by part of the twigs of the hypogastric various size are lodged in the region of the trigone of the bladd
plexus, splanchnic branches of the fifth lumbar and the Erst three fewer are scattered on the walls of the bladder. The nerve branch
or four sacral ganglia of the sympathetic trunk, and the splanchnic stretching from the vesical plexus itself as well as those rumii
nerves of the first three or four sacral nerves. from the mentioned ganglia are lodged in the subserous areolar t
Most of the branches of the vesical plexus approach the blad sue and, on entering the cystic wall, lie between the muscular ]-
der at the site where the ureter drains into it, one group of twigs ers and in the mucous membrane.
runs to the upper parts of the bladder (the superior vesical nerves), Numerous communicating branches connect the vesical plex
the other—to its lower parts (the inferior vesical nerves). The with the rectal plexus (plexus rertalis), the plexuses of the vas def<
branches of the vesical plexus form a ureteral loop round the term ens and seminal vesicles, the prnstatic plexus (plexus prostaficus)
inal part of the ureter; twigs from this loop ascend on the ureter. males, and die uterine and vaginal plexuses in females.
The vesical plexus is rich in nerve ganglia of various size and
^■Flmbrlae
tubae
Mesosalplnx''
Fimbrla ovarica
Nn. ovarli
.'vartttm
Ductus epoophotl longitudinalis* ^ \ x L l g . latum uteri
Lig. tetes uteri
Epoophoron /
(ductulf transversi)
A. uterina dextra
A. uterina slnistra
Plica rectouterina
A. vaglnaMs
Vagina -
Plexus uterovaglnalis
937. Nerves of uterus and vagina; posterior aspect (%) (specimen prepared by A.Zhuravlev).
(Drawing of the specimen with stained nerves.)
T H E NERVES O F T H E TESTIS
The testis is supplied with branches (Fig, 936) from the lesticu- the latter—the vas deferens. Near to the hilum of the testis they
b r plexus (plexus testiqilarh) and the plexus of the vas deferens unite and then penetrate into the substance of the gland.
(firms tUfereniialU). The former accompanies the testicular artery,
The vagina is supplied with branches (see Figs 914T 937) from continue on its walls to form a thick network in whose loops are
the common uterovaginal plexus (plexus uierovaginalis) whose in- lodged smaller ganglia.
feroanteriur parts are known as the vaginal plexus. The vaginal part of the common uterovaginal plexus is con
The uterine and vagina! plexuses arc a relatively thick network nected with the plexuses of the urinary bladder and rectum a |"
o
of numerous ganglia of different size and shape and ntrvt
via the uterine plexus, with the plexuses of the ovaries and LL
branches. The vagina is surrounded by the nerve branches which
nerves surrounding the uterine tubes, %
DEVELOPMENT AND AGE FEATURES
OF THE NERVOUS SYSTEM1
In trie early stages of development the ectoderm of the neural tube becomes narrow and transforms into the central canal (canalis
groove and then that of the early neural tube is formed of a single centralis medullat spinalis) filled with cerebrospinal fluid (liquor cere
layer of cells. Then, as the result of mitosis or the neuroepithelium, brespin&lis).
the wall of the neural tube acquires multilayered structure. Due to reduction of the caudal part of the spinal cord, a
With the gradual differentiation of the neuroepithehutn, three thread-like structure of nerve tissue forms which becomes the
layers become detectable in it. The inner, ependymal layer, gives filum termlnale subsequently.
rise to ependymal cells lining the central canal of the spinal cord The spinal cord grows slower than the vertebral column in the
and the walls of the ventricles of the brain. The middle, mantle period of infra-uterine development. In the third month at intra-
layer, is rich in cells from which neuroblasts and spongioblasts utetine life, for instance, it occupies the entire vertebral canal; but
form; die neuroblasts develop into nerve cells, the spongioblasts — later (he vertebral column grows more rapidly so that the end of
into neuroglial cells. The outer, marginal layer is poor in cells; it is the spinal cord moves upwards and at the time of birth is at the le
composed of a great number of celt processes and becomes the vel of the third or fourth lumbar vertebra.
white matter later.
The differentiation of the neural tube into the forebrain, mid-
The development of the mantle layer of the neural tube is brain, and hind-brain and spinal medulla have already been de
irregular. The number of nerve cells increases most intensively in scribed (see p.Maket),
die lateral parts in which the sulcus litnitans forms later. The sul- The development of the grey and white matter of die brain
cus divides die lateral wall into two laminae—the dorsolateral differs from that of the spinal cord. In the spinal cord, the grey
fomna dorsoLatemlis) and the ventrolateral (lamina ventrokta-alis). matter occupies the centre, the white matter—the periphery. In
The posterior grey columns of the spinal cord form later from the die brain the neurons also develop close to the ventricles, but mi
former and the anterior grey columns —from the latter, gration of cells from die site of their origin is characteristic of
The mass of die outer (marginal) layer also increases consider some of its areas (the teJencephalon and the cerebellum). In the
ably through the growth of the iongitudjual arrangement of the cerebral cortex, which is made up of several layers, the large neu
neuron processes of the mande layer. The processes are covered by rons forming the innermost layer are the firstto migrate, while die
myclin and form the white matter of the spinal cord. The groups next layer of grey matter is formed of smaller neurons which mi
of fibres of the white matter are separated from one another by the grate to the periphery through other, already formed layers.
anterior and posterior horns or the grey matter, as a result of which The motor roots of the spinal nerves develop from the neural
die anterior, posterior, and lateral white columns of the spinal cord plate which acquires three layers as it transforms gradually into
can be distinguished. the neural tube. The middle layer is formed of a collection of neu
The irregular growth of the lateral laminae leads to a change in roblasts which give origin to the grey matter of the spinal cord,
the shape of the neural tube and the formation of two longitudinal The bundles of their axons either spread in the substance of the
grooves which divide the spinal cord into two symmetrical parts. outer layer of the neural plate to form the white matter of the spi
Widi the gradual development of the spinal cord, the cavity of the nal cord or leave the neural tube to form metamerically arranged
anterior roots. The axons of the anterior roots grow into the meso-
denn in which they unite with the young muscle cells.
The sensory roots originate from the rudiments of the spinal
In view of the fact that students will study the age features af ganglia situated along the borders of the medullary groove. After
ter they are acquainted in detail with the anatomy of a human the neural plate is converted into the neural tube, two neural crests
adult, in this section as well as in other similar sections we dwell with segmental constrictions form and two rows of spinal ganglia
only on some age peculiarities. For details of development we refer appear on the dorsal side of the embryo. The neuroblasts lodged in
the reader to a textbook of embryology. them acquire the appearance of bipolar nerve cells with some of
their processes growing into the neural tube to form the posterior velopment the parts of the spinal cord grow differently, the thor
root and others spreading ventrally and fusing with the anterior acic part growing most of all and the lumbar part growing the
roots on the fourth-fifth week to form the mixed spinal nerves. least. After the age of 6 years the spinal cord grows mostly in its
The cranial nerves differ in origin. The olfactory and optic transverse diameter. Some grooves appearing on the spinal cord of
nerves, for instance, are in essence a continuation of the cerebral the newborn become deeper with age and remain throughout life,
tracts —they develop from the forebrain and are its projections, others disappear after birth.
The other cranial nerves differentiate from the spinal nerves; they The specific features of the brain of the newborn are insuffi
originate from the segmental structures of the cephalic region. cient development and weak differentiation of the nervous system
They lose their segmental structure, however, and the transforma of the newborn as compared to the other systems. Al! the main
tion of the spinal nerves into the cranial is associated with the de sulci and gyri can be seen on examination of the brain and the cor
velopment of the sense organs and the branchial arches with their tex of its hemispheres, but they are not clearly denned; the sulci
musculature. Besides, the cranial nerves are characterized by the are shallow, die gyri are poorly manifested. There are indications
absence of connections between the roots or their reduction, due that the sulci and gyri of the second and, mainly, those of the third
to which they are highly specialized. For instance, the third, fourth, order develop after birth particularly intensively in the first year of
and fifth cranial nerves correspond to'the anterior roots and are live, whereas those already present in the newborn become deeper
motor. The fifth, seventh, eighth, ninth, tenth, eleventh, and and more distinct.
twelfth nerves are homologues of the posterior roots; they are asso The dimensions of the occipital iobe of the cerebral hemi
ciated with muscles developing from the branchial apparatus. Be spheres are relatively larger in the newborn than in an adult. The
sides, such nerves as the tenth and twelfth arc more complex in number, shape, and topography of the gyri change with the child's
origin because Lhey include several spinal nerves. growdi. The greatest changes are encountered in the first 5-6 years
The centres of the autonomic nervous system in the brain and of life; by the age of 15-16 years the proportions acquire the adult
spinal cord form as the result of division and differentiation of the pattern. The cerebellum of the newborn is slightly compressed and
neuroblasts of the cerebral vesicles and neural tube. With gradual elongated; the sulci of its hemispheres are also poorly pronounced;
growth their cells migrate to the periphery in the anterior roots the middle part of the cerebellum, the vermis, is developed most.
and establish connections there with the ganglia of the sympath The brain of a newborn weighs 380-400 g which accounts for
etic trunk lying on either side of the vertebral column. The ganglia one eighth of the body weight on the average. By the end of the
of the sympathetic trunk form from neuroblasts of the ganglionic first year of life the weight of the brain increases twofold and
plate, which migrate along the anterior roots of the spinal nerves. makes up one-eleventh to one-twelfth of the body weight. By the
Cells from the paravertebral ganglia later migrate further to the age of 3 years it increases threefold, and by the age of 5 years it ac
periphery to form ganglia and plexuses round the large vessels. counts for one-thirteenth to one-fourteenth of the body weight. By
The autonomic part of the nervous system in the region of the the age of 20 the initial weight of the brain increases Tour- to five
head develops in a similar manner. Neuroblasts from the medulla fold, making up one-fourtieth of die body weight in an adult.
ohlongata and the ganglionic plate migrate along die branches of Among the peculiarities of age changes of the nerves is their
the trigeminal, vagus, and other nerves, and concentrate along myelinization. This process takes a different course for different
their course or form intramural ganglia, nerves: the motor nerves acquire a myelin sheath first of all, then
Both the central and the peripheral nervous system undergo a the mixed nerves, and lastly the sensory nerves. This refers both to
series of changes after birth. the cranial and to the spinal nerves; myelinization of the anterior
The spinal cord of the newborn has features distinguishing it (motor) roots of the spinal nerves occurs first, and later the myelin
from that of an adult. This applies to its position in the vertebral ization of the sensory roots.
canal—the length, breadth, weight, and size of its separate seg There are indications that myelinization of the cranial nerves
ments, development of the fissures and grooves, the position of the occurs in succession, namely, the auditory nerve has the richest
roots of die spinal nerves. There are some peculiarities in the myelin sheath by the time of birth. In general, the degree of nerve
structure of the white and grey matter of the spinal cord. The functioning is determined to a certain measure by the intensity of
lower end of the spinal cord of a newborn is at the level of the formation of the myelin sheath. Such a process occurs in the optic
third lumbar vertebra (the first or upper border of the second lum nerve in which myelinization of the fibres is most intense in the
bar vertebra in an adult). The spinal cord weighs 3-4 g at birth, first days after birth. It is believed that myelinization continues af
the weight increases almost twofold by the age of 6 months, three ter birth and demonstrates a certain succession: in relation to the
fold by the age of 12 months, reaches 16 g by the age of 6 years, motor nerves —the facial, sublingual, abducent, third division of
and is S5 g by the age of 20 years (the weight of an adult's spinal the trigeminal nerve, oculomotor; in relation to the sensory
cord). The spinal cord of the newborn measures up to 15 cm in nerves the auditory, first and second divisions of the trigeminal
length, by the age of 10 years the length increases almost twofold. nerve, vagus, glossopharyngeal, optic. Myelinization of the cranial
The cervical and lumbosacral enlargements, which form on the nerves takes place in the first 3-4 months and is completed in the
third month of intra-uterine life simultaneously with die develop second year of life. Myelinization of the spinal nerves continues to
ment of die limbs, are well pronounced in the newborn. With de the age of 3 years.
Esthesiologia o
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THE SENSE ORGANS
Organa sensuum
The sense organs (organa. seTtsuum fsensoria]), or the analysers, The peripheral part of the analyser (the receptor or receptive
are complex nerve apparatus specialized in reception, trans - Held) perceives the stimulus and transforms it into nerve excitation
mission, and analysis of nerve excitation. which is transmitted to the centre—the nucleus of the analyser,
The different stimuli originating in the external and internal The analyser nuclei are lodged in the cerebral cortex (cortical nuc
environment of the body arc perceived by receptors (exteroceptors, lei of analysers). The conducting part is represented by sensory
intereceptors, and proprioeeptors), each transforming a definite cranial and spinal nerves.
stimulus into a nerve impulse. The receptors perceive only specific (or appropriate) stimuli.
The excitation arising in the receptor is transmitted along the When inappropriate (nonspecific) stimuli are applied the resulting
nerve conductors to intermediate centres situated either in the spi sensation is poorly differentiated, elementary, and primitive.
nal cord or in the brain stem. Here, the affector neurons are con The peripheral nerve apparatus of each analyser, i.e. the recep
nected to one another and to the effector neurons. tors, together with the accessory structures providing for their bet
From the intermediate nerve centres the nerve excitation is ter appreciation of sensations are called sense organs (orgma sen-
conveyed to the cerebral cortex where h is interpreted. smtrn).
The peripheral receptor and nerve conductors, as well as the The science of the sense organs and sensory phenomena is
nerve centres of the spinal cord and brain stem, and the corre known as aesthesiology (estesiologia).
sponding areas of the cerebral cortex are joined functionally to The Following sense organs are studied in anatomy.
form a single system and are called analysers. 1. The organ of sight (nrganum mms).
The analysers developed due to a need for a rapid and ade 2. The organ of hearing, or the vestibulocochlear organ (otga-
quate response of the organism to external stimuli. Some of them num vestibulocochliare).
specialized into distant (the organs of smell, sight and hearing) 3. The organ of taste (orgarmm. gustus).
and others into contact (organs of taste and general skin sensation) 4. The organ of smell (organum olfactus).
analysers. 5. The organs of skin sensation perceiving temperature, tac
Excitation of the analyser induces a sensation which is the first tile, and pain stimuli.
stage of cognition. The sensation is transformed into notions, con These sense organs have receptors perceiving stimuli from the
cepts, and laws which constitute the highest stage of cognition — external environment {esteroceptors).
the thought. fnteroceptors and proprioeeptors, which give information con
From the anatomo-physiological standpoint, each analyser is cerning the condition of the organism's internal environment (the
divided into three parts: peripheral, conducting, central. viscera, muscles, etc.) are described in textbooks of histology.
THE EYEBALL
The eyeball (bulbus oculi) (Figs 938, 954) has an irregular spher sponding to the anterior pole with the point on the retina corre
ical shape. Only its anterior, smaller and most projecting part, the sponding (o the posterior pole of the eyeball.
cornea, arid the part surrounding it (see Figs 946, 949) can be ex The largest transverse dimension of the eyeball measures
amined visually; the remaining, larger, part is situated deeply in 23,f> mm, the vertical — 23.3 mm, on the average.
the orbit. The line incircling the eyeball midway between its two poles is
The eyeball has two poles: anterior and posterior. The anterior called the equator (equator bulbi oculi). It is 10-12 mm to the back
pole (polus anterior) is the centre of the projecting part of the ante of the cornea] border. Lines drawn perpendicularly to the equator
rior corneal surface; the posterior pole (polus posterior) lies in the and connecting both poles on the surface of the eyeball are called
centre of the posterior segment of the eyeball slightly lateral to the meridians (meridiani bulbi oculi). The vertical and horizontal merid
exit of the optic nerve. ans divide the eyeball into quadrants.
The distance between the anterior and posterior poles is the The contents of the eyeball is formed by its inner nucleus, or
largest dimension of the eyeball and measures 24 mm on the aver transparent media, which is composed of the vitreous body (tatpus
age. vitretttn), the lens, and the aqueous humour (humor aquosus). The
nucleus of the eyeball is enclosed in three coats (Figs 938, 943,
The line connecting both poles is called the external (optic)
949).
axis of the eye (axis bulbi externus), or the geometrical (sagittal) axis
1, The outer, or librous coat of the eye (tunicafibrosabulbi).
of the eye,
2. The middle, or vascular coat of the eye (tunica msculosa
From this axis should be distinguished the internal (visual)
axis of the eye (axis bulbi internus), which measures up to 21.3 mm bulbi).
% The inner, or nervous coat of the eye (tunica interna bulbi).
and connects the point on the inner surface of the cornea corre
THE CHOROID
composed of a layer of large vessels (mainly veins) between which
The choroid (ehorioidea) is continuous anteriorly with the cil
are connective-tissue fibres (elastic predominantly) and pigment
iary body; the jagged edge of the retina, called the orfl serrata, may
cells; this is the vascular lamina (lamina oasculosa); the next deeper
be considered the boundary between them.
layer is less pigmented and has medium-size vessels which are con
The choroid lies on the sclera for the whole distance, except for
nected to a dense network of small vessels and capillaries forming
the region of the macula and the area corresponding to die optic
the choriocapillary lamina (lamina choriacapillaris). The capillar
disk. network is developed particularly well in the region of the macula
In the region of the optic disk is an optic foramen transmitting
lutea retinae.
fibres of the optic nerve. The remainder of the outer surface of the
A fibrous structureless layer called the basal lamina is the
choroid is covered with endothelial and pigment cells, and be
tween it and the inner surface of the sclera is a capillary pericho- deepest layer of the choroid. The anterior part of the choroid be
roidal space (spatium ptrichorioidtah). The rest of the choroid is comes thicker and continuous with the ciliary body.
Vertex corneae
Axis bulbi externus (polus anterior ocuin
Axis visus s
Cornea /Facies anterior corneae
/ (lamina limitans anterior)
Fades posterior corneae
(lamina limitans posterior)
Iris
Stratum pigmentl retinae
M. ciliarls
Tunica conjunctiva
Facies
posterior lends
Ora serrata
M. rettus
lateralls
Corpus vjtreum
#—N. optlcus
Cornea
PupiJJa
Margo pupillarls Iridis
A. ciliaris anterior —
Chorioidea -iM
Sclera
V. vortlcosa
V. chorioidea ocul
N. opticus
fjorlex lentis
Substantia lentis
\ Nucleus lentis
part of the choroid and the posterior pan of the ciliary body for the ciliary body; it is arched, has an uneven surface, and is contin
wards, thus relaxing the ciliary zonule (zanula ciliarisj. The circular uous posteriorly with the choroid.
fibres contribute to the formation of the circular part of the ciliary The ciliary crown {corona dltaris) occupies the anteromedia
muscle whose contraction narrows the lumen of the ring formed part of the ciliary body. Small radially stretching ciliary folds
bv the ciliary body and in this way brings the site of attachment of which are continuous anteriorly with the ciliary processes (processu
the ciliary zonule nearer to the equator of the lens. This causes re ciliares) are distinguished in it- These processes, 70 in number,
laxation of the zonule and increases the curvature of the lens; in hang freely into the cavity of the posterior chamber. At the junc
view of this the circular part of the ciliary muscle is called the con tion between the surface of the ciliaiy ring and the ciliary crown is
strictor muscle of the lens. a rounded edge to which the ciliary zonule, holding the lens in
The ciliary ring (orhiculus tiliaris) is the posteromedial part of place, is attached.
THE IRIS
The iris is the most anterior part of the vascular coat and, in ciliary; iridis). It is attached to the fibrous coat by the pectinate liga
contrast to the other parts, does not come in contact with the ment of the iris (ligamentum pedinaium anguli iridotomealis) in whos
fibrous coat but, being a continuation of the anterior segment of thickness are slit-like spaces of the iridocomeal angle (spatia angul
the ciliary body, lies in the frontal plane at some distance from the iridocomealu). The stroma of the iris is composed of vascular con
npctivc: tia.fli.Ei":., ■ * m f :H-ITI ■ l i f t srnu«th miifl^lr fnh*~Cft A i i t J :i g r t i ^ f IJ.LIIII-
pupil \pupilla).
ber of nerve fibres. The posterior surface of the iris contains pig
The pupil is bounded by a free pupillary border of the iris ment cells which are responsible for the colour of the eyes.
(margo pupillaris iridis). The opposite border, which passes along its The smooth muscle fibres of the iris stretch circularly and radi
entire circumference, is called the ciliary border of the iris (margo ally. The circular layer lies on the circumference of the pupil and
pupillaris
iridis minor
Margo ciliaris —
Lens
Striae
Pt)lus
anterior I e nils seulares
Chorioicfea
ies anterior
tin. I'ifiaresl
Plicae iridis
forms the sphincter of the pupil (musculus sphincter papillae); the ra pupiliar part. This part of the iris measures up to I mm in width.
dially arranged muscle fibres form the dilator of the pupil (musculus The remaining part of the anterior surface of the iris measures
dilator papillae). The anterior surface of the iris (facus anterior iridis) 3-4 mm in width and is related to the outer ring of the iris (anulus
(Fig,941) is convex while the posterior surface (fadesposterior iridis) iridis major), or the ciHary part. The surface of this part sometimes
(Fig, 942) is eon cave. bears depressions called crypts of the iris, a series of radial folds,
On the anterior surface of the iris, around the pupil, ia the in and on the periphery a few circular folds of the iris (plicae iridis).
ner ring of the iris (anulus iridis minor) which is distinguished as the
Corona tfliwis
CnoiloJdEg
, ZonutB ciltaris
Orhiculus olliarts (fibratf 2omifares)
Lens
Retina
A. confunctivatis
anterior
V v . conjunct!vales
Lens
Circuliis arferlosils
iridis minor
Vv. vorticosa.
(V. chorfoldta
oculi)
V, eplsdcralh
A, episcleralis
Aa. ctliarcs
l>ostsriores breves
Vessels of
sheath of opt
n«rve
___^-V. centra] is
retinae"
A. centralist retinae
^enula lemporalis
/ retinae superior
Arteriola macularfs
superior —.,
Arteriola lemporalis
retinae superior
Venula
macularig superior Venula nasalis
retinae superior
Arteriola nasal 19
retinae superior
Discm n, oplfcl-
-Atteriola medial is
retinae
—Venula me dial Is
retinae
Macuja --Arteriola nasalis
retinae inferior
Venula nasalis
Fovea centralis retinae Inferior
maculae
many rods and cones; the rods reduce gradually in n u m b e r to the and an inner layer of epithelial cells which contains pigment in the
front and are absent at the ora serrata. region of the iris.
T h e part of the retina lining the inner surface of the ciliary These retinal layers are joined here more intimately than in the
body (pars aliaris retinae) and the posterior surface of the iris (pars region of the optic part of the retina and are continuous with o n e
iridica retinae) has two layers: on outer pigmented layer which is a another in the region of the pupillary border of the iris (margo pu-
continuation of the piginented layer of the optic part of the retina pillam iridis).
( M l B i ^ .
Supeirilliini
~Pars orl,itaM
* 1 PaTpefea
„ _ { ! * « tarsalls J superior
Angulu? oculi
medlalis
/
Pfllpeiira inferior
{facie5 anterior)
/
r
'Sulcus InfrapalpebraHs
Cilia ^
The line joining the anterior and posterior poles of the lens is stretched zonular fibres (fibrae zpnvlares). The medial ends of the
called the axis of the lens (axis lentis); it measures 3.6 mm on the fibres are inserted into the capsule of the lens, the lateral ends
average. arise from the ciliary body. The sum of these fibres form a liga
The substantia lentis is absolutely transparent and, just like ment round the lens which is called the ciliary zonule (zonula cilia
the vitreous body, is devoid of vessels and nerves. ris). Between the fibres of the ciliary zonule are zonular space* (spa
The main mass of the lens consists of fibres of the tens (fibrae tia zonulariaj.
lentis) which are elongated hexahedral epithelial cells. The aqueous humour (humor aquosus) is a transparent colour
The peripheries of the anterior and posterior surfaces of the less fluid filling the anterior and posterior chambers of the eye
lens are covered with the capsule of the lens (capsula lentis). The The chambers are slit-like cavities in front of and behind the iris.
capsule is a homogeneous transparent membrane which is thicker The posterior chamber (camera posterior bulbi) is bounded by
on the anterior surface of the lens where it overlies a layer of ep the anterior surface of the lens, the ciliary zonule, and the ciliary
ithelial cells. body posteriorly, and by the posterior surface of the iris anteriorly.
The substantia lentis differs in consistency; it is firmer in the The ciliary processes hang freely in it. The posterior chamber com
centre and is called the nucleus of the lens (nucleus lentis), on the municates with the zonular spaces.
periphery it is less firm and is named the cortex of the lens (cortex The anterior chamber (camera anterior bulbi) is formed by the
lentis). posterior, concave, surface of the cornea in front and by the ante
The lens is situated between the vitreous body and the iris and rior surface of the iris behind-
is attached by its peripheral circumference, known as the equator The anterior and posterior chambers of the eye communicate
of the lens (equator lentis)* to the ciliary body by means of fine with each other through the pupil.
Siiperciliuin,
Tunica conjunctiva
Plica seniilunaj-js
Paipehra K conjunct ivae
superior':
CJaiifmiyyuia
pars orlXlaliS" paipebrarum
jraed ialis-
pat* ursali _^»
Limlitis corricae
B ^ - A n g u l u s oculi
medlalis
CoTninissurj ;
palperirarum S
r
lateralis - ""■
-aruricuia Jacrimalis
An yulus
oculi Inteijtlis-'
S \
y / 'N> apilla lacrlinnlls
S /
Lirobus ,jf .'
palpt-bralJs a n t e r i o r - ^
\
S
SUICUB irfrapalpcbfalii
Limlius palpetirulis posterior 1
Palpebra inferior
Pftpflta
The aqueous humour is produced by the vessels of the ciliary the system of the venae vorticosae. Besides, the humour may flow
body and iris. It is drained as follows: from the posterior chamber from the chambers into the sinus venosus sclerae and then enter
the aqueous humour flows into the anterior chamber and then, via the ciliary arid conjunctiva! veins in the venous blood.
the spaces of the iridocorneal angle (spatia, anguli mdocorntalis) into
947. Glands of conjunctiva and skin of right upper eyelid (specimen prepared
V.Kharitonova). (Photograph.)
(Area of totally stained specimen; viewed from the aspect of the conjunctiva.)
948. Glands of conjunctiva and skin of right lower eyelid (specimen prepared
V.Kharitonova). (Photograph.)
(Area of totally stained specimen; viewed from the aspect of the conjunctiva.)
Limbus palpebralis
anterior
Palpebra superior.
^.Limbus palpebralis
posterior
Papilla lacrimalis
Angulus superior
oculi laterals
Puticlura lacrimale
superius
"aruncdJa lacrimalis
Tunica Conjunctiva,
buibi
'unciuin lacrlmaie
Inferius
conjunctivas 1
inferior , _ ■
-Papilla lacrimalis
inferior
'lies semilunaris
conjunctive
Pelpebra inferior
Tunica Conjunctiva
palpebrarum
raised, its skin forma a distinctly seen upper palpebro-orbital fold.the upper and lower'eyelids unite to form the lateral palpebral
A poorly pronounced groove under the lower eyeltd separates commissure (ammksura palpebrarum laterals) and the acute lateral
it from the cheek. When the eyelid is lowered, its skin on the level angle of the eye (angidus oculi lateralis)*
of the inferior orbital border forms the lower palpebro-orbital fold. Between the margins of the upper and lower eyelids, at the me
The orbital margin of the eyelid is the site at which its skin is con
dial angle of the eye, is a pink eminence called the laerimai caruncle
tinuous with the skin of the neighbouring regions, (caruncula lacrimalis): it is surrounded by the lacus lacrimalis. A small
A vertical fold of skin, tbe palpebronasal fold (plica palpebrona-
vertical conjunctival fold forms medially of the laerimai caruncle;
salis), sometimes stretches along the medial margin of the surface this is the plica semilunaris conjunctivae which corresponds to a
of the eyelid curving medially round the medial palpebral liga
tfnrd eyelid (nictitating membrane) in lower vertebrates.
ment.
The margin of the eyelid is separated from its anterior and su
The free margin of the eyelid measures up to 2 ram in thick perior surfaces, respectively, by the anterior and posterior borders
ness. It is arched Forwards for most of its distance, but the curva of the eyelid (limbus palpebralis anterior et posterior). The anterior
ture disappears in the medial portion. Here the margins of the up border is slightly rounded. Numerous hairs, eyelashes (cUk)
per and lower eyelids become rounded upwards and downwards, (Fig. 946) arise behind it from the substance of the eyelid; they
respectively, and joined to each other by means of the medial curve downwards on the lower eyelid and upward* on the upper
palpebral commissure (commissura palpebrarum medialh) to form the eyelid. The ducts of the sebaceous and modified sweat glands open
rounded medial angle of the eye (angulus oculi medklis). Laterally here and are connected with the hair follicles of the evelids.
950. Sebaceous glands oflacrimal caruncle 951. Lacrimal glands (specimen prepared by
(specimen prepared by V. Kharitonova). V. Kharitonova). (Photograph.)
X
(Photograph.) (Totally stained specimen; 14-week-old embryo.)
(Isolated glands from a totally stained specimen of the lacrimal 1—orbital part of low*r lacrimal gland
caruncle.) 2—palpebral part of uppcT lacrimal gland
S^gianduiar lobules
] —root af h«ir
4—dWts-
2—sacs of sebaceous glands. '
The free margin of the upper and lower eyelids carries at the The sites of reflexion of the conjunctiva from the eyelid to the
medial angle of the eye, at the level of the lateral periphery of the eyeball are called the superior and inferior fornices of the con
lacrimal caruncle, a small eminence called the lacrimal papilla (pa junctiva (fornices conjunctivae superior et inferior) (Figs 949, 953).
pilla lacrimalis). The upper and lower lacrimal canaliculi (canaliculi gether with the other parts of the conjunctiva the fornices form the
lacrimalts, superior et inferior) begin here, They have distinctly seen boundaries of the conjunct! val sac (saccus conjunctivae) which
openings on the apex of the papillae, which are called the puncta open anteriorly along the line of the palpebral fissure.
tacrimalia, superius et hiferius. The conjunctiva forms a series of folds in the region of the su
The posterior border of the eyelid is continuous with the poste perior and inferior fornices.
rior surface of the eyelid (fades posterior palpebrae). The part of the eyelid between the skin and the conjunctiva is
The posterior surface of the eyelid is concave and covered en formed of the following structures. Immediately under the skin is
tirely by the palpebral part of the conjunctiva (tunica conjunctiva the orbicularis oculi muscle, behind which in die upper eyelid is
palpebrnrum). The conjunctiva begins from the posterior border of the tendon of the levator palpebrae superioris muscle. The muscle
the eyelids, extends to their orbital margin, and is reflected onto begins from the periosteum of the roof of the orbit in front of the
the front of the eyeball. Covering the anterior parts of the eyeball, optic foramen, stretches forwards, and near to the upper margin of
the conjunctiva reaches the comeal limbus (limbus corneae); this is the orbit continues as a flat tendon. The last-named enters the sub
the ocular part of the conjunctiva (tunica conjunctiva bulbi). It is stance of the upper eyelid and divides into two parts: an anterior
loosely joined to the sclera. part which is first behind the orbicularis oculi muscle but then per-
forates it and runs to the skin of the eyelid; and a posterior part Stretching forwards, the superior tarsal muscle separates from
which is attached to the upper edge of the eyelid cartilage. The re the levator palpebrae superioris muscle and is inserted by the mid
maining part, situated nearer to the free margin, is occupied by the dle part of its medial surface into the upper edge of the tarsus,
tarsus of the upper eyelid (tarsus superior). It in formed of dense thus encircling the lateral part of the last-named. The inferior tar
connective tissue fibres and is rather firm. The tarsus has the ante sal muscle (musatlus tarsalis inferior) is also composed of smooth
rior and posterior surfaces, and the orbital and free edges. muscle tissue; it is at first part of the inferior rectus muscle of the
The posterior surface of the tarsal plate is convex in accord orbit, but then runs forwards, separates from this muscle and is in
ance with the convex surface of the eyeball and is intimately ad serted into the lower edge of the tarsus of the lower eyelid; some of
herent to the palpebral part of the conjunctiva, which ensures the fibres reach the inferior margin of the orbit.
smoothness of the conjunctiva in this region.
The tarsal plates of the upper and lower eyelids contain mo
The anterior surface of the tarsus is convex and is connected dified sebaceous glands called the tarsal glands (glanduhe tarsala);
with the orblcularis oculi muscle by a loose connective tissue. there are 27-40 of them in the upper and 17-22 in the lower eye
The free edges of the tarsus of the upper eyelid and tarsus of, lid (Figs 947, 948).
(he lower eyelid (tarsus superior et tarsus inferior) are relatively
The ducts of these glands open into the intermarginal space,
smooth and face each other. The orbital edges are rounded, the
nearer to the posterior edge, while the ocular parts are directed to
curvature being more marked in the tarsus of the upper eyelid.
the orbital margin or the eyelids and are curved sagittaly in ac
The free edge measures 20 mm in length and 0.8-1.0 mm in thick
cordance with the contours of the tarsi. The ends of the main parts
ness; the tarsus of the upper eyelid measures 10-12 mm in height,
of the glands do not extend beyond the tarsi. In die superior eye
that of the lower eyelid 5-6 mm.
lid, the glands leave free the upper edge of the tarsus, in the lower
In the region of die medial and lateral angles of the eye the eyelid they occupy the whole tarsal plate.
tarsi unite and are attached at the respective bony walls of the or
In the upper eyelid the glands differ in length: they are longer
bit by means of the medial and lateral palpebral ligaments (liga-
in die middle but shorter to the sides. In the lower eyelid they do
menta palpebramm mediate et lateraU).
not differ so sharply in size.
The tarsal plates situated near to the free margin of the eyelid
The ducts of the ciliary (sweat) glands (glanduia aliarts) also
lend it a certain firmness due to which it is known as the tarsal
open on the free margin of the eyelid between the eyelashes; the
part, in contrast to the remaining less firm part of the eyelid, which sebaceous glands (gl&nduUe sebaceae) pass to the hair follicles of the
is called the orbital part. eyelashes.
The superior and inferior tarsal muscles stretch to the superior The tarsi of the upper and lower eyelids sometimes contain
and inferior tarsi. The superior tarsal muscle (musatlus tarsalis supe also lacrimal tarsal glands.
rior) is formed of smooth (nonstriated) muscle tissue which is part
of the tevator palpebrae superioris muscic.
-Suoerdlam
niaiulnla lacTimalli.
Fornlx
conjunctivas
superior.
. Canal iculus laeriisiaJis
superior
lacrimalii
-Caruncula lacfimalls
g 1 - Canaliculus tacrimafis
interior
Palpebra Interior -
B^-Processus frcntalis
iriaxillae
Papilla lacrimalls 1
inferior
953. Right lacrimal gland (glandula lacrimalis) and nasolacrimat canal (canalis nasolacrimalis);
anterior aspect (%).
(The skin and superolateral part of the upper eyelid are cm and reflected; the nasolacrimal canal is dissected and opened.)
ous with the museums larectus musculi recti laterahs most of perior rectus muscle and the eyeball, and is inserted into the eye
whose fibres merge in the sclera, ball behind the equator at a distance of 18 mm from the edge of
It should be pointed out that a. bundle of smooth (nonstriated) the cornea.
muscle fibres forming the orbitalis muscle (musculus orbitalis) is si The inferior oblique muscle (musculus obliqum inferior) origi
tuated in the substance of the initial part of the lateral rectus mus nates in the medial part of the orbit from the lacrimal crest, the
cle. adjacent surface of the maxilla, and the infraorbital margin. It ex
The superior oblique muscle (musculus obliqum superior) extends tends backwards and laterally, passes between the floor of the orbit
from the margin of the optic canal forwards along the medial wall and (he inferior rectus muscle, and is inserted into the lateral sur
Of the orbit above the medial rectus muscle. Near to the superior face of the eyeball behind the equator.
orbital margin, at the trochlear fossa (foota trodikaris), it is continu The lateral and medial rectus muscles (musculi recti, latemlis et
ous with a long cylindrical tendon. The tendon passes through the medialis) rotate the eyeball laterally and medially, respectively. The
trochlea and turns backwards and laterally, passes between the su superior rectus muscle (musculus rectus superior) rotates it upwards
and slightly laterally. The inferior rectus muscle (musculus rectos in- In the anterior parts of the orbit, the sheath of the eyeball is
fertor) is an antagonist of the superior rectus and rotates the eye connected with the palpebral fascia which delimits the orbital cav
ball downwards and slightly medially. ity anteriorly.
The superior oblique muscle rotates the eyeball downwards In the orbit, behind the sheath of the eyball is the fatty body of
and laterally, the inferior oblique muscle—laterally and upwards, the orbit (corpus adiposse orUtae) through which nerves pass. The
The eyeball occupies the anterior part of the orbit and is sepa lesser part of the fatty body lies outside the cone formed by the
rated from the other parts of the orbit by the fascial sheath of the aggregate of muscles of the eyeball, between them and the orbital
eyeball (vagina bulbi) which is connected with the fascia of the eye walls covered by the periosteum of the orbit, the periorbit (perior-
ball muscles and the sheath of the optic nerve. The fascial sheath bita); the greater part lies inside this cone, around the optic nerve.
of the eyeball is connected with the sclera by a series of trabeculae
and together with its surface delimits the episcleral space (spalitim
episderale).
Oista galJi
,Labyrinthii5 ethmoid a] I;
Jrotfilea
Lamina orbital is
Cornea
Tendo L ,Biilbas oculi
obliqui
JjL-Pars palpebralis glandulae
aerimalis
M. rectus medlaits
M. redus tatera
^N. optlcus
(pars orbiialis)
Anutus
tend In a us ;
commurJa -'' <|
M. temportlia—
THE VEINS
All the arterioles of the retina (branches of the central artery of and posterior ciliary veins. T h e anterior ciliary veins (venue dtiares
the retina) are attended by venules of the same name (branches of anteriores) originate from the veins of the ciliary muscle and receive
the central vein of the retina) (Figs 939, 9 4 3 , 944, 623) among on the way vessels from the sinus venosus sclerae. After piercing
which are the superior a n d inferior branches (of the central vein the sclera, these veins receive the episcleral veins (venae episderales)
of the retina) [otnuhe maculares superior et inferior), the medial reti and the conjunctival veins (venae conjunctivales) and open into the
nal branch (vtnuia medialis retinas), the superior and inferior nasal veins of the muscles of the eyeball.
branches (venulae nasales retinae, superior et inferior), superior and T h e posterior ciliary veins (venae dliares posteriores) receive
inferior temporal branches (venulae temporaks retinae, superior et in blood from the posterior parts of the eyeball.
ferior). All the venules (branches) drain into the central vein of the T h e venae vorticosae, 4 - 6 in n u m b e r , form along the equator
retina (vena centralis retinae) which opens into the superior ophthal in t h e thickness of the vascular coat. They drain blood from the
mic vein (vena ophtkalmka superior), or, less frequently, into the cav choroid, the ciliary body, and the iris and empty into the ophthal
ernous sinus (sinus cavernosus). mic veins which, in turn, anastomose with the veins of the face.
T h e remaining part of the eyeball is drained by the anterior
. M. levatgr palpebrae
superior);
N. oculomotnrlLj
Flssura orbttalis (r. superior)
superior-. __
, A, OphthalmEca
iT*~——N. opHcus
M. rectus lateralls
M, rectus medialis
N. abducena
N. oculontotorius
(r. inferior^
T H E NERVES OF T H E EYEBALL
The eyeball is supplied by the long and short ciliary nerves nerves, in the region of the ciliary muscle, is the ciliary plexus
(nervi dliares longi et breoes) which arise from the nasociliary nerve (plexus dliaris) containing nerve cells; the plexus branches run to
(nervus nasodliaris) and the ciliary ganglion (ganglion allure) (see the iris and the ciliary muscle.
Figs 810, 811, 939, 941). On reaching the posterior part of the eye- The skin of the eyelids receives nerves from the first (upper
hall, the ciliary nerves pierce the sclera, stretch between it and the eyelid) and second (lower eyelid) divisions of the trigeminal nerve.
vascular coat, and send twigs to them. Along the course of these
— O? fronts I e
M. rectus superior
Trochlea
M, obllquus
superior
Bulb us oculi 29
Proressus frontalis
M. rectus lateralis
fe,—Crista Lacrimalis
posterior
Cornea
f~""CaJt*Iii nasolacrimaliK
Os zygoma ticuir
The ear (amis) (Fig. 957) consists of three parts: the external organs —the organ of hearing proper which appreciates and differ
ear (amis externa), the sound-collecting part; the middle ear (auris entiates the sound stimuli, and the organ of static sense, which
media), the sound-conducting part; and the internal ear (auris in- reacts to the position of the body in space and changes of equilib
terna), the sound-appreciating part. The internal ear consists of two rium.
THE AURICLE
The auricle (auricula) (Fig. 958) is formed by a fold skin con form the helix which begins above the lobule by the tail of the he
taining the cartilage of the auricle (cartilage auriculae). The carti lix (cauda keliris) which thickens upwards. Ascending, the helix
lage corresponds in shape, on the main, to the external shape of sometimes bears a tubercle (darwinian) of the auricle (tuberatlum
the auricle. The skin adheres to the cartilage more intimately on auriculae) at the junction of the posterior and superior margins of
the lateral surface than on the medial surface where it is movable. the auricle. The helix then passes along the superior margin of the
The lower end of the auricle contains no cartilage but has a well- auricle and turns downwards to form the anterior margin of the
developed layer of fatty tissue which together with the skin forms upper part of the auricle; after that it deviates slightly to the back
the lobule of the auricle (lobulm auriculae). The skin of the auricle and passes on the lateral, concave, surface of the auricle on which
is covered with hairs in the region oF the tragus and antitragus (see it is separated from the supratragal Euberculum situated below by
below) and on the convex surface. Sebaceous and sweat glands are the anterior notch of the auricle (incisura anterior auris) above which
lodged in the thickness of the skin, is the spine of the heltx (spina kdicis).
The free margin of the auricle curves groove-like forwards to In front of the helix, aiong its margin, lies a furrow-like depres-
/
Aiifla externs,.
Auris
Concha auriculae iiiferua
-Auras media
-Membrana tvmpani
. tensor, tympani
Tuba audillva
Csrtilago meatus
atustici — Cartilage tubae auditivae
Glandula parotis
Lolulus auriculae — T E
sion called the scaphoid fossa (scapha) which expands from bottom The medial surface of the auricle carries a series of grooves and
to top. The scaphoid fossa is bounded in front by a ridge called the eminences corresponding to the relief of its lateral surface. The la
antihelix (antkelix) which begins from the antitragus, being sepa teral margin of the medial surface is rounded in conformity with
rated from it sometimes by the posterior sulcus of the auricle (sul the anteriorly curved margin of the helix. Medial to the lateral
cus auriculae posterior), ascends, and then curves forwards to divide margin is the eminence of the scaphoid fossa (eminentia scaphae).
into two crura of the antihelix (crura antitkelicis) between which lies Anterior to it are two other eminences, a larger eminence of the
the triangular fossa (jossa triangularis). cimcha (eminentia conchae) and a smaller eminence of the triangular
To the front of the antihelix, and bounded by it posteriorly, is fossa (emmentia fossae triangularis). The last-named is separated
a large depression which is continuous with the external auditory from the eminence of the concha by a small transverse sulcus of
meatus; this is the concha of the auricfe (concha auriculae). the antihelix (sulcus anthelich iransversvs) which is continuous
The poms acusticus externus (Fig. 957) is situated in the mid downwards with the fossa of the antihelix (fossa anthelicis).
dle of the lateral surface of the auricle, it is bounded anteriorly by The cartilage of the auricle (cartilage auriculae) (Figs 961, 962)
a small projection, the tragus, above which is a small supratragal is elastic and its shape repeats the contours of the auricle. Its ante
tubercle (tuberculum supratragicum). The tragus is continuous rior suface bears a few (1-2) vertical notches of the cartilage of the
downwards with the iticEsura intertragica, to the back of which is a external auditory meatus.
projection whose apex is directed upwards; this is the antitragiis. The posterior margin of the cartilage is separated interiorly
The upper margin of the helix projects into the concha as the from the antitragus by the fissura andtragohelicma which together
cms of the helix (cms hdicis) dividing it into two parts. The upper, with the posterior margin of the cartilage delimits a small islet
smaller part is called the eymba conchae, the lower, larger part is called the tail of the helix (cauda heUcis),
the cavity of die concha (cuvum conchae). The ifiristtra termmalis of the auricle (incisura terwwlis auris)
Helix
Crura antticllcls
Fossa irianfltjlaris
,Cru$ hettctj
Tuberculum auriculae
, ludsura anterior
[aurisl
Seaptia
r^-Ti3bercuium
5L-ptatj"agii:um
tyniha conftiae.
Lone ha
__,— —-Trafrus
auriculae Cavura tuUChiie
■ ^-Meatus a<msikus
extttnus
B — Incisura intertragica
V
1 X
X
W '"-Antitragus
Anttielix'
"Lobulus auriculae
Helix
is situated between the beginning of the helix and the posterior surface of the lamina of the tragus,
wall of the cartilage or the external auditory meatus. 4. The antitragicus muscle (musculus antiimgicus) begins on the
The parts of the cartilage of the auricle communicate by means lateral surface of the posterior parts of the antitragus, ascends
of the auric ularis muscles (musculi auriculares). Besides, the auricle backwards, and is inserted into the base of the tail of the helix
is the site of insertion of some muscles arising on the bones of the (cauda helicis).
skull: the auricularis anterior, superior, and posterior muscles 5. The oblique muscle of die auricle (musculus obliquus auric
(musculi auriculares anterior, superior et posterior). las) lies on the medial surface of the auricle and extends from the
The following are the intrinsic auricular muscles. eminence of the triangular fossa (eminentia fossae triangularis) to th
1. The helicis major muscle (musculus helicis major) originates eminence of the concha (tminenlia conchae)*
on the spine of the helix (spina kelicu), ascends on the anterior mar 6. The transverse muscle of the auricle (musculus tratisversus a
gin of the cartilage, and is inserted into the anterior parts of the riculae) lies below the oblique muscle. It begins from the eminence
helix; some of the fibres extend to the eminence of the triangular of the concha (eminentia conchas) and is inserted into the eminenc
fossa (eminentia fossae iriangularis). of the scaphoid fossa (eminentia scaphae).
2. The helicis minor musde (musculus helicis minor) also arises 7. The pyramidalis muscle of the auricle (musculus pyramidali
on the spine of the helix, runs downwards and laterally on the la auriculare) is a superficial bundle arising from the tragic us muscle
teral surface of the concha to be inserted into crus of the helix. and terminating on the spine of the helix,
3. The tragicus muscle (musculus tragicus) lies on the lateral
M. auricularls superfor
Helix
Crura anthelicls
Fossa triangularis
Scapba^
Anthellx-^
£.— M. helicfs major
Spina helicts
hellcis
minor
„-■* Inclsura
tertnlnalls aurfs
M. antftragicus^oj
Fissura antltragohelicina
Antltragus ^ M . traglcus
Cauda hellcis
Inclsura intertragica
961« Cartilage of right auricle (cartilago auriculae); lateral surface; anterior aspect (%)
Eminentia scaphae
M, auricularis superior
Eminentia v \
v
fossae triangular^ ^3ai^
V M. obllquus auriculae
v
x \
Sulcus anthelicis ■ ^
transverSuS
V
"v
Fossa anthellcis
M, aurioilaris "x
anterior (prgfutidus)
X ,^,— M- trans versus
M J t * - ^ " XPi/' auriculae
Splna hellcli I
Membrana tympani
962. Cartilage of right auricle and external auditory meatus; posterior surface; posterior aspe
CAY
T H E M I D D L E EAR
The middle ear (auris media) (cavum tympani) (Fig. 957) in-
d u d e s the lympaaic cavity (catmm tympani), the auditory ossicles
(otsicula uuditus), and the pharyngotympanic tube (tuba auditiva).
Chorda tympani
f&^M N. faclalis
/ / AfluluS ilb'rtxiartllagineus
f Pars tensa mem b ran a o tympani Tuba auditiva S
limbo membranae tympani
Pars tensa membranae tympani
Ail u I us f I brocartila gi heus
B
Carialls semicLrcularis anterior
Canalis jlarls posterior
2miclrcu!arls lateralis
Llg. mallei superlus^
Jendo m. stspedll
Recessus epflympamousv
N, laclalts
Capltulum mallei s^.
Lig. mallei l a t e r a l ^
wy "^
N. vestibulococ hi earls
^--Cochlea
Recessus membranae
tympani superior-^
^.~M tensor tympani
'Canalis CarotlcuS
Processus anterior mallei
Manubrlum mallei —
■Tuba auditiva
Stapes
THE MALLEUS
The malleus (Figs 964-965) fits against the lateral wall of the
The handle of the malleus is a bony stem which deviates
tympanic cavity and is fused with the tympanic membrane.
slightly medially. Its lower end is fused with the tympanic mem
It has a head (esjpui mallei), neck (collum mallei), handle (menu- brane. Connective-tissue fibres of the membrane fuse here with the
brium mallei), an anterior process (processus anterior mallei), and a la
periosteum of (he malleus and form on the outer surface of the
teral process (processus lateralis mallei).
membrane a funnel-like depression; the corresponding projection
The head of the malleus is in the upper part of the tympanic on the inner surface of the membrane is called the umbo of the
cavity (epkympanum). It is the largest part of the malleus, oval in tympanic membrane (umbo membraneae tympani).
shape, wider towards one of its ends, and bears on its posterior and
Two processes arise from the base of the handle—one is the
partly on its medial surface a saddle-like articular facet which is
anterior process (proceisus anterior) which begins at the neck, ex
covered by cartilage. Inferior to the articular facet a small projec
tends forwards and slightly laterally and fits into the squamotym-
tion, or a spur of the malleus, forms. The lower portion of the head
panic fissure (fismra petratympanka); the other is the lateral process
is narrowed and continuous with the neck which connects the head
(process™ lateralk) which is directed laterally; its end abuts firmly
with the handle of the malleus.
against the tympanic membrane and, as a result, the prominence
Articulatio iircudomallearis
Caput m a l l e i - J j ^
Malleus
,Crus posterius
Processus anterior
^ p u t mallei
Facies articularis
Facies artlcularij
.Xollum mallei
Cotlum malle
Processus anterior
Processus lateralis
Processus \ «
lateralis'"^ Manubrlum mallei
-rManubrlUin
/ mallei
Processus anterior
B C
Fades articularis
Corpus incudis
Corpus incudis
Crus breve
Crus longum
Crus longum
Processes Processus
Processus lenticularis lentlcularis
lenticularis
Crus posterius
Cms anterius
(stapedis) Crus stapedis
Crus anterius
Membrana
stapedis^,
Mem bran a
Metnbrana
stapedi5 / Basts stapedis
stapedis ^
Basis stapedis
medial periphery of the base of the handle, It originates from the tensor tympani (semkanalis musculi tensoris tympani) the muscle en
circumference of the lateral orifice of the musculotubal canal (can- ters the tympanic cavity and extends to the handle of the malleus.
alis musculotubanus), the petrous part of the temporal bone, the The muscle is innervated by the nerve to the tensor tympani mus
greater wing of the sphenoid bone, and from the cartilage of the cle (nervus tensoris tympani) from the otic ganglion (ganglion oticum
pharyngotympanic tube. After passing through die canal for the
THE INCUS
The incus (Figs 964, 966) has a body (corpus incudis) and two tened at the medial and partly at the upper periphery of the
processes—a short process (crus breve incudis) and a long process articular capsule.
(crux longum incudis). The posterior periphery of the body of the incus is continuous
The body of the incus is situated in the epitympanum behind with the short process.
the head of the malleus. It is attached at the roof of the tympanic The short process (crus breve incudis) stretches backwards and
cavity by means of the superior ligament of the incus (ligamentum narrowing cone-like, is inserted into the posterior wall of the tym
incudis supenus). panic cavity in the region of the fossa for the incus by means of the
The anterior surface of the body has a cartilage-covered sad posterior ligament of the incus (ligamentum incudis posterius).
dle-shaped articular facet for the corresponding articular facet of The long process (crus longum incudis) arises from the body of
the malleus to lorm the incudomalleolar joint (artiadatia incudomal- the incus and descends to be situated in the mesotympanum me
learis). Due to the presence of a braking spur on the malleus and a dial to the handle of the malleus. The lower end of the long pro
corresponding notch on the incus, this is a braking joint. The cap cess becomes thinner gradually and curves medially. On its free
sule of the joint is attached along the borders of the articular fac surface is a small lentiform nodule (processus lenticularis) which art
ets. The cavity of the joint contains an articular disk which is fas- culates with the stapes.
THE STAPES
The stapes (Figs 964-967) has a head (caput stapedis), a base The posterior limb is slightly arched and more bulky than the
(basis stapedis), an anterior limb (crus anterius stapedis), and a posteanterior limb which is almost straight.
rior limb (crus pasterius stapedis). The peripheral ends of both limbs unite with the base and
The posterior surface of the head of the stapes bears a concave form together with it a closed ring.
articular facet covered with cartilage, which articulates with the On the inner surface of the ring is a groove to which the obtu
lentiform nodule of the incus forming a ball-and-socket joint. rator membrane of fhe stapes (membrana stapedis) is attached.
The tendon or the stapedius muscle is inserted into the head of The base of the stapes has two borders: an upper convex and a
the stapes close to the origin of the posterior limb. This muscle ori lower concave border which are continuous with each other. The
ginates in the depression u n d e r the pyramid of the t y m p a n u m free surface of the base of the stapes is covered with cartilage. The
(enttttentia pyramidslis) and after emerging from it runs to the base of the stapes is fastened in the fenestra vestibuli by means of
stapes. connective-tissue fibres of the annular ligament of the base of the
The muscle is innervated by the nerve to the stapedius muscle stapes (ligamentum anulare stafiedis) producing the lympanostape-
(nerous stapedius), a branch of the facial nerve. dial syndesmosis (syndesmosis tympanostapedia).
The anterior part of the head is continuous with the anterior
and posterior limbs; between the head and the crura is a con
stricted portion —the neck of the stapes,
Canalis
setnldrcularis anterior^
Cochlea
Cupula cochleae
Crus commune
Canalis
semtclrcularls
lateraliS—.
Canalis
semicircular^
posterior^-"'
Crus simplex
970. Right osseous labyrinth (labyrintkus osseus); anterolateral aspect (%) (a cast).
THE VESTIBULE
T h e vestibule (oestibulum) is an oval cavity situated between the T h e medial wall of the vestibule forms die fund us of the inter
tympanic cavity and the internal auditory meatus. nal auditory meatus. It bears two depressions—the spherical and
T h e lateral wall of the vestibule is the medial wall of the elliptical recesses (reKssut sphericus et dlipticus) separated by a verti
middle ear; in it, facing the middle ear, is the fenestra vestibuh' de cal vestibular crest (crista vestibuli) whose anterior end terminates
scribed above, which is closed here by the base of the by a small elevation termed the pyramid of the vestibule (pyramis
stapes, vestibuli).
Cartalis
semicircularls anterior
Ampulla ossea
j anterior
Recessus eilipticus
Macula crlbrosd
superior
Maculs cribrosa
medla
Crlsta vestibuli /
Cochlea
y Cupula cochleae
C r l l l . i IIS
semicircular] s
lateral is — ^Recessus
spheric us
Canalis
semicircularls Canahs splralls
posterior - - cochleae
-Lamina spjralis ossea
Orifice
crus coiniimtie Scaia lympani
Seals vestibuli
Arnpulla ossea posterior'
^Lamina splralls secundaria
Apertura interna * Macula cribrosa inferior
aquaeductus vestibuli "Apetuira interna
canaliculi cochleae
T h e surface of the pyramid and the bony subs lance around it T h e spherical recess (recessus spkericas) is in front and inferior of
are perforated by a great n u m b e r of small openings which form the crest of the vestibule. It is spherical in shape and bears on its
areas called the maculae cribrosae. T h e macula cribrosa superior inner wall many openings forming the area of the macula cribrosa
communicates the vestibule with the internal auditory meatus. T h e media which corresponds to the inferior vestibular area (area vesti-
upper portion of the fundus or the internal auditory meatus corre bularis inferior) on the fundus of the internal auditory meatus.
sponds to the macula cribrosa and is called the superior vestibular In the posteminferior part of the spherical recess, on its medial
area (area vestibularis superior). wall, is a small depression called the cochlear recess (recessus mcktea-
Downwards and to the back of the vestibular crest is a small ris) which lodges the blind end of the membranous cochlea (duct
opening termed the internal opening of the aqueduct of the vesti of the cochlea).
bule (apertura irtterna aqu(a)eductus vestibuli). From it begins a nar T h e elliptical recess (recessus etlipticus) is to the back of and
row cattahculus called the aqueduct of the vestibule (aqu(a)eductus above the crest of the vestibule and is elongated in shape. Its walls
vestibuli) which terminates on the posterior surface of the petrous have five openings of the three semicircular canals.
p a n of the temporal bone by the external opening of the aqueduct
of the vestibule (apertura externa aqu(a)eductus vestibuli).
Each canal has two ends, or osseous crura (crura ossei) which are called the prominence of the lateral semicircular canal (prominentia
connected by means of its arched part. One crus of each canal is canalis semidrcularis lateralis).
dilated and termed the ampullary crus (crus osseum ampullae) in The superior semicircular canal (amahs semicircularis anterior
contrast to the other, nondilated crus simplex (cms osseum simplex). measures 18-20 mm in length, Its ampullary end opens in the ves
The crura simplex of the Superior and posterior semicircular ca tibule next to the aperture of the ampullary part of the lateral
nals join to form the crus commune (crus osseum commune). That is semicircular canal, directly above the fenestra vestibuli. The crus
why the three semicircular canals open into the vestibule by five simplex of the superior semicircular canal, as it is pointed out
apertures. above, joins the crus simplex of the posterior canal to form me
There are three bony ampullae (ampullae osseae), in accordance crus commune (crus osseum commune) which opens on the media
with the number of semicircular canals: (a) the superior bony am wall of the posterior part of the vestibule, to the back and above
pulla (ampulla ossea anterior)', (b) the posterior bony ampulla the inner orifice of the aqueduct of the cochlea.
(ampulla ossea posterior); (c) the lateral b o n y ampulla (ampulla ossea The convexity of the superior semicircular canal faces up
laferalis). wards, producing the arcuate eminence (eminentia arcuata) on the
The lateral semicircular canal (canalis semidrcularis (ateralis) anterior surface of the petrous part of the temporal bone.
measures 14-16 mm in length. Its ampullary end opens in Front of The posterior semicircular canal (canalis scmiriradaris posterior
and lateral to the Fenestra vestibuli; the crus simplex Opens in the measures 22 mm in length. Its ampullary crus opens on the
vestibule between the aperture of the crus commune and the am posteroinferior wall of the vestibule where the macula cribrosa in
pullary part of the posterior semicircular canal. The convexity of ferior is located. The foramen singufare of the internal auditory
the lateral semicircular canal bulges into the tympanic cavity and meatus correspond to this macula.
produces an elevation on the medial wall of the epitympanum
THE COCHLEA
The cochlea (Figs 971-974) begins in the anteroinferior part of which terminate in the spiral canal of the modiolus (canalis spiralis
the lateral wall of the vestibule where there is a depression to modioli). The apex of the modiolus does not reach the cupola of the
which corresponds a promontory (promontorium) on the surface fac cochlea but continues as a thin bony lamina of the modiolus (lam
ing the tympanic cavity. The spiral canal of the cochlea (canalis spi ina modioli) forming a wall between the second and third coils of
ralis cochleae) begins here. It is called so because it curves spirally to the cochlea.
form 2J^-2% coils. The walls of the canal are formed by the bony The coils are separated from one another by an intermediate
Substance of this part of the labyrinth. wall formed by the bony substance of the cochlea, The osseous spi
The beginning of the canal of the cochlea is separated from the ral lamina (lamina spiralis ossea) (Fig. 973} projects from the modio
tympanic cavity by the medial wall of the last-named and forms lus into the cavity of the spiral canal for its whole length. It begins
the promontory (promonlorium) on it. on the inner wall of the vestibule near to the fenestra cochleae, as
The Erst coil of the cochlea is called basal, the second—mid cends winding round the modiolus, and terminates in the region of
dle, and the last—apical. the last coil by a curved edge called the bamulus of the spiral lam
The cochlea has the shape of a cone and has a base (basis coch ina (kamttlus laminae spiralis).
leae) measuring 7-9 mm in width and a cupola (aipula cochleae). The The base of the spiral lamina is thicker than the free border
distance from the base to the cupola measures 4-5 mm. The base and contains the spiral canal of the modiolus (canalis spiralis modi
of the cochlea faces the internal auditory meatus (meatus acusticus oli) for the whole distance. This canal communicates by means of
internus), the cupola faces the tympanic cavity and the musculotu- lhe longitudinal canals of the modiolus (canales longitudinales mod
bal canal. oli) with the openings in the region of the base of the cochlea, and
The spiral canal of the cochlea measures 28-30 mm in length with the spiral organ by means of a slit-like spiral fissure passing
and ends blindly at the cupola. It is widest (measuring 6 mm) at for the whole length of the spiral lamina.
the beginning but narrows gradually to a diameter of 2 mm as it The cochlea also has a secondary spiral lamina (lamina spiralis
approaches the cupola, secundaria). This is a small bony plate (measuring 0.5 mm in width)
In the centre of the cochlea is a pillar around which the coils which projects from the outer wall of the cochlea half-way into its
wind; it is called the modiolus. The modiolus is made up of spongy cavity.
bone and forms the inner wall of the spiral canal. Its wide part, A basilar membrane (membrana spiralis) stretches from the Fre
base of the modiolus (basis modioli) faces the internal auditory mea edge of the osseous spiral lamina to the outer wall of the cochlea for
tus and has numerous openings forming the tractus spiralis for- the whole length; it is part of the membranous cochlea (see below),
aminosus (Fig. 972). These openings are continuous with the lon The osseous spiral lamina together with the cochlear canal di
gitudinal canals of the modiolus (canalcs longitudiualcs modioli} vides the cavity of the spiral canal into two stair-like passages; the
Cupula cochleae.
Hamnlus laminae
Lamina modioli / splralis
-'Helicotrema
Cochlea
■Lamina spiralis
ossea ,Sca!a vestibull
Lamina spiralis
ossea
Modiolus - Seala tympani
Tractus spirali
foramlnosus
Tract us spiral
foramlnosus.^*^ Fusion of wall ^ ^ Modiolus
of cochlcar coil
with modiolus
Cupula cochleae
J.amlrm modlotl
Haoiulus Samtnae
Cochlea : pi rails ^
Lamina spiralis
Lamina spiralis ossea i ossea
N K
Area cochleae'' /
V /
Basis cochleae Traettts spiralfs
foramlnostis
A B
Hamulus
laminae spiralis. Modiolus
Hellcotrema«.
,Canalls longitudinal la
raodioli
CanaHs
spiralis inodiolt Scala vestibuli
Scala tympani
Lamina spiralis
0SK4B
Scala vestibuli
Canalls spiralis
cochleae
Scala tympan
Canalls spiralis
modioli
Tracuis 3plral1s Meatus acustlcus
toramlnosus
Intemus
cochkam) is the place of distribution of the peripheral apparatus of the saccule are the site of distribution of the peripheral apparatus
the cochlear nerve (pars tocklearis nervi ottavi). It is related to the or of the vestibular nerve (pars vestibulans nervi ortavi). They compos
gan of hearing and forms the spiral organ (organum sphah). the vestibular apparatus and are the organ of balance.
The membranous semicircular duets as well as the utricle and
THE DUCT OF 1
The duct of the cochlea (dudus cochkarisj (Figs 975, 976) is situ of the cupola of the cochlea and is termed the caecum cupulare (u-
ated inside the spiral canal of the cochlea and, following its course, cum atpulare}.
makes 2',4-2% coils. It is trihedral and has two blind ends: one is at The duct of the cochlea is situated in the lateral part of the spi
the beginning of the cochlea in the vestibular region and is termed ral canal, between the free edge of the osseous spiral lamina and
the caecum vestibulare (cetmm vertibulare}, the other is in ihe region the outer wall of the cochlea; together with the lamina it separates
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344 THE ORGAN O F HEARING
the scala vestibuli from the sea la tympani except for the hehco- tributes to the formation of the floor of the duct; it enters the cav
trema where both scalae communicate in the region of the cupola ity of the duct.
of the cochlea. At the junction of the spiral ligament of the cochlea with the
The cavity of the duct communicates with the sacculus via the basilar lamina is a spiral prominence (pTominentia spiralis) which
ductus reuniens and is bounded by three walls: the lateral wall (pa- contains vessels. Medial to it is the external spiral sulcus (sakus spi
ties txternus dudus cocklearis) is connected with the outer wall of the ralis externus).
cochlea; the other wall is called the vestibular membrane (paries A vessel called the vas spirale is situated in the substance of
vesiihularis ductus cocklearis [membrana vestibular^j ) ; the third wall isthe basilar lamina below the spiral organ; it is a capillaiy receiving
at the junction with the sea I a tympani and is termed the floor (pa arterioles, which approach it through the osseous spiral lamina,
ries tympankus ductus cocklearis [membrana spiralis]). It is a continuaand small veins running from the spiral ligament of the cochlea.
tion of the osseous .spiral lamina and is called here the basilar la The thickened limbus laminae spiralis contains connective-tis
mina (lamina basilaris), or the membranous spiral lamina. sue and epithelial elements. A vestibular lip (labium limbi vestibx-
The lateral wall of the duct is fused with the periosteum lining lare) hangs freely from it into the cavity of the duct of the cochlea
the inner surface or the cavity of the bony cochlea. It consists of and is continuous with the membrana tectoria. At the junction of
three layers; an outer connective-tissue layer is a continuation of the basilar lamina with the osseous spiral lamina the limbus lami
the spiral ligament of the cochlea (ligamentum spirale cochleae), by nae spiralis forms a projection called the tympanic lip (lahium limbi
means of which the basilar lamina is attached to the outer wall of tympanicum).
the cochlea; a middle layer of fibrous vascular tissue called the These two lips are separated from each other by the internal
stria vascularis whose vessels are concerned with secretion or spiral sulcus (sulcus spiralis internus). The border of the tympanic li
maintenance of endolymph; and an inner layer of epithelium lin is perforated by foramina for nerves (foramina, nervasa) by means o
ing the cavity of the duct. A vessel called the vas praminens passes which the slit-like spiral fissure of the osseous spiral lamina opens
between the periosteum of the cochlea and the lateral wall of the into the duct of the cochlea.
duct; it forms from union of two eanaliculi arising from the saccu The spiral organ (organum spirale) is situated in the cavity of
lus and utricle and draining into the aqueduct of the vestibule. the duct for the whole length of the basilar lamina. It is a complex
The vestibular membrane of the ductus of the cochlea arises structure located lateral to the tympanic lip and consists of three
on the surface of the osseous spiral lamina facing the cavity of the groups of epithelial cells among which are the inner and outer sen
seal a vestibuli. Stretching towards the outer wall of the cochlea, sor}' (auditory) hair cells. The spiral organ is covered by a reticular
the vestibular membrane forms an angle of 45 degrees with the membrane (membrana reticularis) which is a complicated entirety o
osseous spiral lamina. It is the thinnest wall of the duct and con membranes bounding the upper surface of the spiral organ cells.
sists of connective tissue covered with epithelium. The spiral organ contains the receptor apparatus of the cochlea
The tloor of the duct, the basilar lamina, stretches between the nerve (pars cochkaris nervi octavi) (Fig. 976). Dendrites of cells form
free end of the osseous spiral lamina and the outer wall of the ing the spiral ganglion of the cochlea (ganglion spirale cocklearis) ru
cochlea to which it is attached by the spiral ligament of the coch to the spiral organ in the substance of the osseous spiral lamina;
lea. The extreme lateral part of the osseous spiral lamina also con the axons of these cells form the cochlear nerve.
DuCtuS cochlearls
Scala vestibuli
v \ I ^
J *\ \ I Central processes
/ V I' , \\> of ganglion spirale
Ganglion spiraie
L Lig, spirale
cocfileae \ Peripheral processes of
ganglion spirale cells
\
Osseous wall of cochlea Sea!a tympaiii
cued here, whitish due to the presence of otoliths (statoconiaj, and otoliths (statoconia) which are rich in lime crystals and contain sen
contains sensory, or hair (sensory-epithelial) cells (cdlvlat [sensori- sory hair cells on their surface. The otoliths are held in place by
epitkeiialesj pilosae)* the m e m b r a n e of the otoliths (membrane, statoconiorum) which is a
The utricle (utricutus) is elongated. It bears on its. inner surface thin mucous membrane lining the inner surface of the utricle. O n
the macula of the utricle (macula utriaili) which Occupies part of the outer surface the region of the macula is separated from the
the lower, anterior, and outer walls. T h e utricular nerve (nervus utri- rest of the utricle by a constriction; this part of the cavity of the ut
cvlaris) ramifies there. ricle is termed the elliptical recess (reassus dlipticus) (Fig. 971) and
The macula of the utricle measures up to 3 mm in length and communicates with the semicircular ducts.
nr> to 2_,1 into in wiiilh. is whitish in m l o n r diif to the presence of
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346 THE ORGAN O F HEARING
DllCtLS
cochlearl
Ductus utrlculosat'.cularls
N. sacculoris Ductus
sernicifculaiis
posterior
N, ampulJarls posterior^ Ductus endolymphatlcus ' /
Sdccuius , / /
Ductus reunlens ' l Saccus endolymphalicus
Ampulla memhranatea posterior' Ductus iemiclrculaiis laleralfs
Ductus semidrculaTia
anterior
\ 1
Rr cochleae a. labyrinth! N, ampullarls lateral!?
\
vestibulares a. labyrinthl ^
Ductus coclilearis a Ampulla rtiembranacea
lateralls
Cms commune
978, Blood vessels of right labyrinth; inner aspect (schematical representation, after
F.Siebemann).
tier) which is a branch of the external carotid artery (arteria carotis from the adjacent parts of the mucous membrane. These arteries
externa). ramify in the tympanic membrane to form two vascular net
The venous blood is drained by the anterior auricular veins fffe- works—an outer one in the skin and an inner network in the mu-
nae auriculares posteriores) emptying into the retrornandibular vein, cosa of the tympanic membrane.
and by the posterior auricular vein (vena auricularh posterior) which In conformity with the arteries, the veins form venous plex
empties into the external jugular vein (oena juguhris externa). uses, the veins of the lateral surface communicating with those of
The vessels of the external auditory meatus. The external audi the medial surface of the tympanic membrane.
tory meatus is supplied with arterial blood by the auricular The vessels of the middle ear. The following arteries supply the
branches of the superficial temporal artery (rami auriculares anted- middle ear.
ores) and by the deep auricular artery (arteria aadeularis prqfunda) 1. The anterior tympanic artery (arietta tympanka anterior) (a
which is a branch of the maxillary artery (arteria maxillaru). branch of the maxillary artery) enters the tympanic cavity through
The venous blood is drained by the system of the maxillary the squamotympanic fissure (fiiiura petratympanka).
vein fews maxitlaris). 2. The inferior tympanic artery (arteria tympanka inferior) (a
The vessels of the tympanit membrane. From the side of the branch of the ascending pharyngeal artery) penetrates into the
external auditory meatus the tympanic membrane is approached tympanic cavity through the petrosal fossa (fossuta petrasa) and the
by a branch of the deep auricular artery and by other arteries of canaliculus for the tympanic nerve (canalituha, tympanicus),
the skin of the external auditory meatus. From the side of the mid 3. The superior tympanic artery (arteria tympanka superior) (a
dle ear the tympanic membrane receives branches from the tym branch of the middle meningeal artery) extends into the tympanic
panic artery (maxillary artery) and other arteries extending to it cavity.
4. T h e caroticotympanic branches (rami airoticotympaniri) of posterior auricular artery (arteria auricularis posterior).
the internal carotid artery enter the tympanic cavity through the 1. T h e internal auditory artery (arteria labyrinthi) is a branch of
carolicotympanic foramina in die posterior wall of the carotid the basilar artery (arteria basilaris). It enters the internal auditory
canal. meatus and divides into the cochlear branch (ramus cochtearis) and
5. T h e stylomastoid artery (arteria stylomastoidea) (a branch of the vestibular branches (rami vestibulares) (Fig. 978).
the posterior auricular artery) enters the canal For the facial nerve (a) T h e cochlear branch sends arteries to the first (basal) coil of
through the stylomastoid Foramen and sends into the tympanic the cochlea and, stretching along the axis of the cochlea, gives off
cavity via the anterior canaliculus for the chorda tympany the pos branches to the spiral ganglion, the osseous spiral lamina, to the
terior tympanic artery (arteria tympanica posterior), the slapedial middle and apical coils, and to the periosteum (endosteum) lining
branch (ramus stapedius) to the stapedius muscle, and the mastoid the scala tympani.
branches (ram mastoidei) to the mucous membrane of the air cells (b) T h e vestibular branches supply the membranous vestibule,
ot the mastoid process. the semicircular ducts, and the periosteum (endosteum) of the ves
T h e branches of these vessels unite to form a thick arterial net tibule.
work in the mucous membrane of the tympanic cavity; the deep 2. T h e stylomastoid artery (arteria stylomastoidea) in the canal
layers of the mucous m e m b r a n e contain large arterial trunks, ca for the facial nerve gives off a small branch which enters the mid
pillary networks prevail in the superficial layers. dle ear through the fenestra cochleae and runs to the cochlea.
T h e vessels of the pharyngtitympanic tuhe. T h e tube is sup T h e internal ear is drained by the following veins,
plied with arterial blood by: (1) the pharyngeal branches (rami 1. T h e vein of the cochlear canaliculus (vena canalicvli cochleae)
pharyngei) of the ascending pharyngeal artery (arteria pkaryngea as- drains blood from the vein of the spiral lamina, the veins of the
cendms); (2) the artery of the pterygoid canal (arteria eanalis pterygoi- spiral ligament of the cochlea and those or the spinal ganglion (the
dei) from the descending palatine artery (arteria palatina descenders) anterior and posterior spiral veins are located in the scala tym
which is a branch of the maxillary artery; (3) the superficial petro- pani), and from the veins of the saccule and utricle,
sal branch (ramus petrosus) of the middle meuingeal artery (arteria T h e vein of the cochlear canaliculus stretches on it and emp
meningeti media); (4) branches of the inferior tympanic artery (arte ties into the upper bulb of the jugular vein.
ria tympanica inferior), which is a branch of the ascending pharyn 2. T h e vein of the aqueduct of the vestibule (vena aquaedudus
geal artery, to the bony part of the tube. vestibuti) drains blood from the veins of the semicircular ducts and
T h e veins of the middle car drain blood into the maxillary and the utricle; it emerges from the petrous part of the temporal bone
middle meningeal veins (venae maxillares et m-eningeae mediae), the along the aqueduct of the vestibule and empties into the superior
internal jugular vein (vena jugularis internal and the pharyngeal petrous sinus.
plexus (plexus pheryngeus). 3. T h e internal auditory veins (aenue labyrinthi) collect blood
The vessels of the internal ear. T h e internal ear is supplied by from the walls of the internal auditory meatus, the auditory nerve,
the internal auditory artery (arteria labyrinthi) and by a branch of and spiral nerves of the cochlea; they empty into the inferior pe
the stylomastoid artery (arteria stylomastoidea) originating from the trous sinus.
meatus amstici extimi) — sends a branch to the tympanic membrane formed for the most part by the tympanic nerve (nervus tympanicus),
(mnm membranae tympani), a branch of the glossopharyngeal nerve,
2. The auricular branches of the vagus nerve (rami auriculares 2. Nerves from the communicating branch with the tympanic
ntroi vagi) form the tympanic plexus; its branches form another, plexus of the Facial nerve (ramus communicant cum pUxu tympanko
subepithelial, plexus supplying the skin and the proper lamina of nervi fackdis).
the tympanic membrane.
3. The caroticotympanic nerves (nervi caroticotympanid) origi
Branches of the tympanic plexus (plexus iympankus) run to the nating from the internal carotid plexus (plexus caroticus internus).
tympanic membrane from the side of the middle ear (see Fig. 829), The nerves of the pharyngotympanic tube. The pharyngotym-
The nerves of the middle ear. The mucous membrane of the panic lube is supplied by branches from the tympanic and pharyn
middle ear is innervated by die following nerves. geal plexuses (see Fig. 829),
1. Nerves from the tympanic plexus (plexus tympanicus) which is
THE SKIN
The skin (cutis) (Figs 981-990) forms the common integument ridum) formed of 3 Or 4 rows of cells filled with a peculiar shining
of the body (integumentum commune) in which are lodged the sen substance called e lei din.
sory nerve endings, the sweat and sebaceous glands, muscles, hairs, The outermost layer of the epidermis is called the horny layer
and nails. (stratum comeum) which consists of flattened keratinized cells.
The skin performs a protective Function, takes part in ther- These cells transform into squames which are continuosly shed
moregulation and metabolism, in the processes of excretion, secre from the surface of the epidermis to be replaced by new cells pro
tion and respiration, and possesses a vast receptive area. duced in the deeper layers. Between the epidermis and the true
The skin is composed of two layers: skin lies the basement membrane.
(1) the epidermis; The true skin or dermis (corium s. dermis) is a derivative of the
(2) the true skin (corium or dermis) with subcutaneous tissue mesoderm and consists of fibrous connective tissue. Its fibres inter
(telu subcutanea). lace in various directions and form a thick network lodging vessels,
The epidermis is a derivative of the embryonic ectoderm and nerves, muscles, glands, and hair follicles.
forms the superficial layer of die skin. It measures 0.07 to 0.4 mm The dermis is formed of two layers: (1) the corpus papiliare
in thickness and is thickest on the sole. (stratum papiliare) and (2) the reticular body (stratum reticulare).
The epidermis is made up of stratified epithelium and keratinl- The corpus papiliare consists of loose connective tissue; it is
zation occurs continously in its outer layers. Its deepest layer, con named so because its surface bears papillae projecting into the epi
sisting of 5 to 15 rows of cells, is termed the germinative layer. dermis. Nerve endings, blood capillaries, and blind projections of
Some of the cells of this layer which are directly adherent with the lymph capillaries of the superficial (subepidennal) network of the
true skin and are prismatic in shape are set apart as the basal-cell skin are lodged in the papillae.
layer (stratum basalc [tylmdriaimj). As the result of cells division The skin is rich in elastic and -collagen fibres which are di
new layers of epidermis are produced to replace gradually the rected from the fascia into the subcutaneous fat and dermis. The
outermost keratinized layer. elastic fibres form networks under the papillae; fine nets and sepa
The germinative layer contains pigment the amount of which rate fibres extend from the networks to the papillae, thus causing
determines the colour of the skin. elasticity of the skin.
The prickle-cell layer (stratum spinomm) overlies the germina Figs 987 and 988 represent schematically the distribution of
tive layer and is covered by the granular layer (stratum gramilosum) elastic and collagen fibres in the skin. The network also interlaces
which is composed of several rows of cells containing keratohyalin the sebaceous glands and hair follicles. The elastic tissue of the
in the cytoplasm. skin is developed better in skin areas most exposed to pressure (the
palms, the soles, the regions of the joints}.
Superficial to the granular layer lies the clear layer (stratum fa-
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THE COMMON INTEGUMENT
354
Duct of giandula
sudorifera
Fatty lobules^ I
/
* .... , „ . ^
Glandula seoacea
\ II.
\ Follicuius pill
^U
V x
v Radix plli
lula sudorifera
Qlandula iiiHnrifpra Papilla pili Bulbus pill
Retlnacula cutis
Fatty tissue may occur in large amounts in the region of the Elevations of skin rich in fat and containing connective-tissue
mammary glands, the anterior abdominal wall, and die thighs. Its bands and nerves form on the palms and soles; they are called the
amount is greatest in the gluteal region and the soles. T h e collec tortile elevations (Fig. 984). They occur on the palmar surface of
tion of subcutaneous fat in the cheek is enclosed in a connective- the distal phalanges of the fingers, over the metacarpophalangeal
tissue capsule and is called the buccal pad of fat (corpus adifrosum joints, on the thenar and hypothenar. The skin ridges in the region
htccae) (see Fig. 266 of Vol.11), of the tortile elevations have a very complicated pattern of loops,
Some skin areas are always devoid of fat, e.g. the skin of the arches, and coils, which is strictly individual and does not change
eyelids, the auricles, the mammary areolae, the scrotum and penis. with age. T h e permanent character and individuality of the pattern
T h e surface of the skin is uneven because it bears many folds allows establishing the identity of persons by examining their
(plicae), grooves (mid), elevations, or ridges (cristae), and pores fingerprints (dactyloscopy) (Figs 983, 983a, 983b).
(pori). The skin folds are classified into permanent and inconstant. T h e skin of the eyelids, auricles, the prepuce of the clitoris, the
The epidermal grooves run in different directions and form rhom pudendal tips, etc. is related to die permanent skin folds. Folds
boid and triangular fields. also occur in the regions of the joints, e,g, the elbow joint, the
T h e permanent folds are those on the palms and soles, the inguinal fold, etc.
ridges of the skin (cristae aitisj, which are separated by grooves of The inconstant folds of skin form on muscle contraction in
the skin (said cuiis). T h e folds are formed by the corpus papillare areas of poorly developed tela subcutanca, e.g. the transverse folds
projecting as the ridges of the true skin separated from one an of skin on the forehead, the vertical fold between the eyebrows, in
other by the grooves of the true skin. In the ridges the papillae are the region of the eyelids, etc.
arranged in paired parallel rows. The ducts of sweat glands open The skin surface bears some grooves, for instance, the nasolab-
on the apices or the ridges, these openings are called the pores of ial groove (sulcus nasolabialis), the mentolabial groove (sulcus mento-
the sweat glands (pori svdoriferi) (Fig. 981), labialis), sulci of elbow joint, etc.
H^^^
ilil$i&
THE NAILS
The nails (ungais) (Gk eyrytW) (Figs H84-986) are derivatives
of the epidermis. They are horny plates, slightly convex transver
sely, situated on the dorsal surfaces of the distal phalanges of the
fingers and toes.
The nails begin developing in the third foetal month. In a full-
term fetus they protrude above the ends of the phalanges.
The nail has a body (corpus unguis), a root (radix unguis), and
four borders: a free border (margo liber) extending beyond the tip
of the phalange, a hidden border (margo occultus) in the proximal
part of the nail, and two collateral borders (margined lattrales).
The nail lies on the nail bed (matrix unguis) formed by the con
nective tissue of the dennis and the germinative layer of the epi
dermis. The nail bed bears on its surface longitudinal ridges (cristae
matrias ungttif) and is bounded proximally and on the sides by a
groove (mkus matrias ungais) which is deepest where the root of the
nail sinks into it. A nail wall (vallum unguh) overlaps the sides and
proximal end of the nail.
The germinative epithelium of the nail bed, which is responsi
ble for the nail growth, is particularly well developed in the region
of the root. A whitish crescent-shaped area can be seen here
through the nail, it is called the lunula. In the region of the root of
the nail is the eponyehium, a band of comified layer covering the
lunula of the nail. A slightly thickened epidermis under the free
border of the nail is the hyponychium.
THE HAIR
The hairs (pili) (Gk trickos) (Figs 981, 982) are the epidermis
derivatives and start developing on the third foetal month. They
cover the whole skin surface with the exception of the palms, soles,
vermilion border, labia minora, glans penis, and the deep surface
of the prepuce.
The primary hairs are fine and have a downy appearance; they
are termed down (lanugo). Eventually they are replaced by stronger
secondary, or permanent hairs. The downy hairs of the body (lan- 983b. Grooves (sulci), ridges (cristae), and pores
ago), the hairs of the head (capilli), the hairs of the eyebrows (super-
cilia), and the eyelashes {alia) are the permanent hairs. Tertiary
of shin of finger; palmar surface (%).
I — su3ci cutts 2 — cristae cutis 3 — pori aiidftrifrri
hairs appear in the period of puberty under the effect of increased
activity of the organs of internal secretion (sex glands); these are eyelids emerge perpendicularly. Sometimes, the hairs are directed
the beard (barba) and whiskers, the axillary hairs (hira), the pubic so that they form cross-like figures which are called hair eruces
hairs (pubes), the hairs of the nose (vibrus&e) and the hairs of the ear (eruces pilorum); this determines the boundaries of skin areas (for
(tragi). instance, the expanded depression in the region of the sacrum, the
The hairs usually emerge obliquely from the skin surface their Michaelis's rhomboid), the measurement of which is very import
direction coinciding, on the main, with Langer's lines (Figs 987, ant in clinical practice.
988), and form the hair streams (flumina pilorum). The hairs are ar The hair has a root (radix pili) embedded in the skin, and a
ranged in groups (2-7 hairs in each group) stretching one after an shaft (srnpus pili) raised above the skin. The root of the hair is set at
other. Since these lines are spiral in some areas of the skin, the an angle in relation to the skin surface. Its thickened part is called
hairs following their pattern form hair whorls (vortices pilorum) the bulb of the hair (bulbuspili) at the bottom of which the hair pa
where they are arranged fan-like, particularly around a centre. The pilla (papilla pili) is lodged. The hair papilla is a modified papilla
hairs of the external auditory meatus, of the nostrils, and of the of the skin and carries vessels.
Margo laieralis
Sulcus matricis unguis
Margo occultus \
Radix unguis
Margo liber
MatrU unguis Cristae matricis unguis
Vallum unguis
Sulcus matricis unguis
The hairs grow at the cost of producing cells covering the hair and an internal circular layer. The arrectores pilnrum muscles are
papilla; when nutrition of these cells is disturbed, the production inserted into the external layer, their contraction raises the shaft of
of new cells ceases. The cells of the bulb in this case become kerat- the hair.
inized, the bulb takes the shape of a fla.sk and separates from the The hair is composed of a medullary substance called the me
papilla, the hair dies and is shed, and a new hair forms from a new dulla pili, a cortical substance termed the cortex pili, and the cuti
papilla. cle, or cuticula pili. The medulla is located along the axis of the
The root of the hair is invested in a sheath which has an inter hair; it is absent from the downy hair.
nal and an external layer and is a continuation of the germinative The cortex forrns the main bulk of die hair; it consists of
layer of the epidermis. tightly packed keratin cells and contains pigment giving the hair its
The sheath of the root is enclosed in a hair follicle (folliailw colour.
pili) formed of epidermal cells and connective tissue. The connec The cuticle covers the hair on the outside and is formed of
tive tissue of the follicle forms two layers: an external longitudinal amicleated horny overlapping squames.
1
\ Phalanx media
M. flexor digltofniTi prDfuntlu1; (tetldQ)
Stratum granulosam j
TurjeroMtas. pllalatigis distalis
\ \ Epidermis
S
Stratum cOrneurtl
Vallum unguis
Corpus unguis
Matrix unguis
Sulcus matrlcls unguis
Phaltnx distaLis
Tubetositas phajangia dL&talis
'-^= B l o o d vessels
Muscles:
1— teniporalia
2—masseler
S— ptacymia
4— sternoc I <? idem astoideus
5—omohyaid ens
6—jterriohyoideus
7—levator scapulae
8—trapearns
9—stcrnothyroidens
10—deltoidcus {part originating from the cfavide)
11 —deltoideus (part originating from the aciomion)
12—pe^toralis major
13—coracobrachialis
14—triceps brachii {caput louguni)
16—biceps brachii
16—brachialis
17—pronator teres
IS—bra c h iorad i.il i a
19—tlexor carpi radial is
20—flexor digilorum superficialis
21—flexor pollicis lon^us
22—ibductOT pollicis fongus
2S—abductor pollicis brevis
24—flexor pollicis bTevis
25—opponens pollicis
26—abdtittor dijiti minimi
27—palmaris longus
28—cbliquus extern us abdominis
29—reetus abdominis
30 — tensor fasciae latae
31—pectineus
32—sartorius
33—adductor longtiS
i)4—reetus femoris
35—gracilis
36—vastus lateral is
37—adductor tnagtms
33—vastus medialig
39—peroneus lorijgug
40—tibialis anterior
41 —extensor digilorum
42—peroneus brevis longus
43—extesisor hallucis longus
44—exteiiior digitonim brevis
45 — intcrossei dor-sales
46—ejtiensor hallucis brrvis
47—abductor liallucis
48—soleus
50—gastrocnemiua (caput mediate).
Muscles;
1—infraspinatuE
2—teres miner
3 —deltoid ens (part originating from spine of scapula)
+—Jeltoidtus- {part originating Froiw fttfQ?tti&tt)
S—tarei major
6—triceps brachii (caput longum)
7 —triceps brachii (capul lateral e)
8 — brach iorad iali s
&—extensm- carpi radLalia krngus '
1Q—smconcus
11 — supinator ■
12 — extensor carpi radial is brtvi?
IS— eJEtgfilox carpi ulnarU
i4—extensor dijjjilomiTi comntunis ~ -
15 —abductor pollicis longus Ww
1-6 — extensor pollicis brcvLs
17—adductor pollicia
IS—hiterussei dcrWes
19—abductor digiti minimi
7fi—-extensor indicit
21 — ■rxtemor pollkis lonjyfus
22 —cxttdKH; digiti minimi prop rt us
23—flexor dEgitoruin pro-ftindua
24—flttor carpi ulcaris
25—triceps brachii (caput mcdiale]
26—latisE-imus dorsi
27—gluten* medius
26—glutcus- majfiimis
23 —adductor magnu*
30 —biceps femorii (caput longum)
31 —seuiitcndinosus-
32 —biceps femoria (caput breve)
33—wkttl
34 — flexor hallutts longu?
55—abductor digiti minimi
36 —flexor digrt«>niiTi bTevis
37 — flexor digitoruiik longus
38—gastrctfnenu us
S9—scm irnembraiios-Lis.
K. maxiHarts
N. mandibitJsrls
K. aurlcularls mflgmis
NTI. supraclavlculares
Rr. ;■ ii !.!■■;
antcriorcs laler&les
N, tutaneus
hracbfl lateralI
R r cjtanel l i t e r a l *
N. cujaneui
brachll medial is ~
Rr. cutancl
anterloTes mediates.
N. cuianeus
brachii posterior
l y lliohypogastrlcus A
N. iliolngulnalls
R. femorsUa
n. gSTiltoienmralJs
R. palmaris
n. roetfiani
R. sup*rfic1alis
n. radiali5 v
R. tutaneus
patmarls
n. ulnaris^
Nn, dlgitales paimares,
n. medianl^--^'
R. Superficial^ >
ri. u l r m i s X
N. cutarELS dorsalts
medians
N. tutaneus dursalls
inlermedius
Nn. dlgltales
pJantares pmprll
N. peroneus
ffJbulsrls) profundus
NTI- supraelavlculares
N. rutMTiL-iiS brachll
Lite rails
_ M. cutaneus hrach.ll
medlalls
Rr. cutanel dorsales
medlales
N. cutarieus bradill
posterior
R cntflJieuJ anfebracfill
posterior
R, SuperllclalLs
^ m s n u s n. radial is
^ R . dprgalls
(""_} man us
J 11. ulnarls
^Nn_ digits I es
^"paJmarespropfli
N- eutfltieua dorsails
pedis lateral Is
N, cutaneus plentarls
medlalls
^.■*N. ciitancus
plantarls laterally
Glandulae endocrinicae
The endocrine glands (glandular endocrinicae), in contrast to the 1. Branchiogenous glands developing From the epithelium of
exocrine glands, have no ducts. The ductless glands and paragang- the pharyngeal pouches. This group includes the thyroid gland,
lia produce hormones, which enter the blood (venous) or lymph the parathyroid glands, and the thyrnus.
capillaries. The tissue structures of these gJands are braided with a 2. Enlodermal glands represented by the endocrine part of the
thick network of blood and lymph capillaries. The ductless glands pancreas.
are as Follows (Fig.991): the thyroid gland (glandula thyroidea), the 3. Mesodermal glands developing from the coelomic epithel
parathyroid glands (glanduhc parathywideae), the thymus, the su ium. These are the cortex of the suprarenal glands and the sex
prarenal glands (glandulne suprarewles), the paraganglia, the sex glands.
glands (the testes and ovaries), the hypophysis (glanduia pituitaria), 4. Ectoderm a I glands developing from the sympathetic ele
the pineal body (corpus pineale), and the endocrine part of the pan ments. The medulla of the suprarenal glands and the paraganglia
creas. are related to this group.
Though some glands are related functionally with one another, 5. Neurogenic (ectodermal) glands associated with the devel
they differ in embryonal origin. According to the genetic signs, the opment of the diencephalon. This group includes the hypophysis
endocrine glands can be divided into five groups. and the pineal body.
E
o
o
LL
Q
Q.
CD
>
O
paired and the largest endocrine gland. It is situated in the ante back and consists of two lobes differeing in size, the right lobe \
rior part of the neck, in front of and lateral to the trachea, and oc Q
bus dexter) and the left lobe (lobus sinister), and an unpaired isthma.
cupies the thyroid region which is within the range of the medial of the thyroid gland (isthmus glandulae thyroidme) connecting the cco>
triangle (the last-named is bounded by the hyoid bone, the ster- The isthmus may be absent, in which case the lobes adhere loosi
nocleidomastoid muscles, and the suprasternal notch). The gland to each other. T3
CD
-i—»
CC
CD
o
THE ENDOCRINE GLANDS
Hemtspherium
Corpus callosum cerebrl
Cerebellum~<ige
G lorn us caroiicum^.
Larynx-
/ / %
PV-Perlcardfimi
,,-~
s
-•" 1
h Medulla
Giandula
Hepar''j[
B l x ,-■ . suprarenalis
Giandula suprarenalis J B^- Cortex J
Pancreas-"*?" B-Ren
Corpora
paraaortica' —»f-lniCStinL[ni tenue
wt-Vesica urinarla
;
4S-Glomus coecygeum
-Testls
Os hyoideum
Li g, Uiyrohyoideum medianum
A. Uryngea superior
A. thyrotdea superior'
Lobus pyramidalis
M. thyrobyoideus —•
A, thyroidea superior
Cartilago ihyroidea—
Lobus sinister
/
R. crtcothyroideus ' \
Lobu3 ■■
!:■■ xlrr Isthmus, gtandulae
thyroid eae
M. cricothyroideus
T~ Trachea
A. Ihyroidea inferior
A. thyroidea inferior-
A. ihyroidea ima
The accessory thyroid glands fctsMu tkyroideae accessorise) junction with the isthmus. It may reach the thyroid notch or the
are sometimes encountered They are similar in structure 10 the body of the hyoid bone.
thyroid gland and are either fused with it or connected to it by a The thyroid gland is invested in two (internal and external)
small thin strand. connective-tissue capsules. The internal fibrous capsule feepwla
A pyramidal lobe (lobus pyramidalis) often (in 30 to 50 per cent fihrosa gianduUe tkyroideae} is a fine fibrous lamina which is Fus
of cases) extends upwards from the isthmus or the left lobe at the with the parenchyma of the gland and sends processes into its sub-
. . . . . . . : ■ : . : ' . . .
Palatum molle
A. carotls exlerna
Vv. pharyngeae
Plexus phaiytigeus
aS^-'A. thyroidea superior
GliruLuli]
paiflthyroldea superior
N, la ry age us inferior
Glandula
parathyroidea inferior
Glandula Ihyroidea
R. Csophageus
— - — A . t h y r o l d e a inferior
Esophagus
N, laryngeas reeurrens
Trachea
M. constrictor pharyngis^,
medius
Lig. thyrohyoideum $
Raphe pharyngis.
_M. constrictor
'pharyngis inferior
Glandula parathyroidea
superior
Glandula parathyroidea
inferior
-,-,Cariilagines tracheales
Esophagus
994. Thyroid gland (glandula thyroidea) and parathyroid glands (glandulae parathyroideae).
posterior aspect (%).
stance to divide it into lobules. In the substance of the gland itself lobes to the lateral surfaces of the cricoid cartilage and the nearest
thin layers of connective tissue rich in vessels and nerves form the cartilaginous rings of the trachea.
stroma of the thyroid gland (stroma glandulae thyroideae). The folli In addition, the external capsule is connected to the connec
cles (foltiadae glandulae thyroidea) lie in its loops. tive-tissue sheath of the neuro-vascular bundle of the neck.
The fibrous capsula is covered by the external capsula of the Between the external and internal capsules is a slit-like space
thyroid gland which is a derivative of the cervical fascia. The con filled with loose fatty tissue in which the extraorganic vessels of the
nective-tissue bundles of the external capsula fasten the thyroid thyroid gland, lymph glands, and the parathyroid glands are
gland to the neighbouring organs—the cricoid cartilage, the tra lodged.
chea, and the stern ohyo id and sternothyroid muscles; the thickest The anterolateral surfaces of the thyroid gland are covered by
of these bundles form specific ligaments stretching from the gland the sternohyoid and sternothyroid muscles and by the superior
to the organs lying close to it. bellies of the omohyoid muscles.
Three bundles are developed best; these are the middle liga At the junction of the anterolateral and posteromedial sur
ment of the thyroid gland attaching the capsule in the region of faces, the thyroid gland is in relation with the neuro-vascular bun
the isthmus to the anterior surface of the cricoid cartilage, and dle (the common carotid artery, internal jugular vein, and vagus
two, right and left, lateral ligaments of the thyroid gland which nerve). The recurrent laryngeal nerve runs on the posteromedial
fasten the capsule in the region of the inferomedial parts of the surface, and the tracheal lymph glands are also found here.
T h e lower parts or the right and left lobes reach the fifth or Its arteries proper supply the parenchyma and anastomose with
sixth trachea! ring, the vessels of the neighbouring organs. The venous blood is col
The posteromedial surfaces of the gland are in relation with lected in a wide subcapsular venous plexus (plexus venasus suhcapsu-
the lateral surfaces of the upper tracheal rings, the pharynx, and laris) which is developed best in the region of the isthmus and the
the oesophagus, and superiorly—with the cricoid and thyroid car anterior surface of the trachea.
tilages.
Innervation: nerves from the cervical ganglia of the sympath
The isthmus of the gland lies at the level of the first to third (or etic trunks (nervi thyroidei), taking part in die formation of plexuses
second to fourth) tracheal cartilages. Its middle part is covered round the vessels approaching the gland, and from the cervical
only by the fused pretracheal and superficial layers of the cervical part of the vagus nerves (the superior laryngeal, external laryngeal,
fascia and the skin. and recurrent laryngeal nerves).
The weight of the gland differs with the individual and ranges Blood supply: the right and left superior thyroid arteries from
from 30 to 60 g. The longitudinal dimension of each lobe mea the external carotid arteries; the right and left inferior thyroid ar
sures up to 6 cm, the transverse dimension—4 cm, and thickness —
teries from the thyrocervical trunk; sometimes the thyroidea ima
2 cm.
artery from the innominate artery of the arch of the aorta (less fre
The gland grows in the period of puberty. Its dimensions may quently from the common carotid artery or the subclavian artery).
change depending on its blood filling. At old age connective tissue Veins: the right and left superior thyroid veins (empty into the
develops in the gland and its dimensions diminish. internal jugular veins or common facial veins); right and left infe
T h e thyroid gland produces thyroxine, triiodothyronine, thyro- rior thyroid veins (drain into the innominate veins); the inconstant
calcitonin, and calcitonin—the hormones regulating die metabolic thyroidea ima vein (empties into the left innominate vein or the in
(calcium and phosphorus) rate and intensifying processes of bone ferior thyroid vein).
formation in the organism. The lymph vessels mostly accompany the arteries and empty
The thyroid gland is rich in arterial, venous, and lymph vessels, into the tracheal, deep cervical, and mediastinal lymph glands.
Carlilago thyioidea
i * j V. brachioctphalica
thoracica interna
A. thymica
Aorta
Pulmo minister
/ .
/■ WL fi. pericardiacus
H Pericardium
995. Thyroid gland (glandula ihyroidea) and ikymus; anterior aspect (%,).
(A child of the first year of life.)
THE THYMUS
Olatidula supramnalis
A. Supraren^lis media
V. stiprarenjslip superior
Aorta
V. cava inferior
,K suprarenal is inferior
/ A. renalis
I k ,- Ren
Vv- steliarse
testic^laris
sinislin
Ureter
\ I \
A. mesenteries superior
Aa. testtenlares
dexlra
V. suprartrialis
Facies anterior
Htlus
Area
related to
" v. cava inferior
-Margo medialls-
' - ^ / ■ \
H||us
Fades
posterior
Margo
medialis
Facies renal is
Facies rcnaiis
1000. Inferior mesenteric and hypogastric plexuses ojautonomic nervous system; anterior aspe
(specimen prepared by E.Melman). (Photograph.)
(A newborn male infant; most of the vessels are removed; the ureters a * left intact, m e t h a n e blue .stain with subsequent d i c t i o n
under a binocular lens,)
THE PARAGANGLIA
The paraganglia (or free remnants of the adrenal System) are cific affinity to chromium salts. They are stained yellow or dark-
structures associated genetically with the sympathetic ganglia, brown by these salts, just like the cells of the meduIJa of the su
thence their name. prarenal glands producing adrenaline.
The cell elements, components of these structures, possess spe- In different periods of intra- and extra-uterine development of
Funlculus spermaticus
Fascia cremasterlca
M. c remaster
A. testicularis
Lex us pampiniroimla
Corpus epididymidts
~~w~ Caput epididymidls
■I--Appendix epldidymidis
Appendix testis
Cauda epididymldls
Testis
man, as well as in adulthood, the chromaffin tissue is scattered in present, are referred to as the parasympathetic paraganglia.
different parts of the body, but is always in association with the au- The largest and constantly present paraganglia are the carotid
tonomic nervous system. body {intercarotid pa raga ngiion), the supracardiac paraganglion,
Some o f the chromaffin -tis sue structure s h ave m ore d efined ch ro- and the lu mbo - aortic paraga ngiion.
maffin cells and are related to sympathetic paraganglia; others, The paraganglia resemble the medulla of the suprarenal glands
in which the chromaffin cells are less defined or inconstantly in function.
R. tubartus a. uterinae
^ ; V. Ulbarla
^i^MdL j T u b a uterins
Epoophoron
* ^A. ovarlca
r* V v . ovaricae
A. orsrics
"^Gvarisim
Vagina
1002. Uterus, right ovary and uterine tube; posterior aspect (%).
T H E CAROTID BODY
T h e carotid body (intercarotid paraganglion) (gtomus carotkum) the sympathetic trunk; from the trunk itself; from the vagus nerve
(Figs 831, 991) is a paired spindle-shaped, greyish-pink structure, (inferior ganglion); from the glossopharyngeal nerve (which sup
measuring 5 to 8 m m in length, 1.5 to 5 m m in width, and up to plies the paraganglion and the carotid sinus adjacent to it with the
1.5 mm in thickness. It lies aL the base of the bifurcation of the sinus nerve whose twigs penetrate into the substance of the carotid
common carotid artery, between the internal and external carotid body and the wall of the sinus).
arteries close to either the posterior or the medial surface of the Blood supply: branches from the common and external carotid
common carotid artery. It is bound to the wall of the iu-tery by con arteries; their twigs form a thick vascular network in the substance
nective tissue. of the paraganglion.
T h e fibres of the connective-tissue capsule of the carotid body Veins: the venous blood is collected into a venous plexus lying
penetrate into it to form layers transmitting vessels and nerves. in the connective tissue surrounding the paraganglion.
Innervation: branches from the superior cervical ganglion of
A. hypophyses I is \ ^Hypophysis
A, commumcani?
posterior - ^ N. oculomotorius
A. cerebetH superior-.J|
A. labyrinth!
A. basilarls
1003. Hypophysis cerebri, or pituitary gland (glandula pituitaria); inferior aspect (%)
(Inferior surface of brain.)
N. Opttcas
Infundlbulum
/ Vv. hypophyseaies ■
A. hypophysealis /
A. carotis interna f I
Dlaphragma sellae ^i.'-*. '
\ \ '■< / //
\ \ / [ E / A . hypophysealis
A. comtnunicans posterior \ \ f-^ *V'
/ / M
/ S
•
N. ophtrialmlcus i
•^ Sinus
inter cavemosus
Aa, chornlrieae
posteriores'
A. basilaris^
N. abducens
Hypophysis
1004. Hypophysis cerebti (glandula pituitaria); superior aspect, viewed slightly from the right
(The dlaphragma sellae on the right and the roof of the cavernous sinus are removed.)
Column a fornici*
Nucleus csudatus
V. thalaninstriala
V. chorioidea
Ventrlculus III
Plexus chorloideus
ventrieult laferalls ^
Corpus pineale
V. cerebri magna
G lorn us chorioldeum
Cerebellum
Comu postsrius
1005. Pineal body (epiphysis cerebri s. corpus pineale); superior aspect (Yi).
{The corpus callosum and foriiix are removed; t h e tela chorioidea of t h e third ventricle is cut a n d drawn aside.)
T H E E N D O C R I N E GLANDS
1
It is now believed that this structure is an arteriovenous anas
tomosis but not a glomus.
V. gastroepiploica dextra
V. llertalis
A, pancteatlcoduodenalis superior i
A. Henalls /
V, pancreaticoduodenalis T rune us cdiacus
/ '
Caput pancreatis
Rr. inte&tlnales
(\
, I \ V
:
-}*■■■■■ I
^
Gaud a pancreails
j ^ * 4 ^ Corpus pantreatis
A. mesenterica superior
-—V. mesenteries superior
fc#-—A intestinal is
^_Fiexura duodenojejunalls
— Aorta
Processus uncinatus
A. pancTeaticoduodenalls interior
T H E HYPOPHYSIS CEREBRI
The hypophysis cerebri, or pituitary gland (hypophysis s. glan the floor of the third ventricle. The hypophysis is related on the
dule pituitaria) is sometimes called the lower appendage of the sides to the cavernous sinuses.
brain (Figs 743, 951 t 1003, 1004). This is an unpaired elongated- The dimensions of the hypophysis vary with the individual; the
spherical structure slightly compressed anteroposteriorly. anteroposterior dimension ranges from 5 to 11 mm, the superoin-
The hypophysis is invested in a dense connective-tissue coating ferior—from 6 to 7 mm, and the width—from 12 to 14 mm; its
and lodged in the sella turcica. It is covered by the dura mater weight varies from 0.3 to 0.7 g.
stretched between the anterior and posterior clinoid processes of The hypophysis is composed of an anterior part (anterior lobe,
the sphenoid bone and the dorsum seliae. This is the diaphragma adenohypophysis) and a posterior lobe (the neurohypophysis).
seliae which roofs the hypophyses I fossa (fossa hypopkyseos). The The two lobes differ in development, structure, and function.
diaphragma seliae has a small aperture transmitting the infundibu- The anterior part (anterior lobe, adenohypophysis) (pars distalis
him which connects the hypophysis with the tuber cinereum on [lobus anterior]) is the glandular part of the hypophysis. It is larger
than the posterior lobe and brownish-red on section due to the these cells is brought to the neurohypophysis along their nerve
great number of blood vessels. In the adenohypophysis are distin fibres forming the supra-opticohypophyseal and paraventriculohy-
guished an anterior main part lying in the hypophyseal Fossa of die pophyseal tracts. It is stored in the neurophypophysis and secreted
aella turcica, a distinctly visible narrow area at the junction with from it into the blood. The hormones of the posterior lobe of the
the neurohypophysis, which is the middle part (pars intermedia), hypophysis intensify contraction of the smooth muscles of the ves
and, finally, a small part lying outside the hypophyseal fossa sels and uterus, regulate secretion of the mammary glands (prolac-
(above the diaphragms sellae) and termed the infundibular part tin); vasopressin (VP) has an effect on reabsorption of water in the
(pan infundibularis). renal tubules.
Epithelial cells of various size, shape, and structure are lodged Innervation. Nerve fibres from the internal carotid plexus
in the anterior lobe. (from the superior cervical ganglion of the sympathetic trunk) run
The posterior lobe (neurohypophysis) (lobus posterior) is some on the walls of the vessels stretching to the distal part of the hypo
times called the nervous part of the hypophysis or neurohypophy- physis; fibres from the hypothalamic nuclei and nuclei lying above
sis. It is greyish-yellow on section due to the presence of a yellow the optic chiasma pass to the posterior lobe along the infundibu-
ish-brown pigment; a posterior main part and a median eminence lum.
are distinguished in it. Blood supply. T h e hypophysis is supplied with blood by the
The posterior lobe is composed of a large amount of neuroglial superior and inferior hypophyseal arteries which anastomose with
tissue and a small number of ependymal cells. each other. The superior arteries arise from the internal carotid ar
The pigment mentioned above lies between the glial fibres and tery (at its emergence from the cavernous sinus) and from the pos
increases in amount with age. terior communicating arteries. The inferior hypophyseal arteries
The anterior lobe of the hypophysis produces a group of tropic also arise from the internal carotid artery, but from the part pass
hormones. One of the most important among them is the somato- ing in the cavernous sinus. Without ramifying in the distal part of
tropif hormone (STH) which regulates growth and development of the hypophysis, these vessels pass into the neurohypophysis in
the organism and has an effect on the activity of the pancreatic is which they branch out to form capillaries.
lets. Other hormones stimulate, mainly, the function of the other Veins. T h e venous genua of capillaries in the neurohypophysis
endocrine glands. The adenocorticotrapic hormone (ACTH), for fuse to form venules which are continuous with die portal veins of
instance, stimulates the activity of the cortex of the suprarenal the hypophysis. These extend to the distal part (adenohypophysis)
gland, the thyrotropic hormone (TTH)—that of the thyroid gland, in which they give off small branches emptying into a network of
the gonadotropic hormone (GTH)—die function of the sex sinusoid capillaries. Thus, the portal veins of the hypophysis and
glands, etc. not the arteries are the afferent vessels of the main anterior part of
It has been established that the hormones of the posterior lobe the adenohypophysis. The venous blood flows from it into the cav
of die hypophysis (vasopressin and oxytocin) are actually the pro ernous and intercavernous sinuses of the dura mater of die brain.
ducts of neurosecretion of die nerve cells of the supra-optic and The specific features of the anatomy of the intra-organic hypophy
paraventricular nuclei (nwUvs supm-opticus et nucleus parctaetiiricula- seal vessels are of functional importance.
ris) of the hypothalamus and diencephalon. The neurosecretion of
386 T H E E N D O C R I N E GLANDS
rough and consistency moderately firm. of the skin. The pineal body plays the rale of a peculiar 'biological >
Q.
CO
O
The pineal body is connected with the thalamus by habenulae clock1 regulating the diurnal and seasonal activity of the organism,
which arise from the sides of the base of the gland and are contin Innervation. Sympathetic fibres from the superior cervical
uous with the striae habenularis of the thalamus (striae meduliares ganglia of the sympathetic trunks and fibres connected with the CD
ihahmi). At the end of the habeuula is a triangular expansion habenular nuclei run to the pineal body along the walls of the ves
called the trigonum habenulae in which the habenular nucleus sels. Q
fnucUtts habenulae) is lodged. The right and left habenulae are con a.
Blood supply. Arterial branches stretch from the posterior ar > CO
1007. Development of thyroid gland and derivatives ofpkaryngeal (branchial) pouches (repr
schematically) (from several sources).
1-V—branchial pouches
1 —glandular lolje ofhypophysis cerebri 5 — thyroid gland 9 —trachea
2—pharynjral cavity 6—inferior parathyroid gland 10—amygdaloid sinus, the branchial pouch is opened
'i —hypophysis cerebri (anterior lob^} 7 —thymus on the right.
4—superior parathyroid gland 8—oesophagus
fatty and connective tissue increases, while the amount of the cor gland. The posterior lobe develops later than the anterior lobe
tex and medulla becomes much less. from the infundibular process (Fig. 723) of the diencephalon and
The cortex of the suprarenal develops from the mesoderm, the joins the anterior lobe. The hypophysis of the newborn is usually
medulla appears later and is a derivative of the ectoderm. In a triangular in shape. It measures 4 mm in height, 7.5 mm in length,
child of the first year of life the cortex prevails over the medulla; in 8,5 mm in width, and weighs 0.125 g; the posterior lobe is much
an adult both are equally developed. At old age, hi contrast, the smaller than the anterior lobe in children under 10 years of age.
amount of die cortex is about half diat of the medulla. Bodi glands The pineal body develops from the diencephalon in the region
weigh about 7 g in the newborn; the weight increases by the age of of the epithalamus as a small pouch into which vessels grow later,
fi-S months of life and continues growing to the age of 30 years. and a systepi of tubules surrounded by mesenchymal elements or
The paraganglia (the chromaffin organs) develop in a ganizes in it. The differentiation of the pineal body is completed
16-f7-tnm embryo as two types of cells —sympathe to blasts and by the age of 7 years. In the newborn the pineal body measures
chromaffinoblasts; the Srst form the sympadietic ganglia, the sec 3 mm in length, 2,5 mm in width and 2 mm in thickness; it weighs
ond contribute to the formation of the chromaffin organs —the 0.7 g at birth, by the age of 6 years its weight is equal to that of the
paraganglia. The paraganglia are developed best by the age of 12 gland in an adult. The pineal body reaches maximum develop
to 18 months, and almost all of them undergo regression by 10 to ment by the age of 14 years.
13 years of age. The pancreas is layed down in the form of two outgrowths of
The sex glands—the testes and ovaries—are layed down in the entodermal epithelium of the duodena! wall. The dorsal out
itially as indifferent germs of the sex glands, in the mesodermal ep growth unites with the duodenum and may determine the forma
ithelium of the embryonic body cavity on the inner surface of the tion of the accessory duct; the odier, ventral, outgrowth fuses with
pronephros. Later they begin differentiating into the male or fe the dorsal one to form a single organ (at the end of the second foe
male glands. The testes develop slowly till the pubertal period. tal month) which communicates with the duodenum via the main
They measure 10-10.5 mm in length in the newborn, 15 mm in a duct. The epithelium forms strands in the substance of the out
5-year-old child, and 20 mm in a 15-year-old child; the anteropos- growths which transform into tubules, while the epithelium lining
terior dimension of the testis in the newborn measures about them gives origin to the glandular tissue.
5 mm. The testis weighs 0.3 g in the newborn, 1 g at the age of The endocrine part of the pancreas, the islets or Langerhans,
12 months, 8 g at the age of 16 years, and 20 g by the age of 20. develop from the entoderm; their formation continues after birth
The ovary of a newborn girl is slightly elongated and cylindri also. The islets measure from 0.1 to 0.3 mm in size.
cal. It is usually situated at a high level, even at the level of the The pancreas of the newborn resembles a trihedral prism in
promontory and begins descending in the first four years of life. shape and its head is smaller but die body and tail longer than in
The surface of the ovary is smooth in young girls but becomes irre the gland of an adult. These proportions persist to the age of 5 or
gular later. T h e ovary weighs 5-6 g in the newborn, 6-8 g in an 6 years, after which the pancreas acquires the adult shape. In the
adult woman; its weight reduces to 2 g by old age. newborn the pancreas measures 4 to 5 cm in length on the average
T h e anterior lobe of the hypophysis eerebri develops from the and weighs from 2.5 to 3 g. The weight doubles by the age of
epithelial diverticulum of the dorsal wall of the oral pit as a pouch 4 years. The connective tissue surrounding the pancreas of the
facing the inferior surface of the brain, in the region of the floor of newborn is poorly developed as a result of which the gland is very
die third ventricle wThere it joins the future posterior lobe of the mobile.
of vestibule, 339
arachnoid mater, 103,114
of brain, 115
Body, carotid, 379
blood supply, 379 c
spinal, 114 innervation, 379
ciliary, 304, 306 Calcar avis, 45
arbor vitac, of cerebellum, 85
coccygeal, 383 canal(s), central, 299
archeocerebellum, 82
fatty, of Orbit, 320 hyaloid, 311
archicortex, 92
pineal, 54, 64, 386 semicircular, 339
area, amygdaloid anterior, 67
blood supply, 386 lateral, 340
cochlear, 346
development, 18, 388 posterior, 340
facial nerve, 140, 346
nuclei, 52 spino-olivary, 99
sulcus, ampullary, 346
ventral, 52 spinoreticular, 99
anterior media.ll, 23
thymus, 373 spinotectal, 99
anterolateral, 74
blood supply, 373 spinothalamic, anterior, 99
of antihelix, transverse, 325
development, 387 lateral, 99
of auricle, posterior, 76
innervation, 373 tectospinal, 68,102
of fourth ventricle, median, 76
limitans, 299 lobes, 373 temporopontiiie, 101
olfactory, 124 veins, 373 of trigeminal nerve, raesencephalic,
posterior, intermediate, 23 thyroid gland, 366 130
lateral, 23 accessory, 366 spinal, 130
median, 23 blood supply, 371 vestibulospinal, 102
spiral, internal, 344 capsules, 368 tractus, solitarius, 74
suprarenal glands, 377 development, 387 spiralis foraminosus, 340, 346
blood supply, 377 innervation, 371 triangle, hypoglossal, 76
cortex, 377 isthmus, 387 vagal, 76
development, 387 ligament(s), lateral, 370 trigone, collateral, 45
hilum, 377 middle, 370 trigonum, habenulae, 54, 62, 386
innervation, 377 lymph vessels, 371 trunk sympathetic, 248,263
left, 377 stroma, 370 cervical, 248, 250
medulla, 377 tissue, subcutaneous, 354 lumbar, 248,263
right, 377 fatty, 354 branches, 263
surfaces, 377 tract(s), afferent, 87, 88 pelvic, 276
veins, 377 ascending, 87, 88,99 sacral ganglia, 248, 276
sweat, 356 association, 87 thoracic 248, 258
bulboreliculospinal, 103 tube, auditory, 300
pore, 356
cerebellodentate, 101 medullary, 16, 299
synapse, 10
cerebellonuclear, 101 neural, 16, 299
syndesmosis, tympanostapedial, 335
cercbellorubral, 101 pharyngotympansc, 330
cerebellothalamic, 101 canal, 332
cerebrospinal, 73, 74, 102 cartilaginous, 332
conducting, 87 isthmus, 332
corticonuclear, 73 lamina, lateral, 332
Taenia, choroidea, 43
corticorubral, 102 medial, 332
of fornix, 47, 49
denlatorubral, 101 membranous, 332
of fourth ventricle, 76
descending, 87, 101 mucous glands, 332
of thalamus, 62
dorsolateral, 89 nerves, 350
tanycytes, 64
efferent, 87, 88 opening(s), 332
taste buds, 351
extrapyramidal, 87 vessels, 34-9
tapetum, 45
Erontopontine, 101 tuber cinerenm, 40
tarsus of eyelid, 317
maraillotegmental, 51 tubercle, of auricle, 324
tcetuin of mid-brain, 18, 67
mamillothalamic, 51 cuneate, 75, 76, 99
tegmen tympani, 330
nucleocerebellar, 101 gracile, 75, 76,99
tela chorioidea, of fourth ventricle,
occipitopontine, 101 grey, 76
75
olfactory, 33, 124 olfactory, 36
subcutanea, 354 olivocerebellar, 101
of third ventricle, 50, 60 supratragal, 325
olivocerebral, 74 of thalamus, anterior, 52, 60
telencephalon, 17 olivospinal, 102
teuton um cerebelli, 108 tuberculum, trigeminale, 75
optic, 57,68, 126
testes, 383 pontocerebellar, 101
blood supply, 383
development, 383
pon toreticulosp ina), 103 u
pyramidal, 74, 87 Umbo of tympanic membrane, 328, 332
innervation, 383 rubrospinal, 68, 102
uncus, 33
veins, 383 spinoccrebeilar, anterior, 99
utricle, 342, 344, 345
thalamus, 43, 2-9 posterior, 99
uvula of vermis, 81, 82
dorsal, 52