NEUROSURGERY

Day 1: BRAIN and SPINE ANATOMY • PARASYMPATHETIC

Gilbert Paul B. Distura, MD o PARASYMPATHETIC NS (Relax) – Conserves energy
as it slows down the Heart rate, increases
OBJECTIVE intestinal gland activity and relaxes sphincter
• To understand the basic organization of the main structures that muscles in the GI tract
form the nervous system
NERVOUS SYSTEM CELLS
• To gain a three-dimensional appreciation of the structures that
form the nervous • NEURONS
system parts of the o Functional unit of NS
brain and their o Conduction of information
relative positions to o Action Potential
one another. o Process and release of Electrochemical substance
• NEUROGLIAL CELLS
o Supporting cells
o Nutrition
o Regulate the internal environment of the brain
Brain • GRAY MATTER
• The brain lies in the cranial cavity and is continuous with the spinal o Collection of cell bodies within the CNS
cord through the foramen magnum. It is surrounded by three • WHITE MATTER
meninges the dura mater, the arachnoid mater, and the pia mater; o Collection of axons within the
these are continuous with the corresponding meninges of the o Myelin (fatty substance) – surrounds the nerve fibers (axons)
spinal cord. The cerebrospinal fluid surrounds the brain in the
subarachnoid space. GRAY MATTER
• CORTEX
DURA MATER ARACHNOID MATER PIA MATER o Collection of cell bodies in the CNS on the superficial areas of the
• Thick membrane • Composed of • Thin membrane cerebral hemispheres and cerebellum
• Dense irregular collagen and elastic • Firmly adheres to • NUCLEUS
connective tissue fibers the brain o Cluster of neurons in the CNS, located deep within the cerebral
• Subarachnoid space hemispheres and brainstem
• Outermost part • Impermeable to
that contains CSF fluid
WHITE MATTER
• Helps protect the
brain and spinal cord • TRACTS
from sudden impact o Collection off fibers from PNS to CNS and vise versa
o Ascending tracts – Upward information
o Descending tracts – Downward Information
NERVOUS SYSTEM
• COMMISURAL FIBERS
• CENTRAL NERVOUS SYSTEM – BRAIN and SPINAL CORD
o Group of white matter bundles that connects the right part to the
• PERIPHERAL NERVOUS SYSTEM– SENSORY and MOTOR PNS
left part of the brain
• ASSOCIATION FIBERS
o Group of white matter bundles that connects the anterior part to
the posterior part of the brain

BRAIN
• FOREBRAIN (PROSENCEPHALON) – Cognitive activities, sensory and
associative functions and voluntary motor activities
o OUTER (TELENCEPHALON) – Cerebral Hemispheres
o INNER (DIENCEPHALON) – Thalamus, Hypothalamus

o SENSORY PNS
▪ SPECIAL SENSATION – Specific Part of the Body
• Vision
• Olfaction
• Taste (Special sense and General Sense)
• Hearing
• Position (Equilibrium)
▪ GENERAL SENSATION – General Part of the Body
• SOMATIC SENSATION – Superficial sensation
o Touch, Temperature, Proprioception
• VISCERAL SENSATION – Internal organs of the body
o Dull pain, Distention of Viscera
o MOTOR PNS
▪ SOMATIC MOTOR RESPONSE (Voluntary)
▪ AUTONOMIC MOTOR RESPONSE
• SYMPATHETIC
o SYMPATHETIC NS (Fright and Flight) – Involuntary
response to danger and Stressful situations

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• MIDBRAIN (MESENCEPHALON) – Movements of the eye, auditory and
visual processing
o Tectum and Tegmentum
• HINDBRAIN (RHOMBENCEPHALON) – Respiratory rhythm, sleep, and
wakefulness
o Cerebellum, pons, medulla oblongata

CEREBRUM
• Largest part of the Brain
• Consists of 2 hemispheres connected by Corpus Callusum
• The hemispheres are separated by a deep cleft, the longitudinal
fissure, into which projects the falx cerebri
• Cortex
• Gyri
• Sulci
• Lobes (frontal, temporal, parietal, occipital)

BRAINSTEM
• MIDBRAIN
o Connects the forebrain and hindbrain
o Cerebral aqueduct – narrow portion of midbrain and connects the
3rd and 4th ventricles
o Contains many nuclei and bundles of ascend- ing and descending
nerve fibers.
• PONS
o horseshoe-shaped collection of nerve fibres located in the
anterior part of the posterior cranial fossa.
o Several cranial nerves originate from the ventral surface of
the pons: CN V, VI, VII, VIII
o Made of different tracts: Descending tracts (corticospinal
and corticobulbar); Ascending tracts (Medial Lemniscus
tracts and Spinothalamic)
• MEDULLA OBLONGATA
o Conical in shape and connects the pons and spinal cord
o It contains many collections of neurons, called nuclei, and
serves as a conduit for ascending and descending nerve
fibers.

CEREBELLUM
• Lies within the posterior cranial fossa
• 2 hemispheres connected by a median portion Vermis.
• The cerebellum is connected to the midbrain by the superior cerebellar
peduncles, to the pons by the middle cerebellar peduncles, and to the
medulla by the inferior cerebellar peduncles

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Day 2: BASIC ANATOMY of the SPINE The vertebral arch gives rise to
seven processes: one spinous, two
Miguel Nicolai T. Victorino MD transverse, and four articular.
The spinous process, or spine, is
VERTEBRAL directed posteriorly from the
COLUMN junction of the two laminae.
The transverse processes are
• central bony
directed. laterally from the junction
pillar of the of the laminae and the pedicles.
body Both the spinous and transverse
• supports the processes serve as levers and
skull, receive attachments of muscles
pectoral and ligaments.
girdle, upper
limbs, and
thoracic cage
• transmits
body weight
to the lower
limbs
• its cavity lies
Notes: The articular
the spinal
processes are
cord, spinal vertically arranged
nerve roots, and consist of two
and the superior and two
covering Inferior processes.
meninges, to They arise from the
which the junction of the
laminae and the
vertebral
pedicles. The two
column gives great superior articular
protection processes of one
• 33 vertebrae vertebral arch
o 7 cervical articulate with the
o 12 thoracic two inferior
o 5 lumbar articular processes
of the arch above,
o 00005 sacral (fused
forming two
to form the sacrum) synovial joints.
o 4 coccygeal (the
lower 3 are
commonly fused).

Notes: The pedicles are

Notes: Although notched on their upper
vertebrae show and lower borders,
regional forming the superior
differences, and Inferior vertebral
they all possess notches.
a common On each side, the
pattern {Fig. 4- superior notch of one
28). vertebra and the
A typical inferior notch of an
vertebra adjacent vertebra
consists of a together forms an
rounded body intervertebral
anteriorly and a foramen.
vertebral arch These foramina, in an
posteriorly. articulated skeleton, serve to transmit the spinal nerves and blood vessels. The anterior
These enclose a and posterior nerve roots of a spinal nerve unite within these foramina with their
space called the coverings of dura to form the segmental spinal nerves.
vertebral Below the axis, the vertebrae articulate with each other by means of cartilaginous Joints
foramen through which run the spinal cord and Its coverings. between their bodies and by synovial joints between their articular processes.
The vertebral arch consists of a pair of cylindrical pedicles, which form the sides of the Sandwiched between the vertebral bodies is an intervertebral disc of fibrocartilage
arch, and a pair of flattened. laminae, which complete the arch posteriorly.

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INTERVERTEBRAL DISC • further protection is provided by the cerebrospinal fluid {CSF), which
• Thickest in surrounds the spinal cord in the subarachnoid space
the cervical
and lumbar
regions,
where the
movements
of the
vertebral
column are
greatest
• Serves as
shock
absorbers
when the
load on the
vertebral column is suddenly increased
• Resilience is gradually lost with advancing age

Notes: Each disc consists of a peripheral part, the annulus fibrosus, and a central part, the
nucleus pulposus (Fig. 4-3B,C).
Annulus fibrosus ls composed of fibrocartilage, which is strongly attached to the vertebral
bodies and the anterior and posterior longitudinal ligaments of the vertebral column.
Notes: -In the cervical region, where it gives origin to the brachial plexus, and in the lower
The nucleus pulposis in the young is an ovoid mass of gelatinous material. It is normally
thoracic and lumbar regions,
under pressure and situated slightly nearer to the posterior than to the anterior margin
where it gives origin to the lumbosacral plexus, the spinal cord is fusiformly enlarged;
of the disc.
-the enlargements are referred to as the cervical and lumbar enlargements
The upper and lower surfaces of the bodies of adjacent vertebrae that abut onto the disc
-Inferiorly, the spinal cord tapers off into the conus medullaris, from the apex of which a
are covered with thin plates of hyallne cartilage.
prolongation of the pia mater,
filum terminale, descends to attach to the posterior surface of the coccyx
LIGAMENTS -The cord possesses a deep longitudinal fissure called the anterior median fissure
• Anterior anteriorly and a shallow furrow called the posterior median sulcus on the posterior
ligament is surface
attached to the -Along the entire length of the spinal cord, 31 pairs of spinal nerves are attached by the
front and sides anterior or motor roots and the posterior or sensory roots
-Each root is attached to the cord by a series of rootlets, which extend the whole length
of the vertebral of the corresponding segment of the cord
bodies and to - Each posterior nerve root possesses a posterior root ganglion, the cells of which give rise
the to peripheral and central nerve fibers.
intervertebral
discs
• Posterior
ligament is
attached to the
posterior border
of the discs
• Supraspinous
ligament runs in
between two adjacent spines
• Interspinous ligament
• Intertransverse ligament

Notes: -The anterior and posterior longitudinal ligament run as continuous bands down
the anterior and posterior surfaces of the vertebral column from the skull to the sacrum
-The anterior ligament is wide and is strongly attached to the front and sides of the Notes: -The spinal cord is composed of an inner core of gray matter, which is
vertebral bodies and to the intervertebral discs.
surrounded by an outer covering of white matter
-The posterior ligament ls weak and narrow and Is attached to the posterior borders of
the discs. -there is no indication that the cord is segmented
-the supraspinous ligament runs between the tips of adjacent spines.
-Interspinous ligament connects adjacent spine.
-The lntertransverse ligaments run between adjacent transverse processes.
-The ligamentum connects the laminae of adjacent vertebrae.
-In the cervical region, the supraspinous and interspinous ligaments are greatly thickened
to form the strong nuchal ligament

SPINAL CORD
• roughly cylindrical in shape.
• begins superiorly at the foramen magnum in the skull, where it is
continuous with the medulla oblongata of the brain
• terminates inferiorly in the adult at the level of the lower border of the
third lumbar vertebra
• surrounded by the three meninges, the dura mater, the arachnoid
mater, and the pia mater

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