BRAINSTEM

Location of brainstem:
Brain:
Brain is composed of;

Cerebrum
Cerebellum
Brainstem

Cerebrum: is the largest part of the brain and is composed of right and left hemispheres.
Cerebellum: is located under the cerebrum.
Brainstem: acts as a relay center connecting the cerebrum and cerebellum to the spinal cord.
Fig. The cerebrum is divided into left and right hemispheres. The two sides are connected by
the nerve fibers corpus callosum.

Lobes of brain:
The cerebral hemispheres have distinct fissures, which divide the brain into lobes. Each
hemisphere has 4 lobes:

 Frontal
 Temporal
 Parietal
 Occipital
Each lobe may be divided, once again, into areas that serve very specific functions. It’s
important to understand that each lobe of the brain does not function alone. There are very
complex relationships between the lobes of the brain and between the right and left
hemispheres.

Broca’s area: lies in the left frontal lobe

Wernicke's area: lies in the left temporal lobe. Damage to this area causes Wernicke's aphasia.
Separation of lobes:
Frontal lobe and parietal lobe is separated by central sulcus(Rolandic sulcus)
Temporal lobe is separated from rest of lobes by Sylvian fissure(Lateral sulcus).
Occipital lobe is separated from rest of lobes by Parieto-occipital sulcus.

The cerebral hemispheres are paired structures separated from each other by the longitudinal
fissure along the midline. A mid-sagittal cut through the longitudinal fissure is used to produce
two hemisected brains.

Cranial fossa:
The cranial fossa is the skull cavity that contains the brain and most vital structures, including
the eyes, nose, mouth, ears, and sinuses.
The base of the skull (occiput) is formed by the occipital bone at the back of the head, which
encloses the foramen magnum, a large opening in the center of the skull through which the
spinal cord passes. The parietal bones form the sides of the skull; these bones meet across the
top of the head to form the frontal bone.
 Parietal bone:
The parietal bone (Latin: os parietale) is located on each side of the skull right behind the
frontal bone. Both parietal bones together form most of the calvaria(the top part of the skull of
vertebrates: Nontechnical name: skullcap).
parietal bone, cranial bone forming part of the side and top of the head. In front each parietal
bone adjoins the frontal bone; in back, the occipital bone; and below, the temporal and
sphenoid bones.
Skull base has 3 cranial fossa;
1. Anterior cranial fossa
2. Middle cranial fossa
3. Posterior cranial fossa
Separation of cranial fossa;
Anterior and middle cranial fossa are separated by lesser wing of sphenoid bone
Middle cranial fossa is bounded anteriorly by lesser wing of sphenoid and posteriorly by
petrous pyramid of temporal lobe.

Anterior cranial fossa:

The anterior cranial fossa is bounded by the frontal bone, the ethmoid bone, and the sphenoid
bone.
The anterior cranial fossa (Latin: fossa cranii anterior) lies at the highest level of the internal
cranial base and is formed by the cribriform plate of the ethmoid bone, orbital plate of the
frontal bone, and lesser wings of the sphenoid.
The anterior cranial fossa contains the following parts of the brain:
Frontal lobe of the cerebral cortex

 Olfactory bulb
 Olfactory tract
 Orbital gyri

Middle cranial fossa:

The middle cranial fossa (Latin: fossa cranii media) is a region of the internal cranial
base between its other two parts - the anterior and posterior cranial fossae. It lies deeper and is
wider than the anterior cranial fossa. The middle cranial fossa is created by the sphenoid,
temporal and parietal bones.

The middle cranial fossa accommodates the following anatomical structures:

 Pituitary gland
 Temporal lobes of the cerebral hemispheres

Posterior cranial fossa:

The posterior cranial fossa (Latin: fossa cranii posterior) lies at the lowest level of the internal
cranial base and is the largest of the three cranial fossae. Its is formed by the sphenoid,
temporal and occipital bones.
The posterior cranial fossa, the largest and deepest of the three cranial fossae, lodges the
cerebellum, pons, and medulla oblongata.

Fig. The floor of the cranial cavity is divisible into three levels (steps): anterior, middle, and
posterior cranial fossae.
Fig. Adult cranium VII. Internal cranial base.The internal aspect demonstrates the contributing bones
and features.

The posterior cranial fossa accommodates two parts of the brain:

 Cerebellum
 Brainstem
 Brainstem is the axial part of brain.
 Formed from bottom to the top by
 Medulla oblongata/bulb
 Pons varolii/pons
 Mesencephalon(midbrain)
 Continues in the caudal area forming the spinal cord, at the level of foramen.
 Continue in upward into diencephalon and the telencephalon.
 Explanation of important terms and parts:
 Diencephalon
The caudal (posterior) part of the forebrain, containing the epithalamus, thalamus,
hypothalamus, and ventral thalamus and the third ventricle.

 Telencephalon(cerebrum)
It becomes two cerebral hemispheres. Surface of these hemispheres consists of gyri and sulci
Hemisphere partially separated by a deep longitudinal fissure.
Gyri, sulci, cisterns and ventricles overview (CSF spaces):
The brain is surrounded by cerebrospinal fluid (CSF) within the sulci, fissures and
basal cisterns. CSF is also found centrally within the ventricles. The sulci, fissures,
basal cisterns and ventricles together form the 'CSF spaces', also known as the
'extra-axial spaces'.
CSF is of lower density than the grey or white matter of the brain, and therefore
appears darker on CT images.
Sulci and gyri:
The brain surface is formed by folds of the cerebral cortex known as gyri.
Between these gyri there are furrows, known as sulci, which contain CSF.

CT image
Fissures:
The fissures are large CSF-filled clefts which separate structures of the brain.
Ventricles(darker in CT scan):
The ventricles are spaces located deep inside the brain which contain CSF.

Lateral ventricles:
 The paired lateral ventricles are located on either side of the brain.
 The lateral ventricles contain the choroid plexus which produces CSF.
Note: The choroid plexus is almost always calcified in adults.

Third ventricle:
 The third ventricle is located centrally.
 The lateral ventricles communicate with the third ventricle via small holes (foramina of
Monro).
Fourth ventricle:
 The fourth ventricle is located in the posterior fossa between the brain stem and
cerebellum
 It communicates with the third ventricle above via a very narrow canal, the aqueduct of
Sylvius (not shown)

Fig. Anatomy of the brain ventricular system

Basal cisterns:
CSF in the basal cisterns surrounds the brain stem structures.
  The cistern that separates the frontal lobe from the temporal lobe is sylvian
cistern
 The cistern which lies above the sella turcica is suprasellar cistern, forms a
pentagonal star shape.
 Perimesencephalic cistern:
A group of interconnected basal cisterns surrounding the midbrain (mesencephalon), important
location of subarachnoid hemorrhage, may see effacement (reduction or loss) with tonsillar
herniation.

 The cistern which lies posterior to midbrain is quadrigeminal plate cistern. Classically
forms a W shape, obliteration associated with upward herniation.
 The cistern which lies in between the pedunlces of midbrain is interpeduncular cistern.
 Ambient and crural is the connections between quadrigeminal and interpeduncular
cisterns.
 The cistern which lies above the pons is called peripontine cistern.
 Cerebellopontine: Located between anterior cerebellum and lateral pons, synonymous
with area of cerebellopontine angle.
 Prepontine: Located at the anterior aspect of the pons.

 Cisterna magna is located between the cerebellum and medulla, receives fourth
ventricular CSF outflow.
 Continue brainstem:
 In the brainstem,we find the emergence of the cranial nerves,from third to
twelfth,and the relevant nucleus,except for spinal part of spinal accessory
nerve(ninth cranial nerve,CN9).
 With the exception of the olfactory nerve (I) and optic nerve (II), the cranial
nerves emerge from the brainstem. The oculomotor nerve (III) and trochlear
nerve (IV) emerge from the midbrain, the trigeminal (V), abducens (VI), facial
(VII) and vestibulocochlear (VIII) from the pons, and the glossopharyngeal (IX),
vagus (X), accessory (XI) and hypoglossal (XII) emerge from the medulla.
 The olfactory nerve (I) emerges from the olfactory bulb, and depending slightly
on division the optic nerve (II) is considered to emerge from the lateral
geniculate nuclei.
Fig. Anatomy of the brainstem, with cranial nerves emergences (cn)
Fig. MRI of the cisternal tracts of normal cranial nerves. Steady-state free procession (SSFP),
axial planes. a Olfactory (circles); b optic (arrows); c oculomotor (arrows); d trochlear (arrows);
e trigeminal (arrows); f abducens (circles); g facial (thin and dotted arrows) and
vestibulocochlear (thick arrows); h glossopharyngeal and vagus nerve (circles); i spinal
accessory (circles); j hypoglossal (arrows).

 MIDBRAIN(mesencephalon):
Location:
The mesencephalon(midbrain) is the portion of brainstem that connects the pons
and the cereblellum to the diencephalon and the telencephalic hemispheres.

 Medulla oblongata:
Location:
The medulla oblongata is located between the spinal cord (below), and the pons(above) and it
is delimited by the bulbopontine sulcus

Bulbopontine sulcus:
It is a bounding groove between the medulla oblongata and inferior margin of the pons.
Cranial nerve VI emerges at surface here.
It is connected to cerebellum through inferior cerebellar pendulces.
The upper rear part of the medulla oblongata forms the lower portion of the fourth ventricle.
Four pairs of cranial nerves emerge on the ventral surface of the medulla oblongata:

 Glossopharyngeal nerve (CN IX)

 Vagus nerve (CN X)
 Accessory nerve (CN XI)
 Hypoglossal nerve (CN XII)

MRI images of brain

 Axial
 Coronal
 Sagittal
 3D
Brainstem:
 Midbrain
 Pons
 Medulla

Copy this link and search it:

https://radiopaedia.org/cases/61691/studies/69700?lang=us