THE BRAINSTEM

J. Leonard Pascual MD FPNA

Associate Professor,
Department of Anatomy, College of Medicine, UP Manila
Department of Neurosciences, Philippine General Hospital
OBJECTIVES

FORM: identify the different structures in the brainstem

External anatomy
Subdivisions (diencephalon, midbrain, pons, medulla)
Fissures and sulci
Cranial nerves
Peduncles
Relationships to surrounding structures and cisterns
Cross-sectional anatomy
Subdivisions (tectum, tegmentum)
Grey matter (cranial nerve nuclei, other nuclei)
White matter (fiber tracts)
FUNCTION: know the significance of each structure of the
brainstem in the normal human being
Neuroanatomy at a Glance
Neuroanatomy at a Glance
Neuroanatomy at a Glance

The diencephalon is actually the most rostral end of the

brainstem
Subdivisions of the Brainstem

Diencephalon
Midbrain
Pons
Medulla
Hypothalamus
Infundibulum
Mammillary body
Internal capsule
Internal capsule

Basal ganglia
Internal capsule

Basal ganglia

Optic nerve
Internal capsule

Basal ganglia

Optic nerve

Optic chiasm
Internal capsule

Basal ganglia

Optic nerve

Optic chiasm

Optic tract
Mammillary body
Hypothalamus
Third ventricle
Putamen
Putamen
Nucleus accumbens
Anterior limb,
internal capsule
Putamen
Nucleus accumbens
 Posterior limb,
internal capsule

Anterior limb,
internal capsule
Putamen
Nucleus accumbens
Hypothalamus
Thalamus
Pineal body
Habenula
Third ventricle
Internal capsule
Internal capsule
Caudate nucleus
 Internal capsule

Putamen Caudate nucleus

Third ventricle
Thalamus
Subthalamus
Infundibulum
Hypothalamus
Anterior commissure Posterior
commissure
Third ventricle
Mammillary body
Thalamus
Thalamus
Hypothalamus
Third ventricle
Interthalamic adhesion
Thalamus

The thalami are paired symmetrical bulb-shaped masses

obliquely and lateral to the 3rd ventricle
Thalamus

The thalami are paired symmetrical bulb-shaped masses

located obliquely and lateral to the 3rd ventricle
Thalamus

Lies medial to the posterior limb of the internal capsule

Thalamus

Between 70-80% of humans will have an interthalamic

adhesion (massa intermedia) connecting both thalami
Neuroanatomy at a Glance
Neuroanatomy at a Glance
Neuroanatomy at a Glance
Subdivisions of the Brainstem

Diencephalon
Midbrain
Pons
Medulla
Subdivisions of the Brainstem

Diencephalon
Midbrain
Pons
Medulla
Subdivisions of the Brainstem

Diencephalon
Midbrain
Pons
Medulla
Subdivisions of the Brainstem (lateral view)
Subdivisions of the Brainstem (dorsal view)
Subdivisions of the Brainstem (ventral view)
Midbrain (cerebral peduncles)
Pons (basis pontis)
Medulla oblongata
Interpeduncular
fossa
Cerebellopontine
angle
Pontomedullary sulcus
Anterior median sulcus
Anterolateral sulcus
Pyramid
Olive
Pontomedullary
sulcus
Anterior median
sulcus
Anteriorolateral
sulcus
Posterolateral
sulcus
Pyramid
Pyramid
CP angle
Medulla
Pons
Midbrain
Thalamus
 Posterior
commissure
Cerebral peduncle
Superior cerebellar
peduncle
Superior colliculus
Inferior colliculus
Middle cerebellar
peduncle
Middle cerebellar
peduncle
Pons

Latin for “bridge” (ventral pons appears like a bridge

between cerebellar hemispheres)
Cerebellar peduncles
Superior cerebellar peduncle (brachium conjunctivum)
Middle cerebellar peduncle (brachium pontis)
Floor of the 4th
ventricle
*
Obex
Open medulla

*
Obex

Closed medulla
Open medulla

*
Obex

Closed medulla
Inferior cerebellar
peduncle

*
The Cranial Nerves
Olfactory nerve
Optic nerve,
chiasm, and
tract
Interpeduncular fossa
Midbrain

The oculomotor nerve exits from the ventral surface of

the midbrain into the space between the two cerebral
peduncles (interpeduncular fossa)
Oculomotor nerve
Oculomotor nerve

Uncus
Midbrain

The trochlear nerve exits dorsally at the junction

between the caudal midbrain and pons
Trochlear nerve
Neuroanatomy at a Glance

Trochlear nerve
Trochlear nerve

Parahippocampal
gyrus
Pons

The trigeminal nerve enters the brainstem at mid-pons

Tri – Gemini (3 twins): ophthalmic, maxillary, and
mandibular nerves
Trigeminal nerve
Trigeminal nerve Middle cerebellar
peduncle
Pons

3 other cranial nerves enter / leave along groove

between pons and medulla (pontomedullary sulcus)
Pons

The abducens nerve is the smallest and most medial

of the 3 cranial nerves that enter / leave at the
pontomedullary junction
Pons

The facial nerve is further lateral

Consists of a larger medial root and a smaller sensory
root (nervus intermedius)
Pons

The vestibulocochlear nerve is slightly lateral to the

facial nerve
Consists of a vestibular division and a more lateral
cochlear division
Abducens nerve
Abducens nerve

Pontomedullary sulcus
Facial nerve
Vestibulocochlear nerve
Vagus nerve
Vagus nerve

Olive
Hypoglossal nerve
Hypoglossal nerve

Pyramid
Abducens nerve
Facial nerve
 Vestibulo-
cochlear nerve
Posterolateral sulcus
Glossopharyngeal nerve

Vagus nerve
Anterolateral sulcus
Hypoglossal nerve

Spinal accessory
nerve
Spinal accessory
nerve
The Brain “Stem”: Nuclei
Organizational Set-Up of the Nervous System

ROSTRAL CAUDAL
Organizational Set-Up of the Nervous System

DORSAL

VENTRAL
Organizational Set-Up of the Nervous System

DORSAL

VENTRAL

Neurons specialized for receiving information (SENSORY)

from the environment and their axons are located dorsally
Organizational Set-Up of the Nervous System

DORSAL

VENTRAL

Neurons specialized for receiving information (SENSORY)

from the environment and their axons are located dorsally

Neurons that control movements (MOTOR) are located

ventrally
Organizational Set-Up of the Nervous System
Organizational Set-Up of the Nervous System
Organizational Set-Up of the Nervous System

Curling of the neural

tube results in rotation of
structures in the
telencephalon
Ventral structures come
to lie anteriorly (MOTOR)
Dorsal structures come
to lie posteriorly
(SENSORY)
anterior dorsal

ventral dorsal anterior posterior

posterior ventral
Organizational Set-Up of the Nervous System

The dorsal:sensory /
ventral:motor orientation
remains the same within
the brainstem and spinal
cord

anterior dorsal

ventral dorsal anterior posterior

posterior ventral
Embryology and the Architecture of the Brainstem

4th Ventricle

Somatic afferent column

Sensory inputs
Located dorsally and
laterally
Embryology and the Architecture of the Brainstem

4th Ventricle

Somatic afferent column

Sensory inputs
Located dorsally and
laterally

Somatic efferent column

Motor output for
muscles
Located ventrally and
medially
Embryology and the Architecture of the Brainstem

4th Ventricle

SENSORY

Sulcus limitans

MOTOR
Embryology and the Architecture of the Brainstem

Somatic afferent column

Somatic afferents
4th Ventricle Visceral afferents

Somatic efferent column

Somatic efferent
Visceral efferent

Unlike the spinal cord which innervates only skeletal

muscles (somites), the brainstem also innervates
muscles in the face derived from the branchial arches
Embryology and the Architecture of the Brainstem

Somatic afferent column

Somatic afferents
GSA
SSA
4th Ventricle
Visceral afferents
GVA
SVA
Somatic efferent column
Somatic efferent
GSE
Visceral efferent
GVE
SVE
Additional components in cranial nerves are innervations
for special functions
Embryology and the Architecture of the Brainstem

Somatic afferent column

Somatic afferents
GSA
SSA
Visceral afferents
GVA

Vision
Somatic efferent column
Somatic efferent
GSE
Visceral efferent
Hearing and
balance GVE

SSA: afferents to the special senses

Embryology and the Architecture of the Brainstem

Somatic afferent column

Somatic afferents
GSA
SSA
Visceral afferents
GVA
Olfaction Taste SVA
Somatic efferent column
Somatic efferent
GSE
Visceral efferent
GVE
Choking
SVA's are sensory nerves that develop in association
with the gastrointestinal system
Embryology and the Architecture of the Brainstem

Somatic afferent column

Somatic afferents
GSA
SSA
Visceral afferents
Smiling and facial GVA
movements SVA
Chewing Somatic efferent column
Somatic efferent
GSE
Visceral efferent
GVE
Swallowing and digesting SVE
SVE's innervate muscles derived from the branchial
arches (branchiomotor nerves)
Embryology and the Architecture of the Brainstem

4th Ventricle

Somatic afferent column

SSA
GSA
GVA
SVA
Embryology and the Architecture of the Brainstem

4th Ventricle

Somatic afferent column

Somatic efferent column

GVE
SVE
GSE
 Somatic afferent column
Somatic afferents
GSA
SSA
Visceral afferents
GVA
SVA
Somatic efferent column
Somatic efferent
GSE
Visceral efferent
GVE
SVE
Columnar arrangement of
cranial nerve nuclei
 Cranial nerve fibers will
proceed to / arise from cranial
nerve nuclei
Cranial Nerve Nuclei in the Midbrain

III

Oculomotor nerve nuclei complex

Cranial Nerve Nuclei in the Midbrain

EW
III

Oculomotor nerve nuclei complex

Edinger-Westphal nucleus
Cranial Nerve Nuclei in the Midbrain

EW
III

IV

Oculomotor nerve nuclei complex

Edinger-Westphal nucleus
Trochlear nerve nucleus
Cranial Nerve Nuclei in the Midbrain

EW
III
V

IV

Oculomotor nerve nuclei complex

Edinger-Westphal nucleus
Trochlear nerve nucleus
Mesencephalic nucleus of CN V
Cranial Nerve Nuclei in the Midbrain

EW
III
V

IV

Oculomotor nerve nuclei complex

Edinger-Westphal nucleus
Trochlear nerve nucleus MB
5
Mesencephalic nucleus of CN V 34
Cranial Nerve Nuclei in the Pons

Motor nucleus of CN V
Cranial Nerve Nuclei in the Pons

VI

Motor nucleus of CN V
Abducens nucleus
Cranial Nerve Nuclei in the Pons

VI

VII

Motor nucleus of CN V
Abducens nucleus
Facial nucleus
Cranial Nerve Nuclei in the Pons

VI

VII

Motor nucleus of CN V
Abducens nucleus
Facial nucleus
Superior salivatory nucleus (CN X)
Cranial Nerve Nuclei in the Pons

V
V

VI

VII

Main sensory nucleus of CN V

Cranial Nerve Nuclei in the Pons

V
V

VI

VII V

Main sensory nucleus of CN V

Spinal nucleus of CN V
Cranial Nerve Nuclei in the Pons

V
V

VI
VII
VII V

Main sensory nucleus of CN V

Spinal nucleus of CN V
Vestibular nucleus (CN VIII)
Cranial Nerve Nuclei in the Pons

V
V

VI
VIII
VII V
VIII
X

Main sensory nucleus of CN V

Spinal nucleus of CN V
Vestibular nucleus (CN VIII)
Cochlear nucleus (CN VIII)
Cranial Nerve Nuclei in the Pons

V
Motor nuclei
V

VI
VIII
VII V
VIII
X
Cranial Nerve Nuclei in the Pons

Sensory nuclei
V
Motor nuclei
V

VI
VIII
VII V
VIII
X
Cranial Nerve Nuclei in the Rostral Medulla

XII

Hypoglossal nucleus
Cranial Nerve Nuclei in the Rostral Medulla

IX

XII X

Hypoglossal nucleus
Ambiguous nucleus (CN's IX and X)
Cranial Nerve Nuclei in the Rostral Medulla
IX
IX

XII X

Hypoglossal nucleus
Ambiguous nucleus (CN's IX and X)
Inferior salivatory nucleus (CN IX)
Cranial Nerve Nuclei in the Rostral Medulla
IX
IX

X
XII X

Hypoglossal nucleus
Ambiguous nucleus (CN's IX and X)
Inferior salivatory nucleus (CN IX)
Dorsal motor nucleus of CN X
Cranial Nerve Nuclei in the Rostral Medulla
IX
IX
X
X
XII X

Solitary nucleus (CN X)

Cranial Nerve Nuclei in the Rostral Medulla
IX
IX
X V
X
XII X

Solitary nucleus (CN X)

Continuation of Spinal nucleus of CN V
Cranial Nerve Nuclei in the Rostral Medulla
IX
IX VIII
X V
X
XII X

Solitary nucleus (CN X)

Continuation of Spinal nucleus of CN V
Continuation of Vestibular nucleus
Cranial Nerve Nuclei in the Caudal Medulla

XI

Accessory nucleus
Cranial Nerve Nuclei in the Caudal Medulla

V
XI

Accessory nucleus
Spinal nucleus of CN V (continuation)
The Brain “Stem”: Long Tracts
Organizational Set-Up of the Nervous System

DESCENDING

ASCENDING
Organizational Set-Up of the Nervous System

DECUSSATION
Organizational Set-Up of the Nervous System

LAMINATION
The Brainstem and its contents

Grey matter on the inside

White matter on the outside
The Brainstem and its contents

Grey matter on the inside

Cranial nerve nuclei
Reticular formation
Pontine nuclei
White matter on the outside
The Brainstem and its contents

Grey matter on the inside

Cranial nerve nuclei
Reticular formation
Pontine nuclei
White matter on the outside
Ascending
Descending
Mixed ascending and descending
The Brainstem and its contents

Grey matter on the inside

Cranial nerve nuclei
Reticular formation
Pontine nuclei
White matter on the outside
Ascending
Reticular activating system
Spinothalamic tract
Spinocerebellar tract
Medial lemniscal – dorsal column pathway
Auditory pathway
Gustatory pathway
Descending
Mixed ascending and descending
ASCENDING RETICULAR ACTIVATING SYSTEM
ASCENDING RETICULAR ACTIVATING SYSTEM

Portion of the reticular formation concerned with arousal

Ensures that thalamocortical impulses are fired to “awaken”
the cerebral hemispheres
Damage leads to coma
Affected by psychotropic drugs and anesthetics
Overactivity (imbalance of norepinephrine) has been linked
to ADHD (attention deficit hyperactivity disorder)
The Brainstem and its contents

Grey matter on the inside

Cranial nerve nuclei
Reticular formation
Pontine nuclei
White matter on the outside
Ascending
Descending
Corticospinal tract
Corticobulbar tract
Mixed ascending and descending
The Brainstem and its contents

Grey matter on the inside

Cranial nerve nuclei
Reticular formation
Pontine nuclei
White matter on the outside
Ascending
Descending
Mixed ascending and descending
Medial longitudinal fasciculus
Corticospinal tract
Spinothalamic tract
Medial longitudinal fasciculus
Cross-sectional
Anatomy of the
Brainstem
Organizational Set-Up of the Nervous System

EXTRA-AXIAL

INTRA-AXIAL
Organizational Set-Up of the Nervous System

EXTRAMEDULLARY

MEDULLARY
Architecture of the Brainstem

General morphology of the

brainstem:
Tectum: roof of ventricular cavity
Tegmentum: floor of ventricular
cavity:
Dorsolateral: sensory fibers /
nuclei
Ventromedial: motor cranial nuclei
In between: reticular formation
Base: mainly motor fibers
Neuroanatomy at a Glance
Neuroanatomy at a Glance

Cerebral aqueduct
Neuroanatomy at a Glance

Cerebral peduncle
Midbrain

Large cerebral peduncles

on its anterior surface
Neuroanatomy at a Glance

Substantia nigra
Neuroanatomy at a Glance
Neuroanatomy at a Glance
Neuroanatomy at a Glance

Thalamus
Neuroanatomy at a Glance

3rd ventricle
Thalamus
Neuroanatomy at a Glance

Red nucleus
Neuroanatomy at a Glance

Pinkish color is attributed to

iron content

Red nucleus
Neuroanatomy at a Glance

Pinkish color is attributed to

iron content
Mainly responsible for
Red nucleus movement in animals without
corticospinal tracts (controls
large muscle groups)
Neuroanatomy at a Glance

Red nucleus

Crawling of babies and arm

swing is controlled by this
nucleus
Midbrain (Internal Structure)

Rostral midbrain: contains the superior colliculi

Extends from the intercollicular groove to the posterior
commissure
Rostral Midbrain

Superior colliculus: paired bumps in the midbrain tectum

Its neurons respond to visual, auditory, and somatosensory
stimuli
Together with the inferior colliculus = corpora quadrigemina
Rostral Midbrain

Superior colliculus: involved in saccades (fast eye

movements)
Helps orient the head and the eyes towards something seen or
heard
Rostral Midbrain

Substantia nigra: pale on myelin-stained brain tissue, dark

on unstained brain tissue
produces dopamine
Receives and sends fibers to the putamen (striatum) and
caudate nucleus
Rostral Midbrain

Ventral tegmental area

of the midbrain

Ventral tegmental area: lies

close to the substantia nigra
and red nucleus
Provides dopaminergic
innervation to the frontal
cortex and limbic system
Activities that elicit pleasure
activates this area (including
psychostimulants like cocaine)
Reward / addiction
Fear / avoidance behavior
Rostral Midbrain

Oculomotor nucleus: in the floor of the cerebral aqueduct

Actually a complex of 2 groups of smaller subnuclei that
innervate individual muscles
Rostral Midbrain

Oculomotor nuclei complex: the subnucleus for the levator

palpebrae superioris (upper eyelid) is shared by both
oculomotor nuclei
Rostral Midbrain

SR

Oculomotor nuclei complex: the nucleus for the superior

rectus (SR) muscle travels in the contralateral oculomotor
nerve (similar to CN IV) to innervate the contralateral
muscle.
Rostral Midbrain

MR IO

IR

Oculomotor nuclei complex: the nucleus for the medial

rectus (MR), inferior oblique (IO), and inferior rectus (IR)
muscles travel in the ipsilateral CN III to the eyeball
Rostral Midbrain

Edinger-Westphal nucleus:
Lies in close proximity to CN
III nucleus
Sends GVE's to the ipsilateral
ciliary ganglion
Ciliary ganglion innervates
the sphincter pupillae (iris)
and ciliary muscle
Midbrain (Internal Structure)

Caudal midbrain: contains the inferior colliculi

Extends from where the trochlear nerve emerges to the
intercollicular groove
Caudal midbrain

Cerebral aqueduct

Periaqueductal gray

The 4th ventricle has narrowed into the cerebral aqueduct

The periaqueductal gray matter encircles the aqueduct
Caudal midbrain

Periaqueductal gray:
Role in defensive behavior in
animals (freezing, jumping,
rapid heart beat, high blood
pressure)
Role in female copulatory
behavior (lordosis behavior)
via pathway from the
hypothalamus
Excited by endorphins and by
opiate analgesics
Caudal midbrain

Inferior colliculus

The inferior colliculus: principal nucleus of the auditory

pathway in the midbrain
Relays auditory input from the contralateral ear to the
thalamus (medial geniculate body)
Caudal midbrain

MLF

The MLF continues its course in the midline below the

floor of the cerebral aqueduct
Caudal midbrain

Trochlear nucleus
Caudal midbrain

Superior medullary velum

Trochlear nucleus: fibers decussate in the superior

medullary velum of the tectum and exit dorsally.
Caudal midbrain

Trochlear nucleus: innervates the contralateral superior

oblique muscle of the eyeball
Neuroanatomy at a Glance
Pons (Internal Structure)

Rostral pons: from the point of attachment of the

trigeminal nerve to the beginning of the cerebral
aqueduct / at the point of emergence of the trochlear
nerve
Rostral Pons

The median longitudinal fasciculus (MLF) lies near the

midline beneath the 4th ventricle
Rostral Pons

The superior cerebellar peduncle appears in the lateral

walls of the 4th ventricle
Major outflow from the cerebellum (efferent) to the
thalamus
Rostral Pons

Locus ceruleus: contains norepinephrine, innervates

virtually the entire CNS, from spinal cord to cerebral
cortex
Increased firing rate of neurons during arousal, decreases
with drowsiness, and abolished during sleep
Receives afferents from hypothalamus, cingulate cortex,
and amygdala
Activated during stress, neurons seen to be depleted in
posttraumatic stress disorder patients
Pons (Internal Structure)

Caudal pons: bottom half of the pons from the point of

attachment of CN V to the lateral wall of the 4th ventricle
Caudal Pons

Caudal pons: bottom half of the pons from the point of

attachment of CN V to the lateral wall of the 4th ventricle
Caudal Pons

The pyramidal tract is broken up by pontine nuclei and

their decussating fibers, which form the middle cerebellar
peduncle
Cranial Nerve Nuclei in the Pons

VI

VII

Motor nucleus of CN V
Abducens nucleus
Facial nucleus
Superior salivatory nucleus (CN X)
Cranial Nerve Nuclei in the Pons

V
V

VI
VIII
VII V
VIII
X

Main sensory nucleus of CN V

Spinal nucleus of CN V
Vestibular nucleus (CN VIII)
Cochlear nucleus (CN VIII)
Caudal Pons

CN VI

CN VII

The facial colliculus is formed by fascicles from the facial

nucleus which loop around the abducens nucleus which
lies on the floor of the 4th ventricle
Caudal Pons

CN VI

CN VII

The facial colliculus is formed by fascicles from the facial

nucleus which loop around the abducens nucleus
which lies on the floor of the 4th ventricle
Caudal Pons

The abducens innervates the

lateral rectus muscle of the
eyeball (GSE)
Due to the long distance it
travels en route to the
eyeball, it is most frequently
compressed / stretched by
space-occupying lesions in
the cranial cavity
Usually stretched /
compressed against the
clivus
Caudal Pons

The abducens lies in close

proximity to the parapontine
reticular formation (PPRF)
which is the horizontal gaze
center in the pons
Caudal Pons

The MLF is nearby (yokes /

synchronizes the movements of
the eyeballs)
Connects the abducens to the
contralateral oculomotor
nucleus in the midbrain
Neuroanatomy at a Glance
Neuroanatomy at a Glance
Neuroanatomy at a Glance
Neuroanatomy at a Glance
Medulla (Internal Structure)

Rostral medulla: from the obex to the lateral recess

where the inferior cerebellar peduncle enters the
cerebellum
Rostral Medulla

The rostral medulla no longer looks like the spinal cord

due to the presence of the 4th ventricle dorsally
Rostral Medulla

The inferior olivary nucleus is a prominent feature of the

rostral medulla, forms the swelling called the olive.
Fibers from each nucleus arch across the midline to enter
the contralateral inferior cerebellar peduncle
Cranial Nerve Nuclei in the Rostral Medulla
IX
IX

X
XII X

Hypoglossal nucleus
Ambiguous nucleus (CN's IX and X)
Inferior salivatory nucleus (CN IX)
Dorsal motor nucleus of CN X
Cranial Nerve Nuclei in the Rostral Medulla
IX
IX VIII
X V
X
XII X

Solitary nucleus (CN X)

Continuation of Spinal nucleus of CN V
Continuation of Vestibular nucleus
Rostral Medulla

Fascicles of the hypoglossal nerve exit between the

pyramid and the inferior olivary nucleus
Rostral Medulla

Fascicles of the hypoglossal nerve exit between the

pyramid and the inferior olivary nucleus
Innervates the muscles of the tongue (general visceral
efferent)
Rostral Medulla

A pair of medial longitudinal fasciculi (MLF) lie beneath

the floor of the 4th ventricle posterior to the medial
lemniscus, can be traced all the way to the midbrain
involved in yoking eye movements as well as vestibular
functions
Rostral Medulla

The dorsal motor nucleus of the vagus lies in the floor

of the 4th ventricle, dorsolateral to the hypoglossal nucleus
Main parasympathetic nucleus
Sends GVE to the thoracic and abdominal viscera
Rostral Medulla

The solitary tract and nucleus of the vagus lies in the

floor of the 4th ventricle, lateral to the dorsal nucleus of X
Taste impulses from the CN VII, IX, X, and XI (gustatory /
rostral half of the solitary nucleus)
Rostral Medulla

The solitary tract and nucleus of the vagus:

The caudal half of the solitary nucleus receives cranial
afferent inputs related to cardiovascular, respiratory, and
gastrointestinal receptors
Rostral Medulla

The solitary tract and nucleus of the vagus:

Mediates the cough reflex, baroceptor reflex, gag reflex,
baroceptor and chemoreceptor reflexes, among others
Rostral Medulla

The solitary tract and nucleus of the vagus:

Projects efferent output to the hypothalamus, cingulate
gyrus, and other brainstem nuclei (heart beat, breathing)
Rostral Medulla

Nucleus ambiguus

The ambiguous nucleus:

Cannot be distinguished in myelin stained brain tissue
Located dorsal to the inferior olivary nucleus, within the
ventrolateral tegmentum, embedded within the reticular
formation
Rostral Medulla

The ambiguous nucleus:

Gives rise to SVE's that travel within the glossopharyngeal
nerve to innervate the stylopharyngeus muscle, and within
the vagus nerve to innervate the rest of the pharyngeal
muscles (swallowing)
Rostral Medulla

The vestibular and cochlear nuclei are found

dorsolaterally
The Pontomedullary Junction

The vestibular and cochlear nuclei occupy the

ventricular floor at the pontomedullary junction
Neuroanatomy at a Glance
Medulla (Ventral aspect)

Pyramids contain the descending fibers of the

corticospinal tract
Crossing over of the fibers to the other side (decussation)
Medulla (Dorsal aspect)

The dorsal columns of

the spinal cord continue
into the medulla
The cuneate
fasciculus ends in a
swelling called the
cuneate tubercle
(overlying the nucleus
cuneatus)
Medulla (Dorsal aspect)

The dorsal columns of

the spinal cord continue
into the medulla
The fasciculus gracilis
near the midline ends
in a similar small
bump called the
gracile tubercle (or
clava) overlying the
nucleus gracilis.
Medulla (Internal Structure)

Caudal medulla: from pyramidal decussation to the obex

Similar appearance to the spinal cord
Caudal Medulla

The pyramids of the corticospinal tract lie most

anteriorly
Fibers will decussate and travel to the contralateral
anterior horn of the spinal cord
External Relationships of the Brainstem
External Anatomical Relationships of the Brainstem

The ventral brainstem is bathed in cerebrospinal fluid

within the subarachnoid space
Contains blood vessels and cranial nerves
External Anatomical Relationships of the Brainstem

Interpeduncular cistern = the space between (and

around) the two cerebral peduncles in the midbrain
External Anatomical Relationships of the Brainstem

Interpeduncular cistern = the space between (and

around) the two cerebral peduncles in the midbrain
External Anatomical Relationships of the Brainstem

The basilar artery runs across the midline of the pons

within the pontine cistern
External Anatomical Relationships of the Brainstem

Medullary cistern
External Anatomical Relationships of the Brainstem

The cerebral peduncles of the midbrain must pass

through the incisura of the tentorium cerebelli
External Anatomical Relationships of the Brainstem

Clivus is a sloping shallow depression of the sphenoid

bone of the base of the skull which supports the pons
External Anatomical Relationships of the Brainstem

The sphenoid sinus is one of the paranasal sinuses

that lies beneath the sella turcica (where the pituitary
gland sits) and anterior to the clivus
External Anatomical Relationships of the Brainstem

CN V
CN VII

CN VIII

Pontocerebellar cistern over the cerebellopontine angle

The facial and vestibulocochlear nerves as well as the
trigeminal nerve lie close to the cerebellum
External Anatomical Relationships of the Brainstem

Foramen magnum is the largest opening of the skull

through which the medulla passes to become the spinal
cord
Pons (Dorsal Aspect)

Cerebellar peduncles
The superior cerebellar peduncles form the roof of diamond-
shaped cavity of the 4th ventricle