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Chapter 12

Superior
Right <

f Left
Thalamus

Inferior
o p t i c nerve ( C N II)-

Optic chiasm

Oculomotor nerve ( C N III)

Optic tract

Trochlear ner\'e ( C N I V )

Interpeduncular fossa

Trigeminal nerve ( C N V)
Cerebral peduncle

Abducens nerve ( C N V I )

Midbrain

Facial nerve ( C N VII)

M i d d l e cerebellar peduncle

Vestibulocochlear nerve ( C N VIII)

Pons

Glossopharyngeal nerve ( C N IX)

Cerebellopontine angle
Inferior olive

Medulla

Vagus nerve ( C N X)
Pyramid

Hypoglossal nerve ( C N XII)

Pvramidal decussation

Spinal accessory nerve ( C N XI)

Spinal cord
CAUDAL
ROSTRAL
Superior
Left i

> Right
- Thalamus

i'ineal body

Inferior

Superior colliculus

Brachium of superior
colliculus

Inferior colliculus
Anterior medullary v e l u m
Superior cerebellar peduncle
M i d d l e cerebellar peduncle
Inferior cerebellar peduncle
Obex
Dorsal (posterior)
c o l u m n tubercles:
Nucleus cuneatus
Nucleus gracilis
Dorsal (posterior) columns:
Fasciculus gracilis
Fasciculus cuneatus

Lateral geniculate nucleus

,
Medial geniculate nucleus

y Midbrain
j

Brachium of inferior
colliculus
Trochlear nerve ( C N IV)

Pons

Facial colliculus
Hypoglossal trigone
Glossopharyngeal
nerve ( C N IX)

Medulla

Vagus ( C N X)
Vagal trigone

Spinal accessory nerve ( C N XI)

Spinal cord

Brainstem !: Surface Anatomy and Cranial Nerves

Lateral geniculate
body

497

Superior

.Brachium of
Anterior ^
superior colliculus
Medial geniculate
body

^ Posteri

>- Thalamus

Inferior

Superior colliculus
Brachium of inferior colliculus

Optic nerve ( C N II)

> Midbrain

Inferior colliculus

Cerebral peduncle
Oculomotor nerve ( C N III)

Superior cerebellar peduncle

M i d d l e cerebellar peduncle

Trochlear nerve ( C N IV)

Inferior cerebellar peduncle

Trigeminal nerve ( C N V)

Facial nerve ( C N VII)

>Fons

Vestibulocochlear nerve ( C N V l l l )
Abducens nerve ( C N VI)
Glossopharyngeal nerve ( C N IX)Pyramid
Olive-

Dorsal (posterior) columns:

Fasciculus gracilis
Fasciculus cuneatus

^ Medulla

Vagus nerve ( C N X ) '

Hypoglossal nerve ( C N X I I ) '

Spinal accessory nerve ( C N XI)

Spinal cord

FIGURE 12.2 Surface Anatomy of the

Brainstem and Cranial Nerves
turn (meaning "roof") of the midbrain. The ventral surface of the midbrain is
formed by the cerebral peduncles, between which Ues the interpeduncular fossa
(see Figure 12.2A; see also Figure 5.6). The pons is Umited dorsally by the fourth
ventricle (see Figure 12.1). More dorsolaterally the pons is attached to the cerebellum by large white matter tracts called the superior, middle, and inferior cerebellar peduncles (see Figure 12.2B). O n the ventral surface of the medulla, the
pyramids can be seen descending from the pontomeduUary junction to the
pyramidal decussation (see Figure 12.2A). It is often useful to divide the medulla
into a rostral portion and a caudal portion. I n the rostral medulla the prominent bulges of the inferior olivary nuclei can be seen just lateral to the pyramids
(see Figure 12.2A). I n the caudal medulla the iriferior olivary nuclei are no longer
seen, but the posterior columns and posterior column nuclei are visible on the
dorsal surface (see Figure 12.2B).
The floor of the fourth ventricle extends from the pons to the rostral half of
the medulla. A l o n g the floor of the fourth ventricle, several bumps are visible. These include the fadal colliculi, formed by the abducens nuclei and fibers
of the facial nerve (see Figure 12.2B; see also Figure 14.1C). The hypoglossal
trigone and vagal trigone (see Figure 12.2B) are formed by the hypoglossal n u cleus (CN XII) and the dorsal motor nucleus of C N X, respectively. Recall that
rostrally, the fourth ventricle joins the cerebral aqueduct, w h i c h runs through
the midbrain (see Figure 12.1). Caudally, the fourth ventricle drains into the
subarachnoid space via the foramina of Luschka (located laterally) and foramen of Magendie (located i n the midline). The fourth ventricle ends caudally
at the obex (see Figure 12.2B), marking the entry to the spinal cord central canal,
which i n adults is normally closed.

(A) Ventral view w i t h cerebral hemispheres removed. (B) Dorsal v i e w w i t h

cerebellum removed, exposing floor of
the fourth ventricle. (C) Lateral view.