七科联考-系统解学-解剖-脑干课件

1、人体解剖学Human Anatomy吉林大学解剖学教研室石岫昆2006年9月供五、七年制用（据王云祥 吕衡发主编人体解剖学第八版吉林科学技术出版社出版）人体解剖学吉林大学解剖学教研室供五、七年制用 Section 2 脑 Brain Brain contains almost 98% of bodys neural tissue, average weight about l,400 grams and is composed of an estimated 100 billion neurons. Although it accounts for only 2% of a persons b

2、ody weight, brain receives approximately 20% of total resting cardiac output (about 750 2100 ml of blood per minute ). Section 2 脑 Brain Brai Brain needs a continuous supply of oxygen and nutrients. So a failure of cerebral circulation for as short an interval as 10 seconds causes unconsciousness. B

3、rain needs a continuous s Brain is divided into four principal parts: 脑干 Brain stem consists of medulla oblongata, pons and midbrain. Its lower end is continuous with spinal cord. 小脑 Cerebellum lies behind pons and medulla oblongata. 间脑 Diencephalon consists primarily of hypothalamusand thalamus; an

4、d over it spreads. 端脑Telencephalon. Brain is divided into four pPart 1. 脑干 Brain Stem 基本要求 掌握脑干的组成及各部的主要结构；脑神经核的名称、位置、纤维联系、性质和功能；脑干内非脑神经核的名称，位置与性质；脑干内长的上、下行纤维束名称、起始、终止、性质、各纤维束交叉的部位。 熟悉第四脑室的位置、境界，脉络组织、脉络丛的概念。 了解网状结构，脑干各代表平面的结构与损伤后的表现。Part 1. 脑干 Brain Stem 基本要求质 Brain stem is stalk like part of brain,

5、 which connects cerebrum, cerebellum with spinal cord. Optic tract serves as rostral boundary of brain stem, which separates it from diencephalon. Plane corresponding to level of foramen magnum serves to separate it from spinal cord. Brain stem is stalk like p On ventral aspect, two distinct transve

6、rse grooves just above superior border and below inferior border of pons demarcatethree parts of brain stem, from below upwards, medulla oblongata, pons and midbrain. On ventral aspect, two dis I.脑干的外形 External features I)延髓 Medulla oblongata is most caudal part of brainstem. Its ventral surface res

7、ts upon basilar portion of occipital bone, while its dorsal surface is in large part covered by cerebellum. Fissure and sulci presented in spinal cord extend upwards in medulla oblongata and a series of rootlets of cranial nerves enter or leave through these fissure or sulci. I.脑干的外形 External featur

8、es st 1.腹侧面 Ventral surface 锥体 Pyramid on each side of anterior median fissure isan oblongated elevation, contain corticospinal (pyramidal) tract. 锥体交叉 Decussation of pyramid formed by crossing fibers of corticospinal tract. 前外侧沟 Anterolateral sulcus rootlets of hypoglossal n. ( XII ) emerge from it

9、. 1.腹侧面 Ventral surface an obl 橄榄 Olive posterolateral to pyramid is an oval elevation, produced by underlying inferior olivary nucleus. 橄榄后沟 Retroolivary sulcus rootlets of glossopharyngeal, vagus and accessory n. ( IX, X, XI ) emerge from it. 橄榄 Olive posterolateral 2.背侧面 Dorsal surface 1)Lower po

10、rtion: 薄结节 Gracile tubercle produced by underlying gracile nucleus at lower angle of fourth ventricle. 楔结节 Cuneate tubercle marks site of cuneate nucleus lateral and adjacent to Gracile tubercle. 小脑下脚 Inferior cerebellar peduncle a thick rounded ridge, rostral togracileand cuneate tubercles. 2)Upper

11、 portion: forms lower half of rhomboid fossa. 2.背侧面 Dorsal surface gracile II)脑桥 Pons interposes between midbrain and medulla oblongata. It rests upon dorsum sellae of sphenoid bone and adjacent basilar part of occipital b. 1. Ventral surface 基底部 Basilar part hugeventral swelling , contain both long

12、itudinal and transverse fibers intermixed with pontine nuclei. 基底沟 Basilar sulcus a marked shallow median groove on ventral surface of pons, in which basilar artery is lodged. II)脑桥 Pons interposes betwee 延髓脑桥沟 Bulbopontine sulcus from medial to lateral, abducent, facial and vestibulocochlear n. (VI

13、, VII, VIII) appear.小脑中脚 Middle cerebellar peduncle is formed by transverse fibers of basilar part that converge on each side into a compact mass. 三叉神经 Trigeminal n. (V) consisting of a smaller superomedial motor root, and a large inferolateral sensory root, emerges from junction of basilar part and

14、 middle cerebellar peduncle. 脑桥小脑三角 Pontocerebellar trigone lies junction of medulla, pons and cerebellum. 延髓脑桥沟 Bulbopontine sulcus 2. Dorsal surface 小脑上脚 Superior cerebellar peduncle are two prominent along lateral borders of fourth ventricle. 前髓帆 Superior medullary velum a thin lamina ofwhite mat

15、ter between two superior cerebellar peduncles. 滑车神经 Trochlear n. (IV) emerge from superior medullary velum. 3.菱形窝 Rhomboid fossa is floor of fourth ventricle and is rhomboidal in shape. It is formed by posterior surface of both pons and open part of medulla oblongata. 2. Dorsal surfacewhite matte It

16、s boundaries are superior cerebellar peduncles, inferior cerebellar peduncles, and cuneate and gracile tubercles from above downwards. Of the four angles to rhomboid fossa, two are laterally placed; caudal angle of rhomboid fossa is continuous with central canal in closed part of medulla oblongata,

17、rostral angle with mesencephalic aqueduct of midbrain. 髓纹 Striae medullares divide rhomboid fossa into pontine and medullary parts. Its boundaries are superio 正中沟 Median sulcus divide rhomboid fossa into symmetrical halves. 内侧隆起 Medial eminence a ridge on each side of median sulcus. 界沟 Sulcus limita

18、ns bound medial eminence laterally. 蓝斑 Locus ceruleus adjacent to top of sulcus limitans there is a depression that presents bluish-grey in colour. 面神经丘 Facial colliculus is a rounded swelling at middle of medial eminence and overlies nucleus of abducent n. and genu of facial nerve. 正中沟 Median sulcu

19、s divide 舌下神经三角 Hypoglossal triangle is a medial triangular area on each side of median sulcus verlying hypoglossal nucleus. 迷走神经三角 Vagal triangle is a lateral triangular area on each side of median sulcus and overlies dorsal nucleus of vagus n. 前庭区 Vestibular area is a triangular field lateral to s

20、ulcus limitans and overlies vestibular nuclei. 听结节 Acoustic tubercle lies lateral angle of vestibular area overlying dorsal cochlear nucleus. 舌下神经三角 Hypoglossal triangle 4.第四脑室Fourth ventricle 1)Position: Situated ventral to cerebellum, and dorsal to pons and cranial half of medulla. 2)Boundaries: I

21、nferolateral: gracile and cuneate tubercles, inferior cerebellar peduncle; Superolateral: superior cerebellar peduncle; Roof: Anterior part formed by superior cerebellar peduncle and superior medullary velum; 4.第四脑室Fourth ventricle 2Posterior part formed by inferior medullary velum and choroid plexu

22、s of fourth ventricle; Floor: rhomboid fossa. There are three apertures, one median aperture (正中孔) and two lateral apertures (外侧孔) of fourth ventricle, opening into subarachnoid space.Posterior part formed by inf III)中脑 Midbrain is shortest part of brain stem. It connects pons and cerebellum with ce

23、rebrum. 1. Ventral surface 大脑脚 Cerebral peduncle a pair of longitudinal columns. 0n transverse sections, it is semilunar in shape and termed crus cerebri (大脑脚底 ), which consists of descending fibers from cerebral cortex. III)中脑 Midbrain is shortest Pyramidal tract occupies middle 3/5; Frontopontine

24、tract occupies medial l/5, and Corticopontine tract from temporal, parietal and occipital lobes occupies lateral l/5 of crus cerebri. Pyramidal tract occupies m 脚间窝 Interpeduncular fossa a deep depression bounded by cerebral peduncles, oculomotor nerves ( III ) emerge from medial of crus cerebri. 中脑

25、水管Mesencephalic aqueduct passes through midbrain and serves to connect third ventricle above with fourth ventricle below. 脚间窝 Interpeduncular fossa 2. Dorsal surface 上丘 Superior colliculus two rounded eminences constitute centers for visual reflexes. 下丘 Inferior colliculus two rounded eminences , as

26、sociated with auditory pathway. 2. Dorsal surface 上丘臂 Brachium of superior colliculi a ridge between superior colliculus and lateral geniculate body. 下丘臂 Brachium of inferior colliculi a ridge between inferior colliculus and medial geniculate body. 上丘臂 Brachium of superior Position of Cranial nerves

27、 emerge from Brain stem Position of Cranial nerves 12 pairs Cranial Nerves connected to brain 12 pairs Cranial Nerves con II.脑干的内部结构 Internal structure Internal structure of brain stem comprises Gray matter (cranial nerve nuclei, non-cranial nerve nuclei), White matter (ascending and descending path

28、ways), and Reticular formation. I)灰质 Gray matter 1.脑神经核 Nuclei of cranial n. Almost all cranial nerve nuclei are located in brain stem except first two cranial nuclei, which are evaginations of brain itself. II.脑干的内部结构 Internal structur Functional composition of lower 10 cranial nerve can best be an

29、alyzed by referring development of nuclei. There are 7 characters of nuclei of cranial n. in brain stem. They are: 一般躯体运动核 General somatic motor nuclei, 特殊内脏运动核 Special visceral motor nuclei, 一般内脏运动核 General visceral motor nuclei, 内脏感觉核 Visceralsensory nuclei ( general and special 一般和特殊内脏感觉), 一般躯体感觉

30、核 General somatic sensory nuclei, 特殊躯体感觉核 Special somatic sensory nuclei. Functional composition of 1)一般躯体运动核 General somatic motor nuclei innervate striated muscles that are derived from somites and are involved movement of tongue and eyeballs. They are located closed to median plane and include oc

31、ulomotor, trochlear, abducens and hypoglossal nuclei. 动眼神经核 Oculomotor nucleus is located ventromedially to central grey matter at level of superior colliculus. Their efferent fibers form oculomotor n. and emerge from medial of crus cerebri to supply most of extraocular muscles except lateral rectus

32、 and superior obloquies. 1)一般躯体运动核 General somatic mo 滑车神经核 Trochlear nucleus lies in ventral region of central grey matter close to midline at level of inferior colliculus. Its outgoing fibers pass laterally and dorsally round central grey matter. They reach cranial end of superior medullary velum,

33、 decussating with those of opposite side and become unique cranial nerve, which emerges from dorsal surface of brain stem to supply superior obloquies. 滑车神经核 Trochlear nucleus 展神经核 Abducent nucleus lies deeply in facial colliculus. Fibers course ventrally and inferiorly, passing through basilar part

34、 of pons and emerging from medial end of Bulbopontine sulcus to supply lateral rectus. 舌下神经核 Hypoglossal nucleus lies under hypoglossal triangle. Fibers run ventrolaterally, finally emerging between pyramid and olive to become rootlets of hypoglossal n. to supply muscles of tongue. 展神经核 Abducent nuc

35、leus li舌下神经性交叉瘫 Alternating hypoglossal hemiplegia A relatively small lesion in ventral part of medulla oblongata may therefore impair both corticospinal tract and hypoglossal n. causing a characteristic crossed paralysis. Muscles of tongue are paralyzed on same side as lesion, but muscles of limbs

36、are paralyzed on opposite side of lesion.舌下神经性交叉瘫 Alternating hypoglos NucleusSiteCranial n.FunctionNucleus of oculomotor n.MidbrainSupreior, inferior,and medial recti, inf. obliquus, levator palpebrae superiorisNucleus oftrochlear n.MidbrainSuperior obliquusNucleus of abducent n.PonsLateral rectusN

37、ucleus of hypoglossal n.MedullaMuscles of tongue 一般躯体运动核 General somatic motor nuclei NucleusSiteCranial n.Function 2)特殊内脏运动核 Special visceral motor nuclei innervate muscles that are derived from brachial arches and include motor nucleus of trigeminal n., facial nucleus, nucleus ambiguus and spinal

38、accessory nucleus. 三叉神经运动核 Motor nucleus of trigeminal n. lies in reticular formation of pons, deep to lateral part of floor of fourth ventricle. Motor root of trigeminal n. arises from this nucleus and emerges from junction of basilar part and middle cerebellar peduncle. 2)特殊内脏运动核 Special visceral

39、m 面神经核 Nucleus of facial n. situated at ventrolateral part of reticular formation of pons. Upper portion of nucleus receives fibers from corticonuclear tract of both sides and innervates occipitofrontalis andorbicularis oculi, while lower portion receives fibers from corticonuclear tract of opposite

40、 side only and innervates muscles of lower part of face. Efferent fibers of facial nucleus wind upper pole of nucleus of abducent n. to form genu of facial n. Finally, they emerge from Bulbopontine sulcus. 面神经核 Nucleus of facial n. 疑核 Nucleus ambiguus is placed deeply in reticular formation of medul

41、la oblongata. It provides special visceral efferent fibers for glossopharyngeal, vagus and accessory nerves. rootlets of these nerves leave medulla oblongata by passing through posterolateral sulcus. 副神经核 Spinal accessory nucleus In corresponding to spinal roots of accessory n., it may be located in

42、 grey matter as low as level of fifth cervical segment of spinal cord and gives rise to efferent fibers emerging from Retroolivary sulcus to supply sternocleidomastoid and trapizus. 疑核 Nucleus ambiguus is pla 特殊内脏运动核 Special visceral motor nucleiNucleusSiteCranial n.FunctionMotor nucleus of trigemin

43、al n.PonsMasticatory musclesNucleus of facial n.PonsFacial m., platysma, posterior belly of digastric, stylohyoidNucleus ambiguusMedulla,.Skeletal m. of pharynx, larynx and upper part of esophagusAccessory nucleusMedulla-cervical cordSternocleidomastoid and trapezius 特殊内脏运动核 Special visceral moGener

44、al somatic & Special visceral motor nucleiGeneral somatic & Special visc 3)一般内脏运动核 General visceral motor nuclei are parasympathetic preganglionic neurons that provide autonomic innervations of smooth m. and glands in head, neck and so on. They include EW nucleus, superior and inferior salivatory nu

45、cleus and dorsal nucleus of vagus n. 动眼神经副核 Accessory oculomotor nucleus (Edinger - Westphal nucleus) is situated dorsally to oculomotor nucleus. Their efferent fibers travel in oculomotor n. to relay in ciliary ganglion, subsequently in short ciliary n. to innervate ciliary muscle and sphincter pup

46、illae. 3)一般内脏运动核 General visceral m 上泌涎核 Superior salivatory nucleus lies in pons and sends preganglionic parasympathetic fibers into facial n., which controls secretion of lacrimal, submandibular and sublingual glands. 下泌涎核 Inferior salivertory nucleus lies in medulla oblongata and sends preganglio

47、nic parasympathetic fibers into glossopharyngeal n. to controls secretion of parotid gland. 上泌涎核 Superior salivatory 迷走神经背核 Dorsal nucleus of vagus n. lies under vagus triangle and gives rise to preganglionic parasympathetic fibers, which innervate thoracic visceral organs and a large number of abdo

48、minal visceral organs via vagus n. 迷走神经背核 Dorsal nucleus of 一般内脏运动核 General visceral motor nucleiNucleusSiteCranial n.FunctionAccessory oculomotor nucleusMidbrainSphincter pupillae and ciliary m.Superior salivatory nucleusPonsSubmandibular, sublingual and lacrimal glandsInferior salivertory nucleusM

49、edullaParotid glandDorsal nucleus of vagus n.medullaMany cervical, thoracic and abdominal viscera 一般内脏运动核 General visceral mot 45)内脏感觉核 Visceral sensory nuclei consist of just one nucleus, 孤束核 Nucleus of solitary tract, which is an elongated sensory nucleus in medulla. It receives visceral afferent

50、fibers consisting of primary afferent fibers from facial, glossopharyngeal and vagus n. In fact, Nucleus of solitary tract is shared by these three cranial n. Some authors consider upper end of this nucleus as Special visceral sensory nucleus (特殊内脏感觉核), while lower end of this nucleus as General vis

51、ceral sensory nucleus (一般内脏感觉核). 45)内脏感觉核 Visceral sensory n 内脏感觉核 Visceral sensory nuclei ( general and special )NucleusSiteCranial n.FunctionNucleus of solitary tractMedulla,Taste and visceral sensation 内脏感觉核 Visceral sensory nucle 6)一般躯体感觉核 General somatic sensory nuclei receive and relay sensory

52、 stimuli from skin and mucosa of most of head: spinal nucleus, pontine nucleus and mensecephalic nucleus of trigeminal n. 三叉神经中脑核 Mesencephalic nucleus of trigeminal n. is located in lateral margin of floor of fourth ventricle. It extends upwards to enter lateral portion of periaqueductal grey matte

53、r of midbrain. It is concerned with conduction of proprioceptive impulse from trigeminal n. 6)一般躯体感觉核 General somatic se 三叉神经脑桥核 Pontine nucleus of trigeminal n. lies on lateral side of motor nucleus and extends inferiorly and continues with spinal nucleus. Pontine nucleus receives primary afferent

54、fibers of trigeminal n. Functionally, it relates to conduction of tactile and pressure impulses. 三叉神经脑桥核 Pontine nucleus 三叉神经脊束核 Spinal nucleus of trigeminal n. is directly continuous with substantia gelatinosa of dorsal grey column of spinal cord and lies on medial side of spinal tract of trigemina

55、l n. Spinal nucleus receives primary afferent fibers of trigeminal n. Functionally, it relates to conduction of pain and thermal impulses from skin, mucous membrane, cornea; conjunctiva and meninges through branches of trigeminal n. 三叉神经脊束核 Spinal nucleus oNucleusSiteCranial n.FunctionMesencephalic

56、nucleus of trigeminal n.MidbrainProprioception of headPontine nucleus of trigeminal n.PonsTactile sensation of headSpinal nucleus of trigeminal n.MedullaPain and temperature sense of head 一般躯体感觉核 General somatic sensory nucleiNucleusSiteCranial n.FunctionM 7)特殊躯体感觉核 Special somatic sensory nuclei in

57、clude four vestibular and two cochlear nuclei that receive stimuli via vestibulocochlear n. 蜗神经核 Cochlear nuclei composed of dorsal cochlear nucleus and ventral cochlear nucleus. Two nuclei receive afferent fibers from cochlear ganglion through cochlear nerve that enter cerebellopontine angle. 7)特殊躯

58、体感觉核 Special somatic se 前庭神经核 Vestibular nuclei is made up of medial, inferior, lateral and superior vestibular nuclei in Vestibular area. Major afferent fibers of complex originate from vestibular ganglion and cerebellum; efferent fibers of complex project extensively to spinal cord through vestibu

59、lospinal tract, to cerebellum through vestibulocrerebellar tract, to nuclei of oculomotor, trochlear, abducent, accessory nerve and cervical anterior grey column cells through medial longitudinal fasciculus. 前庭神经核 Vestibular nuclei 特殊躯体感觉核 Special somatic sensory nucleiNucleusSiteCranial n.FunctionC

60、ochlear nucleiPons and medulla Sense of hearingVestibular nucleiPons and medullaSense of equilibrium 特殊躯体感觉核 Special somatic sens 2.非脑神经核 Non-cranial nerve nuclei (传导中继核 Relay nuclei ) 薄束核与楔束核 Gracile and Cuneate nucleus are located in lower medulla oblongata, deep to gracile and cuneate tubercle. A