Brainstem – Pons & midbrain

Dr Shajan Koshy
 Pons
• Has two surfaces - ventral & dorsal surfaces
• Ventral surface is transversely striated
• Basilar sulcus in the median plane which lodges
the basilar artery.
• Laterally the surface is continuous with the
middle cerebellar peduncle.
• Trigeminal nerve is attached to this surface
• Abducent, facial & vestibulocochlear nerves are
attached to the lower border of the ventral
surface.
• Dorsal surface is hidden by cerebellum & forms
the upper half of the floor of the fourth
ventricle.

External features 2
Pons External features

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 Internal structure
• In transverse section pons is divisible into two
parts –
• Ventral or basilar part – is continuous
inferiorly with the pyramids of the medulla, &
on each side with the cerebellum through the
middle cerebellar peduncle
• Dorsal or tegmental part is a direct upward
continuation of the medulla (except the
pyramids).

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 Basilar part of the pons
• Uniform structure • Longitudinal fibres include
throughout its length the corticospinal &
• Grey matter is represented corticonuclear,&
by the pontine nuclei corticopontine fibres
scattered among • Transverse fibres are
longitudinal & the pontocerebellar fibres –
transverse fibres. beginning from the
• White matter – consists of pontine nuclei to the
longitudinal & transverse opposite half of the
fibres. cerebellum, through the
middle cerebellar
peduncle.

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Tegmentum in the pons (lower part)
Grey matter –
• Abducent nucleus
• Facial nucleus
• Vestibular & cochlear nuclei
lie in relation to the inferior
cerebellar peduncle
• Spinal nucleus of trigeminal
nerve
• Salivatory & lacrimatory
nuclei
• Superior olivary nucleus
White matter –
• Trapezoid body –
transverse band of fibres
• Medial lemniscus
• Lateral spinothalamic tract.
• Inferior cerebellar
peduncle.
• Fibres of the facial nerve
follow a peculiar course
(looping around the
abducent nucleus).
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Pons lower part

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 Tegmentum in the pons (upper part)
• Trigeminal lemniscus –
Grey matter – contains fibres arising in the
• Motor & superior sensory spinal nucleus of the
nuclei of trigeminal nerve, trigeminal nerve to the
Motor nucleus is medial. thalamus.
White matter – • Lateral lemniscus – is a part
of the auditory pathway.
• Medial lemniscus,
trigeminal lemniscus, spinal • Medial longitudinal bundle –
lemniscus & lateral is made up of fibres that
lemniscus. interconnect the nuclei of the
cranial nerves III,IV,VI & VIII &
• Medial lemniscus – lateral the spinal part of the
spinothalamic tract, accessory nerve – coordinates
fasciculus gracilis, fasiculus movements of head & neck in
cuneatus. response to VIII cranial nerve
stimulation.
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Pons upper part

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 Blood supply
• Pons is supplied by branches from the basilar
artery
• Median part supplied by paramedian branches
• Lateral part - supplied by short & long
circumferential branches.
• Anterior inferior cerebellar & superior
cerebellar arteries
 Midbrain
• Connects the hindbrain with
forebrain.
• Anteriorly related to the
• Its cavity is known cerebral
interpeduncular
aqueduct.
structures.
• Passes through the tentorial
notch. • Posteriorly related to the
splenium of the corpus
• Relations - on each side to callosum, great cerebral
the parahippocampal gyri,
vein, pineal body,&
optic tracts, posterior
posterior ends of thalami.
cerebral artery, basal vein,
trochlear nerve & the • In transverse sections two
geniculate bodies. regions tectum & cerebral
peduncle.

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Relations (midbrain)

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 External features of midbrain
ventral aspect

• Two large bundle of fibres – crura

• Crura of midbrain separated by a deep fissure
• Parts of the crura just below the cerebrum is the
interpeduncular space
• Oculomotor nerve emerges from the medial aspect
of the crus of the same side
 External features of midbrain
dorsal aspect
• Four rounded swellings – colliculi one superior &
one inferior on each side
• Each colliculus is laterally related to a ridge –
brachium
• Superior brachium connects superior colliculus to
lateral geniculate body
• Inferior brachium connects inferior colliculus to
medial geniculate body
• Just below colliculi is superior medullary velum.
• Trochlear nerve emerges from the velum
Midbrain External features

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 Subdivisions of midbrain
• Tectum is the part posterior • Medial & lateral
to the aqueduct, made up geniculate bodies are
of right & left, superior & situated on the
inferior colliculi. posterolateral aspect of
• Each half of the midbrain the midbrain.
anterior to the aqueduct is • Superior colliculus is
called the cerebral connected to the lateral
peduncle. geniculate body by the
• Each half of the cerebral superior brachium
peduncle is divided into • Inferior colliculus is
crus cerebri, substantia connected to medial
nigra in the middle, geniculate body by
tegmentum posteriorly. inferior brachium.
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 Internal structure
• Central grey matter contains –
nucleus of trochlear nerve in the
ventromedial part,
Mesencephalic nucleus of
trigeminal nerve in the lateral
part.
• Inferior colliculus – receives
afferents from the lateral
lemniscus & gives efferents to
medial geniculate body.
• Substantia nigra – a lamina of
grey matter with deeply
pigmented nerve cells.
Concerned with muscle tone.
Transverse section of midbrain at the level of inferior colliculi.
• White matter
• Crus cerebri contains –
corticospinal tract in the middle,
frontopontine fibres in the medial
one sixth & temporopontine,
parietopontine & occipitopontine
in the lateral one-sixth.
• Tegmentum contains ascending
tracts as follows- lemnisci,
decussation of superior
cerebellar peduncles, medial
longitudinal bundle lies in close
relation to the trochlear nucleus.
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 Midbrain section
(Inferior collicular level)

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 Midbrain ( Internal Structure)
grey matter
• Central grey matter contains –
nucleus of oculomotor nerve,
mesencephalic nucleus of the
trigeminal nerve, oculomotor
nucleus of the two sides are
fused in the median plane.
• Superior colliculus recieves
afferents from the retina &
various other centers. Efferents
to spinal cord as spinotectal
tract.
• Pretectal nucleus lies deep to
the superolateral part of the
superior colliculus. Receives
afferents & gives efferents.
Transverse section of midbrain at the level of superior colliculi.
• Red nucleus is about 0.5 cm in
the diameter.
• Receives afferents from the
superior cerebellar peduncle, the
globus pallidus, subthalamic
nucleus & the cerebral cortex.
Gives efferents to spinal cord,
reticular formation, thalamus,
olivary nucleus, subthalamic
nucleus it has inhibitory influence
on muscle tone.
• Substantia nigra.
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 Midbrain section
( Superior collicular level )

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 Midbrain (superior collicular level) white
matter
• Crus cerebri
• Tegmentum contains – lemnisci, decussation of the
tectospinal & tectobulbar tracts form dorsal
tegmental decussation.
• Decussation of rubrospinal tracts forms ventral
tegmental decussation.
• Medial longitudinal bundle.
• Emerging fibres of oculomotor nerve
• Tectum shows posterior commissure connecting the
two superior colliculi.

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 Blood supply
• Posterior cerebral & superior cerebellar
branches from basilar artery
• Direct branches from basilar artery
• Posterior communicating & anterior choroidal
arteries
• Paramedian & circumferential branches of the
above
• Blood supply to the colliculi – quadrigeminal
artery (circumferential branches)
 Summary
• Ascending tracts & descending tracts of spinal
cord
• Medulla at three levels
• Pons at two levels
• Midbrain at two levels

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Thank you

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