WEEK FOUR : WEDNESDAY , AUGUST, 28 2019

TOPICS : BRAINSTEM AND CRANIAL NERVES

COMPETENCY AREA : 5

COMPETENCY LEVEL : 4A ( ABLE TO IDENTIFY )

LEARNING OBJECTIVES :

After finished laboratory practice Student should be able to:

1. Describe the components of the brain stem

2. Describe anatomical features of the dorsal and ventral areas of the brainstem
3. Describe the location and organization in the brain stem.
4. Describe the 12 cranial nerves and its course in intracranial compartment
5. Describe function of the 12 cranial nerves and its component
6. Describe cerebellum: location and anatomical structures

ATTENTION FOR STUDENTS :

To achieve the learning objectives Students at Dissection Room do the following procedures :

1. Discuss among the group the brainstem ( truncus encephali )

1.1. Components, location and topographical position of the brain stem
- Mesencephalon (mid brain)
o Rostrally it adjoins the diencephalon and caudally it adjoins the metencephalon (after brain)
o Tectum  quadrigeminal plate (Superior and inferior colliculi) and tegmentum
o Cranial nuclei III & IV
- Pons Varoli
o Superior to medulla and anterior to the cerebellum
o Cranial nuclei V, VI, VII
o Pontomedullary junction  cranial nuclei VIII
- Medulla oblongata
o Begins at foramen magnum (3 cm)
o Cranial nuclei IX, X, XII

1.2. Anatomical features of the parts of the brain stem.

1.3. Cranial nerves : intracerebral course and location of their emerge from the brainstem.
- CN III  oculomotor  fossa interpeduncularis
- CN IV  trochlear  dorsal aspect of the brainstem at the level of the caudal mesencephalon, just below the
inferior colliculus
- CN V  Trigeminal  Pons
- CN VI  Abducent  Pontomedullary Junction, medial to the facial nerve
- CN VII, VIII  Facial, Vestibulocochlear  Pontomedullary Junction
- CN IX, X, XI  Glossopharyngeal, Vagus, Accessory  Posterolateral Sulcus
- CN XII  Hypoglossal  Preolivary Sulcus/Anterolateral Sulcus

2. Identify the brainstem at the specimen. Look for :

2.1. Mesencephalon Look for anatomical structures around mesencephalon :
2.1.1. Optic chiasma ( chiasma opticum )
2.1.2. Infundibulum of pituitary gland ( infundibulum glandulae pituitariae / hypophysae )
2.1.3. Mammillary bodies ( corpora mammillariae )
2.1.4. Cerebral peduncle ( crus / pedunculus cerebri )
2.1.5. Interpeduncular fossa ( fossa interpeduncularis Tarini )
2.1.6. Posterior perforate substance ( substantia perforata posterior / interpeduncularis )
2.1.7. Cerebral arterial circle of Willis ( circulus arteriosus cerebri Willisii )
2.2. Pons Varoli
2.2.1. Look for basilar sulcus ( sulcus basilaris )

1
 2.2.2. What anatomical structure occupies basilar sulcus?
2.3. Medulla oblongata. Look for:
2.3.1. Oliva
2.3.2. Pyramid ( pyramis medullae oblongatae )

2
3. Identify the 12 Cranial Nerves. Look for:
3.1. Olfactory nerve ( I , N. olfactorius ).
3.1.1. Olfactory bulb ( bulbus olfactorius ).
3.1.1.1. What makes olfactory bulb ? Fila Olfactoria
3.1.1.2. What is the name of part of ethmoid bone that is used by fibers that make olfactory bulb? Cribiform
plate
3.1.1.3. Where is the origin of that fibers ? Dinding cavumnasi
3.1.2. Olfactory tract ( tractus olfactorius )
3.1.3. Olfactory triangle ( trigonum olfactorius ). What make its borders?
3
 3.1.4. Anterior perforate substance ( substantia perforata anterior ) dorsal to olfactory triangle
3.1.4.1. What is the name of the artery that ends here by dividing into its terminal branches? A. Internal Carotid
3.1.4.2. What are the names of those terminal branches ? A. Middle Cerebral and Anterior Cerebral

3.2. Optic nerve ( II , N. opticus )

3.2.1. Look for optic chiasma ( chiasma opticum )
3.2.2. What is the name of the location of optic chiasma at the base of skull? Sulcus Chiasmaticus
Look for that location at the specimen.
3.2.3. What is the name of the hole that is used by Optic nerve to enter orbita? Canalis Opticus
Look for it at the specimen.

3.3. Oculomotor nerve ( III , N. oculomotorius )  nucleus at the level of superior colliculus

3.4. Trochlear nerve ( IV , N,. trochlearis )

th
3.5. Abducens nerve ( VI , N. abducens )  located in the pons, on the floor of the 4 ventricle, at the level of the facial
colliculus

3.6. Discuss among the group:

3.6.1. The name of the fissure at the base of cranium ( basis cranii ) that is used by III, IV and VI cranial nerves to enter
orbita. Look for it at the specimen. Fissura Orbitalis Superior
3.6.2. What organs are Innervated by those three cranial nerves ?
- CN III  superior, inferior and medial rectus muscle, inferior oblique muscle, levator palpebrae muscle, sphincter
pupillae muscle and ciliary muscle
- CN IV  superior oblique muscle
- CN VI  lateral rectus muscle

3.7. Trigeminal nerve ( V , N. trigeminus ). Discuss among the group :

3.7.1. Name of trigeminal ganglion. Look for it at the specimen. Semilunar/gasserian ganglion
3.7.2. Terminal branches of Trigeminal nerve.
- V1  ophthalmic nerve  fissure orbitalis superior
- V2  maxillary nerve  foramen rotundum
- V3  mandibular nerve  foramen ovale
3.7.3. Holes at the base of cranium that were used by the branches.

3.8. Facial nerve ( VII , N. facialis ) Meatus Acusticus Internus. Discuss among the group :
3.8.1. Name of the hole that is used by Facial nerve to leave cranial cavity.
 Foramen Stylomastoideus  keliatan di preparat yang ada giginya, kecil
3.8.2. Its clinical application and manifestation  Bell’s palsy

3.9. Vestibulocochlear nerve ( VIII , N. vestibulocochlearis / statoacusticus ). Discuss among the group :
3.9.1. Name of the hole that is used by the nerve to enter its site of innervation.
Look for that hole at the specimen. Meatus Acusticus Internus
3.9.2. Name of the cranial bone where that nerve end by dividing into 2 nerves. Distal aspect of Meatus Acusticus
Internus
3.9.3. Name of the nerves and their locations.
- Vestibular nerve  vestibular system in the inner ear
- Cochlear nerve  spiral ganglia in the inner ear

3.10. Glossopharyngeal nerve ( IX , N. glossopharyngeus )

3.11. Vagal nerve ( X , N. vagus ). Why do this cranial nerve named vagal ?

4
  Wanderer, vagus nerve passes through the neck and thorax to the abdomen, has the widest distribution in the body

3.12. Accessory nerve ( XI , N. Accessorius )

3.13. What is the name of the hole at the base of cranium that is used by IX , X , XI cranial nerves to leave cranial cavity ?
Look for that hole at the specimen. Foramen Jugulare
3.14. Hypoglossal nerve ( XII , N. hypoglossus ). What is the name of the hole at the base of cranium that is used by this
nerve to leave cranial cavity ? Look for that hole at the specimen  Canalis Nervi Hypoglossi

4. Identify superior surface the cerebellum at the specimen Look for :

4.1. Anterior lobe ( lobus anterior cerebelli )
4.2. Posterior lobe ( lobus posterior cerebella )
4.3. Anterior cerebellar notch ( incisura cerebellaris anterior )
4.4. Posterior cerebellar notch ( incisura cerebellaris posterior
4.5. Primary fissure ( fissure primarius )
4.6. Cerebellar hemisphere ( hemispherium cerebellaris )
4.7. Culmen
4.8. Declive
4.9. Cerebellar folia ( folia cerebellaris )

5. Identify inferior surface the cerebellum at the specimen Look for

5.1. Lobulus flocculonodularis, consists of :
5.1.1. Flocculus
5.1.2. Nodulus
5.2. Cerebellar vallecula ( vallecula cerebellaris )
5.3. Cerebellar tonsil ( tonsilla cerebellaris )
5.4. Cerebellar vermis ( vermis cerebellaris )

6. Identify cerebellar nuclei ( nuclei cerebellares ). Look for :

5.5.1. Dentate nuclei ( nucleus dentatus )
5.5.2. Emboliform nuclei ( nucleus emboliformis )
5.5.3. Globous nuclei ( nucleus globosus )
5.5.4. Fastigium nuclei ( nucleus fastigius )

5
6