Brainstem: Pons and

Midbrain
Prof. Julien GASHEGU
 Pons
- The pons lies between the medulla
oblongata and the midbrain
- It is 2.5cm in length and 3.8 cm in width
- The pons is anatomical divided in 2
regions:
. Ventral part = basilar pons
. Dorsal part = tegmentum of the pons
- The pons is connected to the cerebellum
by the middle cerebellar peduncles (right
and left
 Pons: gross appearance
Ventral surface
- The anterior surface is convex from side to side
- there is a middle groove = the basilar groove, which
lodges the basilar artery
- transverse fibers which converge on each side to
form the middle cerebellar peduncle
- the trigeminal nerves emerge at each anterolateral
side: it has a smaller medial root which is motor and
larger lateral root which is sensory
- the abducens (abducent) nerves emerge at the
middle of the ponto-medullary sulcus
- the facial nerve and vestibulo-cochlear nerve emerge
at each angle between the pons and the cerebellum
 Pons: gross appearance
Dorsal surface
- the dorsal surface of the pons forms part of the floor
of the 4th ventricle and is hidden by the cerebellum
- it is limited lateral by the superior cerebellar peduncle
and divided in 2 half by the posterior median sulcus
- the medial eminence is lateral to the median sulcus
and is bounded by the sulcus limitans
- the inferior end of the medial eminence is the facial
colliculus, which is produced by the root of the facial
nerve winding around the abducens nucleus
- the vestibular area is lateral to the sulcus limitans
 Pons: Internal structures
- The pons is divided into the posterior part,
the tegmentum, and the anterior basilar
pons by the transversally running fibers of
the trapezoid body
- the internal structures are described at 2
levels:
. Transverse section through the caudal
part, passing through the facial colliculus
. transverse section through the cranial part,
passing through the trigeminal nuclei
 Pons: Internal structures
- the basilar pons is viewed as a extension of the ventral
aspect of the medulla containing the pyramid tract
(corticospinal and corticobulbar tracts)
- the most characteristic feature is the massive bundles of
fibers that run transversally and coalesce as the middle
cerebellar peduncles, which enter the cerebellar cortex
- within the bundles of transverse fibers are the pontine
nuclei
- pontine nuclei receive input from the cerebral cortex and
send fibers to the cerebellar cortex (cerebropontine and
pontocerebellar fibers)
- Differences between caudal and rostral pons are mostly
at the tegmentum, the posterior part of the pons
Pons: caudal internal structures
- the medial lemniscus is at the most
anterior part of the tegmentum
- the trapezoid nuclei between the two
medial lemnisci: it is an auditory relay that
receive auditory inputs from the cochlear
nuclei and transmit auditory signals to
higher centers
- the medial longitudinal fisciculus is located
th
beneath the floor of the 4 ventricle
 Pons: caudal internal structures
- the main nuclei within the caudal tegmentum:
1. abducens nucleus lies in a dorsomedial
position in the pons close to the floor of the
4th ventricle
2. facial nuclei at the ventrolateral aspect of
the tegmentum
3. superior and lateral vestibular nuclei lateral
to the abducens nucleus
4. posterior and anterior cochlear nuclei
 Pons: caudal internal structures
the main nuclei within the caudal tegmentum:
5. superior salivary nucleus of the facial nerve
just ventrolateral to the abducens nuclei: it
mediates the lacrymation, salivation, nasal
secretion
6. solitary nucleus and tract close to the
superior salivary nucleus
7. spinal nucleus and tract of the trigeminal
nerve lateral to the facial nucleus
Pons: Rostral internal structures
- the internal structures of the rostral part of
the tegmentum are similar to those seen in
the caudal level
- specific nuclei of the cranial level of the
pons are:
1. the principal sensory nucleus of the
trigeminal nerve
2. the motor nucleus of the trigeminal nerve
which control the muscles of mastication
 Pons: clinical correlates
Most of syndrome are due to vascular le-
sions and may affect area specifically
supply by a artery branch:
1. Caudal tegmental pontine syndrome
2. Caudal basal pontine syndrome
3. Rostral basal pontine syndrome
4. Rostral pontine tegmental syndrome
 Midbrain
- The midbrain is the shortest part of the
brainstem (2.5 cm in length) and connects
the pons and cerebellum to the
diencephalon
- The midbrain lies within the tentorial hiatus
and is largely hidden by surrounding
structures
- The midbrain is traversed by the cerebral
aqueduc (Sylvis) which contains the
cerebrospinal fluid
 Midbrain: gross appearance
The posterior surface of the midbrain
- 4 (2 pairs) colliculi or corpora quadrigemina
- These rounded eminences are divided into
superior and inferior pairs by a vertical groove
(separating the right and left) and a a transverse
groove (separating the superior and inferior
- The superior colliculus is the center for visual
reflexes
- The inferior colliculus is the lower auditory center
- In the midline below the inferior colliculi, the
trochlear nerve (CNIV) emerge
 Midbrain: gross appearance
- The lateral aspect of the midbrain, the
superior and the inferior brachia ascend in
the anterolateral direction
- the superior brachium passes from the
superior colliculus of the midbrain to the
lateral geniculate body of the thalamus
- the inferior brachium passes connects the
inferior colliculus to the medial geniculate
body of the thalamus
 Midbrain: gross appearance
- The lateral aspect of the midbrain, the
superior and the inferior brachia ascend in
the anterolateral direction
- the superior brachium passes from the
superior colliculus of the midbrain to the
lateral geniculate body of the thalamus
- the inferior brachium passes connects the
inferior colliculus to the medial geniculate
body of the thalamus
 Midbrain: gross appearance
- On the anterior aspect there are:
. interpeduncular fossa: a depression in the
midline which is named posterior perforate
substance
. 2 crus cerebri which bound the
interpeduncular fossa
. the oculomotor nerve emerge from the
interpenducular fossa on the medial side
of the crus cerebri
 Midbrain: internal structures
- The midbrain comprises 2 half = the cerebral peduncles
- Each cerebral peduncles is divided:
. the anterior part = the crus cerebri
. the posterior part = the tegmentum
. between the crus cerebri and the tegmentum is the
substantia nigra
- The narrowed cavity of the midbrain is the cerebral
aqueduct which connects the 3rd and 4th ventricles
- the tectum is the part of the midbrain posterior to the
cerebral aqueduct, it has 2 inferior and 2 superior
colliculi
- the internal structures are different at the caudal level
(inferior colliculus) and rostral level (superior colliculus)
 Midbrain at inferior colliculus
- the tectum contains the inferior colliculus
nucleus and is part of the auditory pathway
- the aqueduct is surrounded by central gray
mater, the periaqueductal gray mater (PAG)
. mesencephalic nucleus of the trigeminal is
located lateral to the aqueduct
- the trochlear nucleus is located just beneath
the PAG and just posterior to the MLF
(medial longitudinal fasciculus)
 Midbrain at inferior colliculus
- the tegmentum contains:
. The superior cerebellar peduncle at the central part
. the medial lemiscus is posterolateral to the superior
cerebellar peduncle
. the substantia nigra is a large motor nucleus between
the crus cerebri and the tegmentum and is
composed cells that possess inclusion granules of
melanin pigment that give the color. The substantia
nigra control the muscle tone
- the crus cerebri contains the descending tracts: the
corticospinal and corticobulbar tacts occupy the
middle 2/3, the frontopontine tract the medial part
and the temporopontine tract the lateral part
 Midbrain at superior colliculus
- the tectum contains the superior colliculus
nucleus and is the center for the visual reflexes
- the aqueduct is surrounded by central gray
mater, the periaqueductal gray mater (PAG)
. mesencephalic nucleus of the trigeminal is
located lateral to the aqueduct
- the oculomotor nucleus is located in the PAG
- just beneath the PAG is located the MLF
(medial longitudinal fasciculus)
 Midbrain at inferior colliculus
- the tegmentum contains:
. the red nuclei, 2 round mass of the gray mater
at the central part of the tegmentum. Its
reddish appearance is due to its vascularity
and the presence of iron-containing pigment
in many of its cells
. the medial lemniscus is posterolateral to the
red nucleus
- Substantia nigra and the crus cerebri are
similar to those at the level of inferior
colliculus
 Reticular formation
- Medullary reticular formation spans the
area between the pyramid and the floor of
th
the 4 ventricle
- Pontine reticular formation is a major part
of the tegmentum
- Midbrain reticular formation is located in
the tegmentum lateral to the superior
cerebellar pudoncule and posterior to the
red nuclei
- RF is connected to cerebellum, cerebral
cortex and the basal ganglia
 Reticular formation: Functions
1. Sensory function: RF receives input from divers
sensory system that help to modulate the
cortical excitability and state of consciousness
2. RF plays a important role in the modulation of
the motor responses
. muscle ton and reflexes (when extensors
contract, flexors relax)
. maintain the the tone of antigravity muscles while
standing
. control of respiratory muscles
. control facial muscle activity associated with
emotions
 Reticular formation: Functions
3. Autonomous functions:
. Cardiovascular system: blood pressure and heart
rate
. Respiration
. Digestive system
4. Control sleep and wakefulness cycle
5. Control consciousness
6. Regulate emotion and behavior
 Midbrain: clinical correlates
1. Weber's syndrome
2. Benedikt's syndrome
3. Parinaud's syndrome
4. Other syndromes