Федеральное государственное бюджетное образовательное

учреждение высшего образования

«Казанский государственный медицинский университет»
Министерства здравоохранения Российской Федерации
Кафедра нормальной анатомии человека

«ЦЕНТРАЛЬНАЯ НЕРВНАЯ СИСТЕМА»

Учебно-методическое пособие по дисциплине «Анатомия
человека» для студентов медицинских факультетов, обучающихся
на английском языке

«CENTRAL NERVOUS SYSTEM»

(for English-speaking students of the General medicine faculty)

Казань, 2020
УДК 611.8
ББК 28.706.991.7я73
Печатается по решению Учебно-методического совета по
преподаванию на английском языке Казанского государственного
медицинского университета (протокол №1/20 от 25.11.2020)

Составитель:
к.м.н., доцент кафедры нормальной анатомии человека
Газизов И.М.

Рецензенты:
к.м.н., доцент, зав. кафедрой топографической анатомии и
оперативной хирургии КГМУ, Баширов Фарид Вагизович
к.м.н., доцент кафедры морфологии и общей патологии КФУ,
Резвяков Павел Николаевич

Центральная нервная система: учебно-методическое пособие по

дисциплине «Анатомия человека» для студентов медицинских
факультетов, обучающихся на английском языке. Central nervous
system: (for English-speaking students of the General medicine faculty) /
И.М. Газизов. – Казань: КГМУ, 2020. – 111 с.

Целью настоящего издания является пошаговая помощь студентам в

освоении основ раздела «Центральная нервная система» при
изучении дисциплины «Анатомия человека».

© Казанский государственный медицинский университет, 2020

1
 CONTENTS
Introduction.…………………………………………………………. 3
Competences, which are formed during studying anatomy…………. 6
Methods of student`s assesment during formation of competences…. 8
Lessons plan for peripheral nervous system…………………………. 9
Program of paractical lessons………………………………………... 10
Plan of practical lessons……………………………………………… 11
Practical lesson 1.……………………………………………………. 12
Practical lesson 2……………..…………………………………….… 21
Practical lesson 3………..……………………………………………. 33
Practical lesson 4………..……………………………………………. 55
Practical lesson 5………..……………………………………………. 67
Practical lesson 6………..…………….……………………………… 97
Criteria for evaluating the response to the theoretical question ……… 107
Criteria for the assessment of the test …………………………..……. 109
Criteria for the assessment of situational problems ………………..… 109
Criteria for final evaluation ………………………………………..…. 109
List of used sources ………………….………………………..……… 110

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 INTRODUCTION

Dear students!
You have reached 3rd term of studying discipline of “Human
Anatomy”. This term you will cover studying “Nervous system”, which
is divided into “Central nervous system” and “Peripheral nervous
system”. This particular manual will help you to study and understand
the topic of “Central nervous system”.
The “Central nervous system” is an integrating topic, which will
help you to understand functioning of the locomotion apparatus, inner
organs and sensory organs. Nervous system by being one of the regulatory
systems through the peripheral system establishes connections between
all organs and central nervous system. In the central nervous system, you
will find different subcortical and cortical centers, responsible for
regulation of somatic and visceral organs of the body.
The central nervous system is the most complicated system to
research, because it is vitally important, any damage to it can lead to
severe consequences and it is well protected (hidden) by bones. The
structure of organs of the central nervous system at microscopical level
and physiology of neurons and glial cell by complexity is breath taking.
The most sophisticated computers in near future (10-20 years) will not be
able to reach the processing power of the human brain. Nowadays the
quickest computers can reach the speeds of processing equal to computing
power of the head ganglion of mollusks. There is special field in
engineering, which tries to develop bio-integrated processors, so studying
and understanding the workings of human brain has great prospective for
future science. For you – future medical doctor the anatomy of central
nervous system holds clues for solving the problems of such diseases as
stroke, cerebral palsy, Parkinson disease, Alzheimer disease, amnesias,
spinal cord paralysis, hydrocephaly and many others. So, it is crucial to
properly dedicate yourself to study heard the topic of “Central nervous
system”. After finishing that topic, after being able to identify all the
anatomical structures in the organs of the central nervous system and
being capable to locate different cortical and subcortical regulatory
3
centers you will feel the sense of accomplishment, which will make you
proud of yourself.
Anatomical knowledge of CNS is essential for all medical
specialties but most needed to neurologists, psychiatrists, surgeons and
traumatologists. As one of the famous russian obstetrician and
gynecologist A.P. Gubarev has wrote: “Without anatomy there is no
therapy or surgery, only omens and prejudices”.
Therefore, each future doctor has to dedicate himself fully for
studying anatomy to understand structure and function of each organ and
of organism as a whole. Anatomical knowledge you will receive during
study at Human Anatomy department at practical lessons and lectures.
Lecture is a type of studying directed primarily for theoretical
education of listeners. The aim of the lecture is to form basis for future
study of the subject, systematization of knowledge, depicting
interdisciplinary role and importance of topic, accentuation on most
difficult and key problems. Lecture is directed for stimulation of students
for active conscious self-study, search for knowledge, formation of
creative thinking and preparation for work with advanced textbooks.
Self-study is needed for increasing, deepening, detailing and
solidification of theoretical knowledge.
Practical lessons develop scientific thinking and speech, teach
usage of anatomical terminology, and form basic practical skills.
In front of you is a methods handbook on the discipline of “Human
Anatomy” prepared for the topic of “Central nervous system”.
Methods handbook gives aim and motivation for each practical
lesson; lists all the competences, which have to be formed after studying
the topic, main anatomical terms and elements of assessments – questions
for preparation for each practical lesson, tests.
The priority for the practical lesson is to acquire knowledge, form
capabilities and practical skills, which are approved by federal
educational standards of Russian higher education for specialty of
“General Medicine”. Capabilities and skills confirm ability to perform
certain action. They differ in level of mastering actions. Capability is
4
ability to perform an action, which did not reach the high level of
completeness and demands concentration of consciousness. However,
capability reflects ability to use knowledge in practice. Skill is ability to
perform a conscious action, which reached high level of completeness,
done partially automatically without realization of intermediary steps.
Acquiring of knowledge, educational capabilities, which are needed for
processing necessary information is initial step in formation of practical
skills:
1. “Student knows” – “unconscious competence” – theoretical basis
for skills;
2. “Student knows how” - “conscious competence” – knows how to do
with tutor`s help;
3. “Student can show how” -“unconscious competence” – capability,
ability to do under guidance of the teacher.
Only after intense training and practical performance capability
becomes reflex, done automatically, forms skill. This is fourth stage in
acquiring practical skill;
4. “Student can show how” - “conscious competence” – capability
becomes automatic after multiple training.

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 COMPETENCES, WHICH ARE FORMED
DURING STUDYING ANATOMY
I. General cultural competences (GCC):
GCC-7 – readiness to provide first aid and apply protection methods
during emergency situations.
As a result of mastering GCC-7 students have to:
Know:
general laws of the structure of the human body, structural and
functional relationships of parts of the body; anatomical and topographic
relationships of organs and parts of the body in adults, children and
adolescents.
Be able to:
to be properly guided in the complex structure of the human body,
to accurately find and determine the locations and projections of organs
and their parts on the body surface, to be able to use the knowledge of the
anatomical and topographic interrelations of organs for understanding
pathology, diagnosis and first aid.
Master skills of:
basic digital technologies: text, table editors, search on the Internet;
appropriate usage of medical and anatomical terminology; usage of the
simplest medical instruments (tweezers, scalpel); the skill of comparing
morphological and clinical manifestations of diseases.
II. General professional competences (GPC):
GPC-7 willingness to use basic physicochemical, mathematical and
other natural science concepts and methods in solving professional
problems
As a result of mastering GPC –7 students have to:
Know:
general laws of the origin and development of life; anthropogenesis
and human ontogenesis; the basic patterns of development and life of the
body of children and adolescents based on the structural organization of
cells, tissues and organs; anatomical, physiological, age-sex and
individual characteristics of the structure and development of a healthy
child and adolescent; functional systems of the body of children and
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adolescents, their regulation and self-regulation when exposed to the
external environment in normal conditions and pathological processes.
Be able to:
use educational, scientific, popular science literature, the Internet for
professional activities; to find on the body main bone landmarks, to
describe the topographic contours of the organs and the main vascular and
nerve trunks; explain the nature of deviations in the course of
development, which may lead to the formation of variants of anomalies
and defects.
Master skills of:
basic digital technologies: text, table editors, Internet search;
medico-anatomical terminology; the skill of comparing morphological
and clinical manifestations of diseases.
GPC-9 ability to assess morphofunctional, physiological states and
pathological processes in the human body to solve professional problems.
As a result of mastering GPC –9 students have to:
Know:
general patterns of the origin and development of life, human
anthropogenesis and ontogenesis; the structure, topography and
development of cells, tissues, organs and systems of the body in
conjunction with their normal function and pathology, features of the
modern and population levels of the organization of life; anatomical,
physiological, age-sex and individual characteristics of the structure and
development of a healthy and sick body; functional systems of the human
body, their regulation and self-regulation during exposure to the external
environment.
Be able to:
use educational, scientific, popular science literature, the Internet for
professional activities; to palpate on the person the main bone landmarks,
to outline the topographic contours of the organs and the main vascular
and nerve trunks; explain the nature of deviations in the course of
development, which may lead to the formation of variants of anomalies
and defects.
Master skills of:
7
 basic digital technologies: text, table editors, Internet search;
medico-anatomical terminology; the skill of comparing morphological
and clinical manifestations of diseases.

METHODS OF STUDENT`S ASSESSMENT DURING

FORMATION OF COMPETENCES
Compet Subcompetences Assessment
ences method
GCC-7 Oral
GPC-7 know the rules of ethics and deontology questioning

GPC-9 know the basic rules for the use of the unclaimed Oral
body, organs and tissues of a deceased person for questioning
medical, scientific and educational purposes
approved by the government of the Russian
Federation
to put into practice the methods of studying the preparation
structure of the human body on a corpse and a
living person
know the safety rules when working with Oral
cadaveric material and the use of anatomical tools questioning
know the traditional and modern methods of presentation
anatomical research s
know the main stages of the development of essays
anatomical science, its importance for medicine
and biology
know latin anatomical terminology Oral
questioning
know the general laws of the structure of the Oral
human body, structural and functional questioning
relationships of parts of the body of an adult
person, children and teenagers
8
 know normal anatomic variations, main Oral
anomalies and malformations of organs and questioning
systems
be able accurately orient in the anatomy of human Oral
body, clearly determine the location and questioning
projection of organs and their parts on the surface
of the body
To be able to use basic digital technologies: text, presentation
table editors, Internet search, educational, s
scientific, popular science literature, the Internet
for professional activities, medical and
anatomical terminology; simplest medical
instruments

LESSONS PLAN FOR PERIPHERAL NERVOUS SYSTEM

Topic All Studying (in hours) Methods of
hou Auditory Self assesment
rs study study
lectur Practi
e cal
lesson
40 8 18 14 Oral questioning
Central nervous using natural
system. anatomical
preparations.
Test control.
Situational tasks.
Topic 1.1.1 7 4 3
Anatomy of the
central nervous
system.
Development of
the nervous system
in phylo- and
embryogenesis.
9
Topic 1.1.2. Spinal 4 3 1
cord. Meninges of
the spinal cord.
Topic 1.1.2. 5 3 2
Rhombencephalon
Topic 1.1.3. 5 3 2
Mesencephalon.
Diencephalon.
Topic 1.1.4. 5 3 2
Telencephalon.
Meninges of the
brain.
Topic 1.2.1. 4 2 2
Afferent pathways.
Topic 1.2.2. 4 2 2
Efferent pathways.
Topic 1.3. Check 6 3 3 Check lists.
point for Central
nervous system.
All hours: 40 8 18 14

PROGRAM OF PRACTICAL LESSONS

Practical lessons are conducted by using the following forms:

theoretical analysis of the material using natural dry and wet anatomical
preparations, muscle and neurovascular corpse, self-study of students
with natural dry and wet preparations using atlases, solving situational
problems, testing, abstract communications.
Duration of lesson - 3 academic hours.

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 PLAN OF PRACTICAL LESSONS

№ Topic and content

lesson
1 Anatomy of the central nervous system. Development of the
nervous system in phylo- and embryogenesis. General
information about the nervous system. The reflex activity of the
nervous system, the morphological substrate of this activity, is the
reflex arc.
2 Spinal cord. Meninges of the spinal cord. Spinal cord, function,
topography, structure. Topography of gray and white matter.
Segmental apparatus of the spinal cord. Meninges and
intermeningeal spaces.
3 Rhombencephalon. Rhombencephalon: medulla oblongata,
pons, cerebellum. Development in phylo- and embryogenesis.
External veiw, internal structure, topography. Isthmus of the
rhombencephalon. IV ventricle. Rhomboid fossa, its layout.
4 Mesencephalon. Diencephalon. Development of the
mesencephalon and diencephalon in phylo- and embryogenesis.
The morphology of the mesencephalon, its function, structure,
topography of gray and white matter. The morphology of the
diencephalon, its divisions, function. III ventricle, structure,
communication with other ventricles.
5 Telencephalon. Meninges of the brain. The cortex of the
cerebral hemispheres. Gyri and sulci of the cerebral cortex. Basal
nuclei. Internal capsule. Lateral ventricles, structure and
communications. The meninges of the brain. Production and
circulation of cerebrospinal fluid.
6 Check point of Central Nervous System. Control of theoretical
knowledge and practical skills, checking the knowledge of
anatomical preparations and abilities to handle preparations
properly.

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 Practical Lesson 1
Anatomy of the central nervous system. Development of the
nervous system in phylogenesis and embryogenesis.

Purpose of the lesson:

- to study the general anatomy of the central nervous system;
- to overview the main steps in development of the organs of the central
nervous system in phylogenesis and embryogenesis.
After studying this topic, students have to:
know:
- principles of division of the organs of central and peripheral nervous
system;
- general anatomy of the organs of the central nervous system;
- functions of the organs of the central nervous system and theoretical
basis explaining functioning of the central nervous system;
- main steps in development of the central nervous system and of the
brain in particular.
be able to:
- competently use anatomical terminology;
- explain development of the organs of CNS;
- draw the scheme of reflex arc and explain it`s structure and
functioning.

Questions
1. Neuron as structural and functional unit of nervous tissue.
2. Nervous system in phylogenesis.
3. Embryological development of the spinal cord and the brain.
4. Reflex arc, structure, function.
5. Classification of neurons.
6. Derivatives of neural crest.
7. Which structures develop from rhomencephalon?
8. Which structures develop from prosencephalon (anterior brain
vesicle)?
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 Brief information and obligatory terms

The nervous system is a set of anatomically and functionally

interrelated structures which provide regulation, coordination of the
activity of the body as a whole and its interaction with the external
environment.
The nervous system is formed by cells (neurons, neuroglia) and
intercellular substance. Neurons are highly specialized cells made up of a
body and processes. There are two types of neuronal processes -
dendrites and axons. Dendrites conduct a nerve impulse only towards the
body of the nerve cell. The main task of dendrites is to collect information.
They begin to branch like a tree near the cell body, gradually thin out and
end in the surrounding tissues. Dendrites increase the receptive surface of
neurons.
Neuron integrates extensive information and based on it makes one of
two possible decisions: either excitation or no excitation. If the total
amount of excitatory signals exceeds the total amount of inhibitory signals
by some quite definite amount, in other words, the stimulation of a neuron
exceeds a certain threshold value, then the neuron is excited. At the point
of stimulation, a series of chemical and electrical changes occur that
spread throughout the neuron. These transmitted electrical changes are
called nerve impulses or action potential. Conduction of nerve impulse is
an electrochemical process. The mechanism of a nerve impulse is based
on a change in the polarity of an electric charge inside and outside the
neuron. The concentration of ions - mainly sodium and potassium, outside
the neuron and inside it, are not the same, therefore the nerve cell at rest
is charged, negatively inside, and positively on the outside. As a result, a
potential difference appears on the cell membrane - the "resting potential".
Any changes that reduce the negative charge inside neuron and thus the
potential difference across the membrane are called depolarization.
Conduction of a nerve impulse is due to the ability of neuronal membranes
to change their electrochemical potential, i.e. the ability to depolarize.
Depolarization is "contagious": when one section of the membrane is
depolarized, it stimulates the depolarization of adjacent sections.
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 In addition to dendrites, neuron always has only one long process - the
axon. This process is always larger, longer and less branched. Rare side
branches sometimes appear only at the very end of it. The axon conducts
a nerve impulse only from the body of the neuron. As a result, the wave
of depolarization quickly runs along the axon. This is called the action
potential or nerve impulse.

Classification of neurons
Neurons can differ from each other in the number of processes, in
function, in the size of the neuron body, etc.
By the number of processes, the following types of neurons are
distinguished: single-process (unipolar), two-process (bipolar), pseudo-
unipolar and multi-process (multipolar).
According to their function, there are:
1) Sensory neurons (afferent) that have sensitive nerve endings
(receptors) that are able to perceive stumulus from the external or internal
environment, carry it to the center;
2) Motor neurons (efferent), which transmit a nerve impulse to the
working organ;
Motor neurons have to be divided at least into two groups. First,
somatic motor neurons, which regulate voluntary contraction of skeletal
muscles. Second, motor vegetative (autonomous) neurons, which regulate
involuntary organs, such as smooth muscle cells and glands.
3) Associative neurons that transmit information from sensory neurons
to motor neurons. They lie only within the central nervous system.
4) Neurosecretory neurons - capable of producing hormons. These
neurons are found in the pituitary gland, in diencephalon.
According to the size of the neuron body, there are 3 groups of
neurons: small, medium and large.
There is a relationship between morphology and function of neurons.
Pseudo-unipolar neurons are receptor cells (general sensitivity). They
accept stimuli such as pain, temperature and touch. Bipolar neurons are
cells of special sensitivity. They perceive light, olfactory, auditory and

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vestibular stimuli. Small multipolar neurons - associative, medium and
large multipolar neurons - motor.
The dendrites of sensory neurons end with sensory endings - receptors.
Receptors convert the energy of external and internal stimulation into a
process of excitation, which is transmitted to the spinal cord and brain in
the form of impulses. The nervous system plays the role of an apparatus
that perceives stimuli, analyzes incoming information and provides a
response from the body.

Nervous system in phylogenesis

The simplest unicellular organisms (amoeba) have no nervous system
and communication with the environment is carried out with the help of
fluids inside and outside the body. It is a humoral (humor - liquid), pre-
nervous, form of regulation.
In multicellular organisms, the nervous tissue takes over the
interaction of the organism with the external environment. A nervous
form of regulation appears.
With the increase in complexity of organisms, the nervous regulation
more and more dominates over humoral, so that a single neurohumoral
regulation is formed with the leading role of the nervous system. Humoral
regulation is achieved through the activity of the endocrine glands. Its
effect on the body lasts for a long period. The nervous system performs
its functions very quickly, precisely, for a short time. So, from the moment
of onset of stimuli to its realization, pass only hundredths of a second.
After eliminating the action of the stimulus, the response stops
immediately.
The nervous system goes through a number of stages in the process of
phylogenesis.
The nervous system in coelenterates, for example, in the hydra,
consists of nerve cells, numerous processes of which are connected to
each other in different directions, forming a network, which diffusely
penetrates the entire body of the animal. When any point of the body is
stimulated, the excitement spreads throughout the entire nervous network,
and the animal reacts by moving the whole body.
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 In invertebrates, nerve cells converge into separate clusters or groups,
from clusters of cell bodies are formed ganglia, from clusters of processes
- nerve trunks - nerves. At the same time, in each cell the number of
processes decreases, and they limit conduction of nerve impulse into a
certain direction.
According to the segmental structure of the annelid worm, in each
segment there are segmental ganglia and nerve trunks. Nerve trunks
connect ganglia in two directions: the transverse trunks connect ganglia
of a given segment; longitudinal ganglia connect ganglia of different
segments. Due to this, nerve impulses arising at any point in the body do
not spread along the body, but pass along the transverse trunks within the
segment. The longitudinal trunks connect all segments into one whole
body.
At the rostral end of the animal, which, when moving forward, comes
into contact with various objects of the surrounding world, develop
sensory organs, and therefore ganglia on rostral end develop more than
the rest, being the prototype of the future brain.
The tubular nervous system arose in animals, as adaptation to
environmental conditions through movement. Such a central nervous
system in chordates (lancelet) arose in the form of a metamerically
constructed neural tube with segmental nerves extending from it to all
body segments - the trunk brain. In vertebrates and humans, the trunk
brain becomes the spinal cord.
Further development of the nervous system and the emergence of the
brain are mainly due to the improvement of the receptor apparatus, in
other words, the appearance and development of the sense organs.
The emergence of new organs requires control over their activities.
The spinal cord does not perform this function. New parts of the central
nervous system are needed in addition to the spinal cord.
Since most of the sense organs arise at the end of the animal's body,
which faces towards the movement, i.e., forward, the anterior end of the
trunk brain develops in order to perceive external stimuli coming through
them. Above the spinal cord, superstructures are formed in the form of

16
different parts of the brain, which coincides with the isolation of the
anterior end of the body in the form of a head - cephalisation.

Embryogenesis of nervous system

The nervous system (systema nervosum) develops from the outer germ
layer, ectoderm, which reflects its function - the communication of the
body with the external environment.
In the early stages of embryonic development, in a certain area of the
ectoderm forms medullary plate. The cells of this plate multiply
intensively and differentiate, acquiring a narrow cylindrical shape.
The first stage in the formation of the central nervous system from this
mass of cells is its transformation from a superficial plate into a tube lying
under the rest of the ectoderm. As in many other cases, this transformation
is carried out by the formation of folds. As a result of intensive division
and uneven growth, the neural plate begins to be depressed in the center
and rise along the edges, thus forming a neural groove. Continuing this
process leads to the transformation of the neural plate into a tube. When
the edges of the neural plate meet, they fuse. The medial components of
the plate connect to each other. The lateral components, consisting of
unaltered ectoderm, also fuse together. Thus, as a result of the same
process, the neural plate turns into the wall of the neural tube, and the
superficial ectoderm closes under the place where the open neural groove
was previously located. Soon after this fusion, the neural tube and
superficial ectoderm separate from each other without retaining any traces
of the previous connection.
Almost simultaneously with the formation of the neural tube, above it
forms neural crest. It hangs from the neural tube in the form of two
ganglionic ridges. The ganglionic ridges transform into ganglia spinalia,
ganglia sensoria nervi craniales, into the peripheral part of autonomic
nervous system and also into some endocrine glands.
In the part of the neural tube, which forms the spinal cord, neurons
concentrate around cavity of neural tube, forming the gray matter. The
processes of these cells, located along the periphery of the neural tube
form white matter. The cavity of the neural tube narrows and turns into
17
the central canal of the spinal cord [canalis centralis]. At the end of 3rd
weeks of embryonic development, the rostral end of the neural tube
transforms into a saccular extension that gives rise to the brain, and the
caudal end gives rise to the spinal cord. The saccular extension on rostral
end of the neural tube soon divides into three primary cerebral vesicles (3
cerebral vesicles stage). The most anterior is the prosencephalon,
followed by the mesencephalon, the last vesicle is the rhombencephalon.
At the 2nd month of development, the first and third cerebral vesicles
split, each forming two secondary cerebral vesicles. The prosencephalon
divides into two vesicles: telencephalon and diencephalon. On each side
of the diencephalon, an eye bubble grows, which forms the nerve elements
of the retina. The optic cup formed by this outgrowth causes changes in
the ectoderm lying directly above it, which leads to the emergence of a
lens from it. Mesencephalon does not divide and becomes the third
cerebral vesicle. The rhombencephalon divides into two vesicles:
metencephalon, which includes the cerebellum and pons, and medulla
oblongata, myelencephalon.
The cavities of these vesicles remain in the adult brain in the form of
cerebral ventricles and cerebral aqueduct, filled with cerebrospinal fluid.
The ventricles of the brain communicate with each other and with the
central canal of the spinal cord.
In human embryos parts of the brain are located in the same plane only
at the very beginning of development. Later, due to the rapid growth of
the brain, bends are formed. The first to appear is the parietal bend
directed by the bulge towards the dorsal side, it is located at the level of
the midbrain. The second appears the occipital bend, which is located in
the region of the posterior cerebral vesicle, at the border between brain
and spinal cord. It is also directed dorsally. The last to appear is the
pontine bend, which is convex ventrally. It forms between the previous
two in the hindbrain region.
After formation of the cerebral vesicles, in central nervous system
undergoes complex processes of differentiation and growth. At 10-20
weeks of gestation, the migrational period in the development of the
central nervous system ends (all neurons migrate to their definite final
18
location of the brain). Due to the rapid growth of the hemispheres, sulci
appear on them, dividing the surface of the hemispheres into lobes, and
then into gyri. At the time of birth all major sulci and gyri are formed in
hemispheri cerebri. In the last months of fetal development ends
formation of the internal structures of the brain (nuclei and tracts).

Reflex
The activity of the nervous system is based on reflex activity. Reflex
is the body's response to a particular external or internal impact. A reflex
arc is a set of formations involved in the implementation of a reflex.
Depending on the complexity of the reflex act, simple and complex reflex
arcs are distinguished. As a rule, simple reflex arcs are formed for the
implementation of unconditioned (innate) reflexes. Conditioned reflexes
are characterized by complex reflex arcs.
Let’s consider the reflex arc of the somatic nervous system. The
afferent link is represented by a sensory pseudo-unipolar neuron, which
is located in the spinal ganglion. From the body of pseudo-unipolar
neuron departs one process, which divides into peripheral and central
process. The peripheral process begins with receptors in the periphery.
The area, where are located receptors, stimulation of which leads to the
emergence of a certain reflex, is called the reflexogenic zone. Nerve
impulses resulting from stimulation of receptors move to the cell body of
neuron and then along it`s central process to the spinal cord. The central
process of the sensory neuron ends on the dendrites of the intermediate
neuron.
The intermediate neuron is a small multipolar neuron with a short
axon, which conducts the impulse to the motor neuron. Motor neuron is a
large multipolar neuron, whose axon leaves the central nervous system
and ends on working organ (striated musculature).
So, we got a geometric shape in the form of an arc (Fig. 1). In this
geometric figure, three links are distinguished: 1) sensitive - carrying
information from the organ to the center, 2) intermediate - transfers
impulses from the sensory link to the motor, and 3) motor - carries out
impulses from the CNS to the working organ.
19
Fig. 1. Reflex arc. 1 – foramen intervertebrale; 2 – ganglion spinale
(sensory neuron); 3 – intermediate neuron; 4 – motor neuron.

Questions for self-control

1. Structure of neuron.
2. Classification of neurons.
3. Nervous system in phylogenesis.
4. Formation of neural tube.
5. Formation of 3 and 5 brain vesicles, their derivatives.
6. Structure of reflex arc.

20
 Practical Lesson 2
Spinal cord. Meninges of the spinal cord.

Purpose of the lesson:

- to study anatomy of the spinal cord;
- to study anatomy of the meninges of the spinal cord.
After studying this topic, students have to:
know:
- topography of the spinal cord;
- external and internal morphology of the spinal cord;
- structure and derivatives of the meninges of the spinal cord;
- spaces between the meninges of the spinal cord.
be able to:
- competently use anatomical terminology;
- show all the details of external structure of the spinal cord on
anatomical preparations;
- draw the scheme of cross section of the spinal cord and explain it`s
structure.

Questions
1. What is the upper and the lower border of the spinal cord?
2. Segmentotopy of the spinal cord.
3. External features of the spinal cord.
4. Distribution of grey matter in the cross section of the spinal cord.
5. Distribution of white matter in the cross section of the spinal cord.
6. Dura mater.
7. Arachnoidea mater.
8. Pia mater.

Brief information and obligatory terms

Topography. Spinal cord (medulla spinalis) is located inside canalis

vertebralis. Upper border can be discerned by 3 criteria: a) foramen
21
magnum; b) exit of radices of 1st n. spinalis cervicalis; c) decussatio
pyramidum. Above that level medulla spinalis continues into medulla
oblongata. Lower border of medulla spinalis is at the level of 1st-2nd
lumbar vertebra.
Morphologia externa. Medulla spinalis in adults is about 43 cm.
long (45 cm. in males, 41-42 cm. in females) cylindrical cord flattened
from front to back with a mass of 34-38 gr., or roughly 2% of brain`s
mass.
Diameter of medulla spinalis is uneven. It has two enlargements
along its length, which correspond to the roots of nerves of the upper and
lower limbs: cervical enlargement (intumescentia cervicalis) and
lumbosacral enlargement (intumescentia lumbosacralis). In these parts
spinal cord has comparatively more neurons to regulate limbs.
Below, at the level of the 1st-2nd lumbar vertebra, medulla spinalis
terminates as a conic tip, called conus medullaris. The conus medullaris
continues distally into a thread-like structure called the spinal part of filum
terminale (pars spinalis fili terminalis), which is the atrophied lower
segment of the spinal cord. Pars spinalis fili terminalis can be also called
filum terminale internum. It is about 15 cm. long and surrounded by
radices of lumbar, sacral and coccygeal spinal nerves. That complex is
called cauda equina or horsetail. Below the level of SII vertebra filum
terminale is made only by remnants of meninges and is called filum
terminale externum. This part is about 8 cm. long and terminates at the
level of CoII vertebra by fusion with it`s periosteum.
On the surface of medulla spinalis could be identified 1 fissure and
5 sulcuses. Anterior median fissure (fissura mediana anterior) is on the
anterior midline and enters into the tissue of the spinal cord deeper then
posterior median fissure (sulcus medianus posterior). These lines separate
the spinal cord into 2 symmetrical right and left halves. At the depth of
sulcus medianus posterior is present septum medianum posterior, which
is made by connective tissue and glial elements, penetrating the substance
of the spinal cord and extending almost to the central canal. At the depth
of fissura mediana anterior is lodged a. spinalis anterior.

22
 Laterally could be seen sulcus anterolateralis et sulcus
posterolateralis. In sulcus anterolateralis exit motor radices of spinal
nerves, which are formed by the axons of the motor somatic neurons from
anterior horns of the spinal cord. Into sulcus posterolateralis enter sensory
radices of the spinal nerves (Bell–Magendie law: anterior roots of spinal
nerves contain only motor fibers and posterior roots only sensory fibers),
which are formed by the axons of sensory pseudounipolar neurons of
ganglion spinale (posterior root ganglion). Ganglion spinale lies on radix
posterior. At the level of foramina intervertebralia radix anterior et
posterior fuse and form n. spinalis. Overall, there are 31 pairs of the spinal
nerves forming from radices. The portion of medulla spinalis with
corresponding pair of radix anterior et posterior (2 anterior and 2
posterior) is called the segment of spinal cord. So, corresponding for 31
pairs of the spinal nerves there are 31 segments of the spinal cord: 8
cervical, 12 thoracic, 5 lumbar, 5 sacral and 1-3 coccygeal segments. To
each segment of the spinal cord belongs a portion of the body for sensory
and motor innervation. Segments in anatomy and neurology are named
and abbreviated as: segmenta cervicalia, CI-CVIII; segmenta thoracica,
ThI-ThXII; segmenta lumbalia, LI-LV; segmenta sacralia, SI-SV; segmenta
coccygea, CoI-CoIII.
The length of medulla spinalis is shorter then the length of canalis
vertebralis, which means that segments of medulla spinalis are not
necessarily located at the same level as corresponding vertebra. For
doctors, especially for neurologists and neurosurgeons, it is important to
know exactly topographical relation of the segments of medulla spinalis
and columna vertebralis. It is needed for performing the lumbar puncture
at correct and safe level, for evaluation patient`s condition and for making
medical prognosis after fractures of vertebra with damage of the spinal
cord.
Segmentotopy of spinal cord or topography of the segments of spinal
cord can be identified by following next rules:
- upper cervical segments are located at the same level as
corresponding cervical vertebrae;
- lower cervical segments are located one vertebra above (so, last
cervical segment CVIII is at the level of CVII cervical vertebra);
23
 - upper thoracic segments are located one vertebra above;
- middle thoracic segments are located two vertebrae above;
- lower thoracic segments are located tree vertebrae above (so, last
thoracic segment ThXII is at the level of ThIX cervical vertebra);
- lumbar segments LI-LV are at the level of ThX – ThXI vertebrae;
- sacral segments SI-SV are at the level of ThXII – LI vertebrae;
- coccygeal segments are at the level of LI vertebra;
- as anatomical variation medulla spinalis can reach level of L II
vertebra, so lower end of medulla spinalis, for precaution, is
considered to be at LII vertebra level.

Morphologia interna. In the cross-section of the spinal cord is

present characteristic distribution of grey matter in the shape of letter “H”
or “butterfly” and white matter around it. At the center of the grey matter
passes central canal (canalis centralis). It is the remnant of the cavity of
the neural tube from embryonic development and filled with cerebrospinal
fluid. Upper end of canalis centralis communicates with IV ventricle and
lower increases in diameter in the region of conus medullaris and becomes
terminal ventricle (ventriculus terminalis). However, it is usually absent
in adults and initially was described only in children less than 5 years old.
The walls of canalis centralis are lined by ependymal cells, around which
is located central gelatinous substance (substantia gelatinosa centralis).
In adults canalis centralis can be obliterated at some sections or along
entire length.

Grey matter (substantia grisea)

Along medulla spinalis on the right and left from canalis centralis
are located symmetrical grey columns (columnae griseae). In front and
behind from canalis centralis columnae griseae are attached one to another
by thin laminas made of grey matter, called anterior and posterior grey
commissure of spinal cord (commissura grisea anterior et posterior
medullae spinalis).
In each columna grisea can be discerned anterior part – ventral
column (columna ventralis s. anterior) and posterior part – dorsal column
24
(columna dorsalis s. posterior). At the level of CVIII-LII segments of
medullae spinalis substantia grisea laterally bulges to form lateral
columns (columnae laterales). Above and below this given level
columnae laterales are absent.
In cross-sections of medulla spinalis, columnae griseae on each side
have the appearance of horns. The wider ventral or anterior horn (cornu
ventrale s. anterius) and narrow dorsal or posterior horn (cornu dorsale s.
posterius) correspond to columna ventralis et columna dorsalis,
respectively. In addition, laterally is present lateral horn (cornu laterale),
which corresponds to columna lateralis.

Fig. 2. Medulla spinalis in cross section. 1 - pia mater medullae

spinalis; 2 - sulcus medianus posterior; 3 – sulcus intermedius posterior;
4 - radix posterior nervi spinalis; 5 - sulcus posterolateralis; 6 - zona
terminalis; 7 - stratum spongiosum (zona spongiosa); 8 - substantia
gelatinosa; 9 - cornu posterius medullae spinalis; 10 - cornu laterale; 11 -
ligamentum denticulatum; 12 - cornu anterius medullae spinalis; 13 -
radix anterior nervi spinalis; 14 - arteria spinalis anterior; 15 - fissura
mediana anterior.

In cornu ventrale are located large efferent or motor neurons. These

neurons are grouped into 5 nuclei: cenral, anterolateral, anteromedial,
25
posterolateral and posteromedial. Cornua dorsalia are represented by
smaller neurons, which mostly synapse with the axons of pseudounipolar
neurons located in the dorsal root ganglion (ganglion spinale) and entering
into medulla spinalis in sulcus posterolateralis. In white matter (substantia
alba), which is immediately attached to apex cornus dorsalis is called
terminal zone (zona terminalis). Substantia grisea of cornua dorsalia is
uneven. There can be distinguished several different in structure zones.
Most dorsal is spongy zone (stratum spongiosum), formed by glial
network with large loops and some intermediate neurons. Ventrally from
stratum spongiosum lies gelatinous substance (substantia gelatinosa),
comprised primarily by glial structures and some tiny neurons (Fig. 1).
Axons and dendrites of neurons from substantia gelatinosa, stratum
spongiosum and some diffuse neurocytes funiculares (look at the
reference for types of neurons below) of substantia grisea medullae
spinalis are forming intersegmental communications. Usually they end
with synapses on motor neurons in cornu ventrales of own segment or
neighboring segments above and below. Axons from cornu dorsale spread
to cornu ventrale on the periphery of substantia grisea, forming thin layer
of white matter, which is divided into anterior, lateral and posterior
fascicles (fasciculi proprii ventrales, laterales et dorsales). Functionally,
it leads to situation, when stimulation of one skin region causes activation
of not the only one directly responsible segment of medulla spinalis, but
several neighboring segments as well. As a result, simple reflex can
involve into efferent reaction whole group of muscles, enabling
coordinated movement, which however remains involuntary.
Among neurons of substantia grisea medullae spinalis can be classified
next types of neurons:
 neurocytus radiculatus, which axons leave medulla spinalis in
radices ventrales;
 neurocytus internus, which axons form synapses within limits of
substantia grisea medullae spinalis;
 neurocytus funicularis, which axons pass in substantia alba in
separate bundles by forming tracts or specific pathways.

26
 Neurons of cornu dorsale usually are intermediate neurons and they
are organized into next major nuclei: substantia gelatinosa, described
previously on apex of cornu dorsale, nucleus proprius cornu posterior,
which is at the center of cornu dorsale and thoracic nucleus (nucleus
thoracicus) (Clark nucleus), which is at the base of cornu dorsale.
Intermediate zone of substantia grisea is located between cornu
ventrale et dorsale, which is at the level of CVIII-LII segments forms cornu
laterale. In cornu laterale are present next collections of grey matter:
medial and lateral intermediate substantance (substantia
intermediomedialis et substantia intermediolateralis). Substantia
intermediomedialis takes part in formation of tractus spinocerebellaris
anterior. Substantia intermediolateralis is the center of sympathetic
innervation and it`s axons exit medulla spinalis in sulcus anterolateralis
together with the axons of motor neurons from cornu ventrale, forming
radix anterior s. ventrale. At the level of cervical segments between cornu
ventrale et dorsale, at the level of upper thoracic segments – between
cornu laterale et dorsale is located reticular formation (formatio
reticularis).
Substantia grisea medulla spinalis, fasciculi proprii together with
radices ventrales et dorsalis nn. spinales forms segmental apparatus of
spinal cord. It`s main function – unconscious local reflexes.

White matter (substantia alba)

Substantia alba in medulla spinalis is located outside of substantia
grisea. Sulcuses and fissure on the surface of the spinal cord divide
substantia alba into 3 funiculuses. Anterior funiculus (funiculus anterior)
is located between fissura mediana anterior et sulcus anterolateralis. In
substantia alba behind fissura mediana anterior is present commissura
alba, which connects right and left funiculi anteriores. Posterior funiculus
(funiculus posterior) is located between sulcus medianus posterior et
sulcus posterolateralis. Lateral funiculus (funiculus lateralis) is located
between sulcus anterolateralis et posterolateralis.
Substantia alba of medulla spinalis is formed by axons of neurons
having different projections. There can be distinguished:
27
  short associative fibers, which connect segments of medulla
spinalis;
 ascending (afferent, sensory) fibers, which reach centers of
telencephalon et cerebellum;
 descending (efferent, motor) fibers, which reach motor neurons in
cornu ventrale medullae spinalis.
Funiculus dorsalis has only ascending tracts, funiculus ventralis –
mostly descending tracts, funiculus lateralis – ascending and descending
tracts.
Funiculus ventralis has next tracts: tractus corticospinalis anterior,
tractus reticuospinalis, tractus spinothalamicus anterior, tractus
tectospinalis, fasciculus longitudinalis dorsalis, tractus vestibulospinalis.
Funiculus lateralis has next tracts: tractus spinocerebellaris dorsalis,
tractus spinocerebellaris ventralis, tractus spinothalamicus lateralis,
tractus corticospinalis lateralis, tractus rubrospinalis.
Funiculus dorsalis has next tracts: fasciculus gracilis et cuneatus.
At different levels of medulla spinalis the ratio of space occupied by
substantia alba et substantia grisea varies. In the lower segments, in the
sacral segments particularly, substantia grisea in the cross section covers
more area then substantia alba. This could be explained by decreasing
amount of motor fibers descending from brain and small amount of
sensory fibers, which only start to collect into ascending tracts at this
topographical level. At the upper levels, ascending tracts gradually
occupy more space. In the cross sections of middle thoracic and upper
cervical segments, area of substantia alba is larger than of substantia
grisea. In intumescentia cervicalis et lumbosacralis substantia grisea
covers more area then substantia alba, because in this enlargements of
medulla spinalis are located neurons responsible for relatively big
anatomical regions – upper and lower extremities, respectively.

Meninges of medulla spinalis

Medulla spinalis is covered by 3 meninges of mesenchymal origin.
Outer – dura mater or pachymeninx (dura mater spinalis). Middle –
28
arachnoid mater (arachnoidea mater spinalis), which is separated from
previous covering by subdural space (spatium subdurale). Inner – pia
mater (pia mater spinalis), which intimately covers medulla spinalis.
Between pia mater et mater arachnoidea is present subarachnoid space
(spatium subarachnoidale). Quite often pia mater et mater arachnoidea
are viewed as one – leptomeninx.
Dura mater spinalis is like an oblong sac made by thick and strong
(comparing to other meninges) walls, which is located in canalis
vertebralis and encompass the cerebrospinal fluid, medulla spinalis with
radices nn. spinales and other meninges. Outer surface of dura mater is
separated from periosteum of canalis vertebralis by epidural space
(spatium epidurale s. cavitas epiduralis). Spatium epidurale is filled with
adipose tissue and occupied by plexus venosus vertebralis internus.
Above, dura mater spinalis strongly attaches to edges of foramen magnum
and continues into dura mater encephali. In canalis vertebralis dura mater
spinalis fuses with periosteum in foramina intervertebralia and with
collagen fibers continues into perineurium of nn. spinales. Moreover, dura
mater spinalis is strengthened by fibrous fibers attached to lig.
longitudinale posterior. Inner surface of dura mater spinalis is separated
from mater arachnoidea spinalis by narrow space - subdural space
(spatium subdurale), which is pierced by multiple thin collagen fibers.
Above spatium subdurale spinalis freely communicates with spatium
subdurale encephali. Below it terminates at the level of SII vertebra. Below
SII vertebra fibers of dura mater spinalis continue as part of filum
terminale externum medullae spinalis.
Arachnoidea mater spinalis is a thin covering beneath dura mater
spinalis, which mesh-like structure gave the term “arachnoidea” (spider).
Arachnoidea mater fuses with dura mater at the edges of foramina
intervertebralia. Tight and strong attachments of the meninges to the
edges of foramina intervertebralia have to be considered as preventive
mechanism against leakage of cerebrospinal fluid from “sac” made by
dura mater.
Pia mater spinalis intimately covers the surface of medulla spinalis
and adheres to it. Connective tissue fibers from pia mater accompany
blood vessels and enter together into the tissue of medulla spinalis. Pia
29
mater spinalis and arachnoidea mater spinalis are separated by
subarachnoid space (spatium subarachnoideum s. cavitas
subarachnoidalis), which is filled with the cerebrospinal fluid (liquor
cerebrospinalis), total volume of which is about 120-140 ml. Spatium
subarachnoideum medullae spinalis forms local caudal enlargement,
surrounding cauda equina, which is called lumbar cistern (cisterna
lumbalis). It extends from the level of conus medullaris to the inferior end
of the subarachnoid space (SII level). During the lumbar puncture, liquor
cerebrospinalis is received for analysis from the cisterna lumbalis. In
Russian textbooks cisterna lumbalis by some tradition received term
cisterna terminalis.
In the lower parts, spatium subarachnoideum contains radices nn.
spinales surrounded by liquor cerebrospinalis. At this level (below L II
vertebra), there is ideal spot to get the sample of liquor cerebrospinalis for
analysis or to reduce the pressure of liquor cerebrospinalis in the urgent
situation. At upper parts spatium subarachnoideum medullae spinalis
freely continues into spatium subarachnoideum encephali. Spatium
subarachnoideum is pierced by multiple thin collagen fibers and plates,
which connect arachnoidea mater and pia mater medullae spinalis. From
lateral surfaces of medulla spinalis (from it`s pia mater), between radices
ventrales et dorsales on right and left side emerge thin but strong plate –
denticulate ligament (lig. denticulatum). Lig. denticulatum has continuous
origin point from pia mater, it spreads laterally and inserts itself with 20-
30 “teeth” to arachnoidea et dura mater at the edges of foramina
intervertebralia. The highest “tooth” of lig. denticulatum begins at the
level of foramen magnum, the lowest – between radices nn. spinales ThXII
and LI. Thus, medulla spinalis is being fixed and “hangs” in the frontal
plane in spatium subarachnoideum by lig. denticulatum. On the posterior
surface of medulla spinalis along sulcus medianus posterior from pia
mater to arachnoidea mater extends fibrous plate/sept, which is more
developed in cervical region. It is named intermediate cervical septum
(septum cervicale intermedium). Besides lig. denticulatum and septum
cervicale intermedium in spatium subarachnoideum are present numerous
radially spreading collagen fibers connecting pia mater to arachnoidea et
dura mater.

30
 In the lumbar and the sacral parts of canalis vertebralis, where cauda
equina is located, lig. denticulatum and posterior median sept are absent.
Adipose tissue and plexus venosus vertebralis internus, all the meninges,
liquor cerebrospinalis and ligaments do not compress medulla spinalis
during movements of columna vertebralis, quite contrary, all of them
protect medulla spinalis. Medulla spinalis is always fixed exactly at the
center of canalis vertebralis and changes it`s position together with
columna vertebralis during all types of movements. Fixation of medulla
spinalis prevents it`s concussion by hitting the wall of canalis vertebralis.
In conclusion, fixation of the spinal cord in canalis vertebralis is achieved
by presence of next factors:
- cerebrospinal fluid;
- ligamentum denticulatum;
- posterior median sept/plate, made by collagen fibers, between pia
mater and dura mater along sulcus medianus posterior;
- multiple radially spreading collagen fibers between pia mater and
dura mater;
- fixation of dura mater to the edges of foramina intervertebralia,
foramen magnum et lig. longitudinale posterior;
- radices nn. spinales cervicalis (because of horizontal direction);
- continuation into the brain stem.

Questions for self-control

1. Name all the depressions on the surface of the spinal cord, explain
them.
2. Name all the anatomical structures on the surface of the spinal
cord, which are located between sulci and fissure. How are they
formed?
3. Name the widest portions of the spinal cord. How and why do the
form?
4. Name the nuclei in the spinal cord, explain them.
5. Identify tracts, which are located in each funiculus of the spinal
cord.
6. Segment of the spinal cord.
31
7. Please sum up all the elements, which take part in fixation of the
spinal cord.
8. Try to explain how cerebrospinal liquid protects the spinal cord.
9. Name all the anatomical elements, which directly (mechanically)
fix the spinal cord and identify in which planes and axes they
restrict the movements.
10. Based on your anatomical knowledge propose where and
how can you with a smaller risk get the sample of the
cerebrospinal liquid?
11. Based on your anatomical knowledge explain at which level
of the vertebral column fractures of the vertebras are more
dangerous.
12. Identify and name pathways passing in funiculus anterior.
13. Identify and name pathways passing in funiculus posterior.
14. Identify and name pathways passing in funiculus lateralis.

32
 Practical Lesson 3
Rhombencephalon

Purpose of the lesson:

- to study anatomy of pons;
- to study anatomy of myelencephalon;
- to study anatomy of cerebellum.
After studying this topic, students have to:
know:
- topography of the pons, myelencephalon and cerebellum;
- external and internal morphology of the parts of the rhombencephalon.
be able to:
- competently use anatomical terminology;
- show all the details of external structure of the rhombencephalon on
anatomical preparations;
- draw the scheme of cross section of pons, myelencephalon and
cerebellum and explain their structure.

Questions
1. What is the upper and the lower border of myelencephalon?
2. What is the upper and the lower border of pons?
3. External features of myelencephalon.
4. External features of pons.
5. External features of cerebellum.
6. Distribution of grey matter in the cross section of myelencephalon.
7. Distribution of white matter in the cross section of myelencephalon.
8. Distribution of grey matter in the cross section of pons.
9. Distribution of white matter in the cross section of pons.
10. Distribution of grey matter in the cross section of cerebellum.
33
11. Structure of fossa rhomboidea.
12. Structure of IV ventricle.

Brief information and obligatory terms

General overview of the brain

Encephalon with surrounding it meninges is located in cranial

cavity. That is why it`s convex superolateral surface by shape corresponds
to internal concave surface of calvaria. Inferior surface of the brain has a
complex layout, which corresponds to the surface of fossae cranii of basis
cranii internae.
The weight of the brain in adults ranges from 1100 gr. to 2000 gr.;
in average in males it is 1394 gr.; in females – 1245 gr. The weight of the
brain in the age interval from 20 to 60 years remains maximal and
relatively stable for each individual. After 60 years old, the mass and the
volume of the brain reduce.
During visual inspection of the brain there are clearly visible 3 large
parts: hemispheriae cerebrales, cerebellum and the brain stem.
Cerebral hemispheres (hemispheriae cerebrales s. hemispheriae
cerebri) is the most developed, biggest, functionally most important part
of CNS. Hemispheriae cerebrales hang over and obscure all other parts of
the brain. Hemispherium cerebralis dexter et hemispherium cerebralis
sinister are separated one from another by deep longitudinal cerebral
fissure (fissura longitudinalis cerebralis), which below, at the depth
reaches corpus callosum. Posteriorly fissura longitudinalis cerebralis joins
transverse cerebral fissure (fissura transversa cerebralis), which
separates hemispheriae cerebrales from cerebellum.
On superolateral, medial and inferior (basal) surfaces hemispheriae
cerebrales have shallow and deep sulci. Deep sulci separate lobi
cerebrales one from another on each hemispherium cerebralis. Shallow
sulci separate gyri cerebrales one from another.

34
 Facies inferior or the base of the brain is formed by ventral surfaces
of hemispheriae cerebrales, cerebellum and ventral surface of the brain
stem.
On the base of the brain, in anterior portion, which is made by
inferior surface of lobus frontales, can be found olfactory bulbs (bulbi
olfactorii). They look like two oval swellings, located laterally from
fissura longitudinalis cerebralis. To the ventral surface of bulbi olfactorii
from cavum nasi through lamina cribrosa ossis ethmoidalis reach 15-20
nn. olfactorii (I pair of cranial nerves). During withdrawal of the brain
from cranial cavity nn. olfactorii rupture, that is why, they are not visible
on anatomical preparations of the brain.
From bulbus olfactorius backwards extends olfactory tract (tractus
olfactorius). Posterior portions of tractus olfactorius widen and thicken,
forming olfactory trigone (trigonum olfactorium). Posterior side of
trigonum olfactorium continues into small area, perforated by multiple
small openings, called anterior perforated substance (substantia perforata
rostralis [anterior]). Here through openings of substantia perforata
anterior arteries enter into brain. Medially from substantia perforata
anterior lies thin, grey in colour lamina terminalis. It limits posterior
portion of fissura longitudinalis cerebralis. Behind to lamina terminalis
adjoins optic chiasm (chiasma opticum). It is formed by fibers of n.
opticus (II pair of cranial nerves), coming from orbita. From chiasma
opticum posterolaterally continue two optic tracts (tractus opticus).
To the posterior surface of chiasma opticum adjoins tuber cinereum
(tuber cinereum). Inferior portion of tuber cinereum narrows, forming
infundibulum (infundibulum). On the inferior end of infundibulum is
located hypophysis (hypophysis), an endocrine gland. Hypophysis lies in
sella turcica of basis cranii interna and during withdrawal of the brain
from cranium in remain in sella turcica, because of rupturing of
infundibulum.
To tuber cinereum from behind adjoin two white spheroid elevations
– mammillary bodies (corpora mammillaria). Behind from tractus opticus
are present two large white longitudinal bundles – cerebral peduncles
(pedunculi cerebri), between which is located interpeduncular fossa
35
(fossa interpeduncularis), bounded in front by corpora mammillaria. The
floor of fossa interpeduncularis is penetrated by multiple vessels, forming
posterior perforated substance (substantia perforata posterior). On the
medial surfaces of pedunculi cerebri emerge roots of right and left
oculomotor nerves (n. oculomotorius, III pair of cranial nerves). On the
lateral surfaces of pedunculi cerebri pass trochlear nerves (n. trochlearis,
IV pair of cranial nerves). Radices n. trochlearis, in a way, are unique,
because they emerge on the dorsal surface of the brain, not ventrally like
11 other pairs of nn. craniales. Exact place of exit of radices n. trochlearis
is – behind colliculi superiores mesencephali, on the lateral sides of
frenulum veli medullare superioris.
Pedunculi cerebri exit from upper part of pons (pons), which look
like a pillow from ventral point of view. Laterally pons by means of
middle cerebellar peduncles (pedunculi cerebellaris media) continues
into cerebellum.
In the border between pons et pedunculi cerebellaris media on each
side exits trigeminal nerve (n. trigeminus, V pair of cranial nerves).
Below pons is visible ventral surface of medulla oblongata,
represented by two pyramids (pyramis medullae oblongatae), which are
separated one from another by fissura mediana anterior. Laterally from
pyramis medullae oblongatae bulges above the surface round structure –
olive (oliva). On the border between pons et medullae oblongatae
ventrally closer to the midline exit roots of abducent nerve (n. abducens,
VI pair of cranial nerves). Laterally from the radices n. abducentis,
between olivae et pedunculi cerebellaris media exit roots of facial nerve
(n. facialis, VII pair of cranial nerves) and more laterally – roots of
vestibulocochlear nerve (n. vestibulocochlearis, VIII pair of cranial
nerves). Dorsally from oliva, in sulcus posterolateralis emerge and then
pass forward roots on next cranial nerves: glossopharyngeal nerve (n.
glossopharyngeus, IX pair of cranial nerves), vagus nerve (n. vagus, X
pair of cranial nerves) and accessory nerve (n. accessorius, IX pair of
cranial nerves). Partially roots of the accessory nerve also emerge from
upper portion of medulla spinalis – spinal roots (radices spinales s. pars
spinalis). In the sulcus, which separates pyramis medullae oblongatae

36
from oliva exit roots of hypoglossal nerve (n. hypoglossus, XII pair of
cranial nerves).
In the sagittal section of encephalon, passing along fissura
longitudinalis cerebralis, are visible facies medialis hemispheri cerebri,
some structures of the brain stem (truncus encephalicus) and of the
cerebellum.
Considerably bigger facies medialis hemispheri cerebri hangs over
smaller in size cerebellum and truncus encephalicus. On facies medialis
hemispheri cerebri as well as on other surfaces are present sulci cerebrales
separating gyri cerebrales.
In the sagittal section of encephalon, facies medialis lobi frontalis,
parietalis et occipitalis are separated from corpus callosum (biggest
commissural fibers of encephalon) by sulcus of corpus callosum (sulcus
corporis callosi). The middle portion of corpus callosum is called trunk
or body (truncus), anterior portion bends down and forms genu (genu).
Further down genu corporis callosi thins, continues into rostrum (rostrum)
and then into lamina terminalis (lamina terminalis). Lamina terminalis, as
it was noted previously, fuses with anterior surface of chiasma opticum.
The posterior portion of corpus callosum thickens and forms splenium
(splenium).
Beneath the corpus callosum is located thin white bundle – fornix
(fornix). Fornix passes forward, gradually bends in an arch downwards
and continues into column (columna (fornicis)). Lower parts of each
columna fornicis descend to lamina terminalis, then diverge laterally, pass
backwards and end in corpora mammillaria. Between columnae fornicis
behind and lamina terminalis in front is located transverse bundle of fibers
– anterior commissure (commissura rostralis [anterior]). This
commissure, as well as transversely passing fibers of corpus callosum,
connect hemispheriae cerebrales between one another.
Between corpus callosum above and in front, rostrum corporis
callosi, lamina terminalis et commissura anterior below and columna
fornicis behind stretches thin sagittally oriented plate – septum
pellucidum (septum pellucidum).

37
 All the structures, described above, belong to telencephalon
(telencephalon s. cerebrum). Structures, located lower, except
cerebellum, belong to truncus encephalicus. The most anterior part of
truncus encephalicus is formed by thalamus (thalamus). Thalamus is
located below corpus fornicis et truncus corporis callosi and behind
columnae fornicis. On the sagittal section is visible only medial surface
of thalamus, on which is present interthalamic adhesion (adhesio
interthalamica). The medial surface of each thalamus limits cavity of
ventriculus tertius from lateral side. Between anterior end of the thalamus
and columnae fornicis is located interventricular foramen (foramen
interventriculare), through which ventriculus tertius communicates with
ventriculus lateralis. From foramen interventriculare backwards, just
below thalamus extends hypothalamic sulcus (sulcus hypothalamicus).
Structures, which are located below that sulcus, belong to hypothalamus
(hypothalamus) and form the floor of ventriculus tertius. These are
chiasma opticum, tuber cinereum, infundibulum, hypophysis et corpora
mammillaria.
Above and behind thalamus, beneath splenium corporis callosi, is
located pineal gland (glandula pinealis s. corpus pineale). The anterior
parts of corpus pineale join between one another by thin transverse
bundle, which has round shape on sagittal sections, called posterior
commissure (commissura posterior s. commissura epithalamica).
Thalamus, hypothalamus, ventriculus tertius, corpus pineale belong to
diencephalon (diencephalon).
Below the thalamus are located structures, which belong to
mesencephalon (mesencephalon). Below corpus pineale lies tectal plate
or quadrigeminal plate (lamina tecti s. lamina quadrigemina [s. tectum
mesencephalicum]), which consists of colliculi superiores et colliculi
inferiores. Ventrally from lamina tecti lie cerebral peduncles (pedunculi
cerebri). The border between lamina tecti et pedunculi cerebri runs at the
level of aqueduct of midbrain or cerebral aqueduct (aqueductus
mesencephali s. aqueductus cerebri). Aqueductus cerebri communicates
cavities of ventriculus tertius et ventriculus quartus. Further backwards in
sagittal sections are located structures of pons et cerebellum, which
belong to metencephalon, and structures of medulla oblongata (medulla
38
oblongata s. myelencephalon s. bulbus). The common cavity for these
parts of the brain is IV ventricle (ventriculus quartus). The floor of
ventriculus quartus is made by dorsal surface of pons et medulla
oblongata, forming together rhomboid fossa (fossa rhomboidea). Thin
plate of substantia alba, which extends from cerebellum to lamina tecti is
called superior medullary velum (velum medullare craniale [superius]).
From the inferior surface of cerebellum backwards, to medulla oblongata,
extends inferior medullary velum (velum medullare caudale [inferius]).
Encephalon can be divided into 5 parts, which develop from 5 brain
vesicles: telencephalon, diencephalon, mesencephalon, metencephalon
and myelencephalon.

The rhombencephalon
The rhombencephalon consists of the myelencephalon and
metencephalon. It has developed from hindbrain. It`s cavity is ventriculus
quartus.

Medulla oblongata
Topography. Medulla oblongata s. myelencephalon s. bulbus is
located between pons above and medulla spinalis below. The lower border
can be discerned by 3 criteria: a) foramen magnum; b) exit of radices of
1st n. spinalis cervicalis; c) decussatio pyramidum. The upper border of
medulla oblongata dorsally runs along stria medullaris ventriculi quarti,
ventrally – along radices n. abducentis, n. facialis et n. vestibulocochlearis
in medullopontine sulcus (sulcus bulbopontinus).
Morphologia externa. The upper portion of medulla oblongata in
comparison with the lower one is wider. Medulla oblongata resembles
cone or onion, that is why it received the name bulbus (onion in Latin).
Medulla oblongata in adults is about 25 mm. long.
In medulla oblongata can be discerned ventral, dorsal and 2 lateral
surfaces, separated among themselves by sulci et fissurae, which continue
up from medulla spinalis and have same names: anterior median fissure
(fissura mediana ventralis s. anterior), posterior median fissure (sulcus
39
medianus dorsalis s. posterior), anterolateral sulcus (sulcus
ventrolateralis s. anterolateralis), posterolateral sulcus (sulcus
dorsolateralis s. posterolateralis).
On each side from fissura mediana anterior are located longitudinal,
slightly thicker above bundles called pyramids (pyramides). In the lower
portion of medulla oblongata, at the border with medulla spinalis, fibers
of pyramides cross into opposite side and enter into funiculi laterales. This
crossing received the name decussation of pyramids (decussatio
pyramidum s. decussatio motoria). And it also serves as border criteria
between medulla oblongata et medulla spinalis. Laterally from pyramides
in the upper portion of medulla oblongata on each side lie inferior olive
(oliva), which are separated from pyramides by sulcus anterolateralis,
which sometimes can be called sulcus preolivaris. From that sulcus exit
radices n. hypoglossi.
On the dorsal surface, on each side from sulcus medianus dorsalis
are located gracile and cuneate fasciculus (fasciculus gracilis et fasciculus
cuneatus), which extend up from medulla spinalis and are separated
among themselves by sulcus intermedius dorsalis. Fasciculus gracilis lies
medially and above widens to form gracile tubercle (tuberculum gracile).
Fasciculus cuneatus lies more laterally and above widens to form cuneate
tubercle (tuberculum cuneatum). Between oliva and fasciculus cuneatus,
in sulcus dorsolateralis (can be called sulcus posterolateralis) exit radices
n. glossopharyngeus, n. vagi et n. accessorii.
The dorsal part of funiculus lateralis above widens and with joining
fibers from nuclei gracilis et n. cuneatus form pedunculus cerebellaris
inferior. Portion of medulla oblongata limited below and laterally by
pedunculi cerebellaris inferior takes part in formation of fossa
rhomboidea, which is the floor of IV ventricle.
Morphologia interna. In the cross section of medulla oblongata at
oliva level can be seen arrangement of grey and white matter different
from the one in medulla spinalis. In medulla oblongata are present 4
groups of nuclei with distinct functions and white mater is distributed in
between. Groups of nuclei:
1. nuclei olivares
40
 2. gracilis et cuneatus
3. nuclei formatio reticularis
4. nuclei nervi craniales

Fig. 3. Medulla oblongata in cross section. 1 - ventriculus quartus; 2

- nucleus hypoglossus; 3 - nucleus dorsalis n. vagi; 4 - nucleus tractus
solitarii; 5 - nucleus ambiguus; 6 - nucleus tractus spinalis n. trigeminalis;
7, 8 - nuclei vestibulares; 9 – region for formatio reticularis; 10 - nuclei
gigantocellulares; 11 – tractus spinocerebellaris dorsalis; 12 - tractus
spinocerebellaris ventralis; 13 - tractus corticospinalis; 14 - region for
lemniscus medialis; 15- nucleus olivaris inferior; 16 – n. hypoglossus; 17
– n. vagus; 18 – fasciculus longitudinalis medialis; 19 – tractus
tectospinalis; 20 – nucleus olivaris accessorius medialis; 21 - nucleus
olivaris accessorius posterior.

In ventrolateral part are present right and left inferior olivary

complex (nuclei olivares caudales). They are bending to form complex
41
structure with hilum of inferior olivary nucleus (hilum nuclei olivares
caudales) directed medially and superiorly. Just above nuclei olivares
caudales lies reticular formation of medulla oblongata (formatio
reticularis medullae oblongata), which is formed by network of
interloping fibers and nuclei formatio reticularis in between. Between
nuclei olivares caudales lie internal arcuate fibers (fibrae arcuatae
internae), which are formed by axons of neurons lying in gracile and
cuneate nucleus (nuclei gracilis et cuneatus). This fibers form medial
lemniscus (lemniscus medialis), which after crossing to opposite side in
decussation of medial lemniscus (decussatio lemniscus medialis s.
decussatio sensoria) convey proprioceptive information to the cortex. In
the superolateral portion of medulla oblongata in the cross section are
visible inferior cerebellar peduncles (pedunculus cerebellaris inferior).
More ventrally lie fibers of tractus spinocerebellaris anterior et tractus
rubrospinalis. In ventral portion of medulla oblongata laterally from
fissura mediana anterior lie pyramides. Above decussatio lemniscus
medialis is located posterior longitudinal fascicle (fasciculus
longitudinalis dorsalis). conscious pathway
In the dorsal portion of medulla oblongata dominate ascending
sensory pathways to cortex cerebri, brainstem and cerebellum, in the
ventral – descending motor pyramidal pathways. In medulla oblongata are
located nuclei for IX (nucleus ambiguus et salivatorius inferius), X
(nucleus tractus solitarii, ambiguus et dorsalis n. vagi), XI (nucleus
motorius n. accessorii), XII (nucleus motorius n. hypoglossi) pairs of
cranial nerves.

Metencephalon
Metencephalon includes pons, located ventrally and cerebellum –
dorsally. Metencephalon is part of rhombencephalon and their cavity is
ventriculus quartus.

Pons
Topography. Pons is located between medulla oblongata below and
mesencephalon above. The lower border dorsally runs along stria
42
 medullaris ventriculi quarti, ventrally – along radices n. abducentis, n.
facialis et n. vestibulocochlearis in medullopontine sulcus (sulcus
bulbopontinus). The upper border of pons dorsally pass through radices
n. trochlearis, which exit on each side from frenulum velli medullare
superior and ventrally corresponds to emergence of pedunculi cerebri.
Morphologia externa. On the ventral surface pons is seen as a
pillow clearly separated from the neighboring parts of the brain. At the
midline of pons is present a shallow basilar sulcus (sulcus basilaris)
lodging a. basilaris. Laterally from it, ventral surface is characterized by
presence of transverse striations, which are formed by fibers going into
middle cerebellar peduncles (pedunculi cerebellaris media). The pons
itself and pedunculi cerebellaris media are separated by exit of radices n.
trigemini. The dorsal surface of pons is directed to IV ventricle and takes
part in formation of fossa rhomboidea.

Fig. 4. Pons in cross section. 1 - ventriculus quartus; 2 –

periventricular grey mater; 3 – pedunculus cerebellaris superior; 4 -
pedunculus cerebellaris media; 5 – fibrae pontis longitudinales; 6 –
lemniscus medialis; 7 – lemniscus trigeminalis; 8 - lemniscus spinalis et
lateralis; 9 – fasciculus longitudinalis medialis; 10 - tractus tectospinalis;
11 – tractus rubrospinalis; 12 – nucleus pontinus n. trigemini; 13 - nucleus
43

Nwomkuof cranial was/ Name / nuclei Hoppe I exist fdeom CONS

motorius n. trigemini; 14 - n. trigeminus; 15- nucleus tractus solitarii; 16
– nucleus salivatorius superior; 17 – nucleus motorius n. facialis; 18 – n.
facialis; 19 – nucleus motorius n. abducentis; 20 – n. abducens; 21 – nuclei
raphe; 22 – nucleus reticularis tegmenti pontis; 23 - nucleus reticularis
pontis caudalis; 24 - nucleus reticularis parvocellaris.

Morphologia interna. In the cross section of pons centrally is

located thick bundle of fibers going in transverse direction, which
received the name trapezoid body (corpus trapezoideum). It belongs to
auditory pathways and divides the cross section into tegmentum of pons
(tegmentum pontis or pars dorsalis pontis) above and basilar part (pars
ventralis or basilaris pontis) ventrally.
Grey matter of pons can be organized into 4 groups of nuclei:
1. nuclei corporis trapezoidei
2. nuclei pontis
3. nuclei formatio reticularis
4. nuclei nervi craniales
In between fibers of corpus trapezoideum are located ventral and
dorsal nuclei of trapezoid body (nuclei corporis trapezoidei ventrales et
dorsalis). Pars basilaris pontis is occupied by longitudinal and transverse
fibers. Longitudinal pontine fibers (fibrae pontis longitudinales) belong
to pyramidal pathways – pontine corticonuclear fibers (fibrae
corticonucleares). Among these fibers are present corticopontine fibers
(fibrae corticopontinae), which terminate on nuclei motorii nn. craniales
or pontine nuclei (nuclei pontis) in pons and then innervate skeletal
muscles. Other portion of fibrae pontis longitudinales after synapsing on
nuclei pontis continue as transverse pontine fibers (fibrae pontis
transversae), decussate to the opposite side and enter into cortex cerebelli
via pedunculi cerebellaris media.
In tegmentum pontis, besides ascending fibers from medulla
oblongata, are present nuclei nervi craniales V (nucleus pontinus, tractus
mesencephalici, tractus spinalis et nucleus motorius n. trigemini), VI
(nucleus motorius n. abducentis), VII (nucleus tractus solitarii, nucleus
motorius n. facialis et nucleus salivatorius superior), VIII (nuclei
44
cochleares anterior et posterior, nuclei vestibulares medialis, lateralis,
superior et inferior). Immediately above corpus trapezoideum are located
fibers belonging to lemniscus medialis, laterally from which – lemniscus
spinalis. Above corpus trapezoideum closer to the midline is present
formatio reticularis and dorsally from it dorsal longitudinal fascicle
(fasciculus longitudinalis dorsalis). Laterally and above lemniscus
medialis lie fibers of lateral lemniscus (lemniscus lateralis).

Cerebellum
Topography. Cerebellum is located dorsally from medulla
oblongata and pons in fossa cranii posterior. Above cerebellum are
occipital lobes of hemispheri cerebri separated from it by transverse
fissure of the brain (fissura transversi cerebralis). Cerebellum connects
to the neighboring parts of the brain (and in some sense separated from)
by 3 pairs of cerebellar peduncles: superior cerebellar peduncles
(pedunculi cerebellares superiores) to mesencephalon, middle cerebellar
peduncles (pedunculi cerebellares media) to pons and inferior cerebellar
peduncles (pedunculi cerebellares inferiores) to medulla oblongata.
Morphologia externa. Cerebellum by outer appearance resembles
cerebrum, but smaller, that is why it received the name cerebellum (small
brain in Latin). In cerebellum are distinguished right and left hemispheres
of cerebellum (hemispheri cerebelli), both of which are bulging/convex.
On the inferior surface is present a wide inclination – vallecula of
cerebellum (vallecula cerebelli), at the center of which lies longitudinal
unpaired vermis of cerebellum (vermis cerebelli) connecting through
itself two hemispheres of cerebellum (hemispheri cerebelli). Outer
surface of cerebellum is divided into superior and inferior surface by deep
horizontal fissure (fissura horizontalis), which stretches between
pedunculi cerebellares media. On superior and inferior surface of
cerebellum there are many other multiple shallower transverse parallel
one to another cerebellar fissures (fissurae cerebelli), which form between
themselves folia of cerebellum (folia cerebelli). Groups of folia cerebelli,
separated by deeper fissurae are arranging lobules of cerebellum (lobuli
cerebelli). Fissurae cerebelli without stopping cut both hemispheri
45
cerebelli as well as vermis cerebelli. As a result, to each lobule of vermis
correspond 2 lobuli on hemispheri cerebelli (right and left). In the middle
vermis cerebelli has a thickening, called nodule (nodulus), from which
laterally and behind pedunculi cerebellares inferiores spread peduncles of
flocculus (pedunculi flocculi) with lobulus called flocculus (flocculus).
Morphologia interna. Hemispheri cerebelli et vermis cerebelli are
made by white substance of cerebellum (corpus medullare), which is
represented by substantia alba and thin layer of substantia grisea covering
it above – cerebellar cortex (cortex cerebelli). Inside folia cerebelli
substantia alba resembles thin plates, which received the name – (laminae
alba).
Inside substantia alba are also present collections of substantia
grisea – nuclei cerebelli. The biggest nucleus is dentate nucleus (nucleus
dentatus). On the horizontal section, this nucleus has a shape of thin bent
plate, which with its convex part is directed laterally and back. In the
medial direction, grey plate does not close and leaves hilum of dentate
nucleus (hilum nuclei dentati) to fill with fibers of white mater from
pedunculus cerebellaris media. Medially from nucleus dentatus, inside
substantia alba, are located emboliform nucleus (nucleus emboliformis),
globose (nucleus globosus), fastigial nucleus (nucleus fastigii).
Corpus medullare et cortex cerebelli in sagittal sections have
characteristic picture, which resembles stem and branches of tree (corpus
medullare s. substantia alba) and above them leaves (cortex cerebelli).
That is why, sagittal sections of cerebellum are referred as arbor vitae of
cerebellum (arbor vitae cerebelli).
Substantia grisea of cerebellum has nuclei n. craniales V, VI, VII,
VIII, which are responsible for the movements of eyes, mimics, function
of auditory and vestibular apparatus; nuclei formatio reticularis and nuclei
pontinus, which are connecting cortex cerebri and cerebellum. In pars
dorsalis pontis are located ascending sensory tracts, in ventral –
descending pyramidal and extrapyramidal tracts. In pars dorsalis pontis
also are present fibers, which enable connection of cerebellum and cortex
cerebri. Inside cerebellum are present nuclei, responsible for coordination
of movements and body posture.
46
 IV ventricle
IV ventricle (ventriculus quartus) develops from the cavity of the
rhombencephalon. In formation of the walls of ventriculus quartus take
part myelencephalon, pons, cerebellum and isthmus of rhombencephalon.
Configuration of the ventriculus quartus resembles “tent”, floor of which
has rhomboid shape (fossa rhomboidea) and is formed by the dorsal
surfaces of pons and myelencephalon. The borderline between
myelencephalon and pons on the surface of fossa rhomboidea is formed
by medullary stria of fourth ventricle (striae medullares [ventriculi
quarti]). They line themselves in transverse direction, starting in lateral
angles of fossa rhomboidea, going and embedding into sulcus medianus.
Roof of the fourth ventricle (tegmen ventriculi quarti) hangs above
fossa rhomboidea. In the formation of the antero-superior part of the roof
take part pedunculi cerebellares superiores and superior medullary velum
(velum medullare craniale [superius]), which is stretched between
pedunculi cerebellares superiores.
Postero-inferior part of the roof is more complex. It is made by
inferior medullary velum (velum medullare caudale [inferius]), which
laterally attaches to pedunculi flocculi. From inside to velum medullare
inferius attaches choroid membrane of the fourth ventricle (tela choroidea
[ventriculi quarti]). Tela choroidea ventriculi quarti forms by
invagination of the pia mater encephali, passing through the fissure
between inferior surface of cerebellum (above) and velum medullare
inferius (below).
Tela choroidea, which is from the side of the cavity of the fourth
ventricle is covered by epithelial plate, forms choroid plexus (plexus
choroideus [ventriculi quarti]). In the postero-inferior wall of the fourth
ventricle is present unpaired median aperture (apertura mediana
[ventriculi quarti] s. foramen Magendi). In the lateral parts of the fourth
ventricle, in the region of vestibular area (area vestibularis), is present
paired lateral aperture (apertura lateralis [ventriculi quarti] s. foramen
Luschka). All 3 apertures communicate the cavity of the fourth ventricle
with subarachnoid space.
47
 Fossa rhomboidea
Rhomboid fossa (fossa rhomboidea) represents rhomboid in shape
impression, which longer axis is directed along the brain. Fossa
rhomboidea, as was discussed previously, is formed by dorsal surfaces of
pons et myelencephalon. The borderline between myelencephalon and
pons on the surface of fossa rhomboidea is formed by medullary stria of
fourth ventricle (striae medullares [ventriculi quarti]). In the postero-
inferior angle of fossa rhomboidea, below the inferior edge of the roof
fourth ventricle, beneath obex (obex) lies entrance into canalis centralis
medullae spinalis. In the antero-superior angle is present opening, which
leads into aqueductus mesencephalici, providing communication of IV
ventricle with III ventricle. Lateral angles of fossa rhomboidea form
lateral recesses (recessus laterales). In the midline, along all the surface
of fossa rhomboidea, from upper angle to lower angle extends shallow
median sulcus (sulcus medianus). On each side from sulcus medianus is
located paired medial eminence (eminentia medialis), which laterally is
limited by sulcus limitans (sulcus limitans). In the upper portions of
eminentia medialis, which belongs to pons, is present facial colliculus
(colliculus facialis). Colliculus facialis by its topography corresponds to
the location of nucleus motorius n. abducentis, which is bent around by
fibers of n. facialis (which nucleus lies deeper and more laterally).
Anterior (cranial) part of sulcus limitans deepens and widens to form
superior fovea (fovea cranialis [superior]). Posterior (caudal, inferior)
end of sulcus limitans continues into barely visible inferior fovea (fovea
caudalis [inferior]).
In the anterior (superior) part of fossa rhomboidea, laterally from
eminentia medialis on fresh anatomical preparations sometimes is visible
blueish in colour place, called locus caeruleus (locus caeruleus). In the
lower part of fossa rhomboidea, which belongs to myelencephalon,
eminentia medialis narrows and ends with hypoglossal trigone (trigonum
nervi hypoglossi). Laterally is located smaller vagal trigone (trigonum
nervi vagi), at the depth of which lies nucleus dorsalis n. vagi. In the
lateral angles of fossa rhomboidea lie nuclei of n. vestibulocochlearis.

48
This region was named vestibular area (area vestibularis). From area
vestibularis arise striae medullares ventriculi quarti.

Fig. 5. Fossa rhomboidea. 1 – sulcus medianus; 2 – eminentia

medialis; 3 – sulcus limitans; 4 – colliculus facialis; 5 – striae medullares
ventriculi quarti; 6 - area vestibularis; 7 – trigonum nervi hypoglossi; 8 –
trigonum nervi vagi.

Projections of nuclei of cranial nerves to fossa rhomboidea.

Substantia grisea beneath fossa rhomboidea is distributed in
collections, groups of nuclei, which are separated one from another by
substantia alba. To understand the topography of substantia grisea beneath
fossa rhomboidea it is necessary to remember development of the
rhombencephalon. During development, cavity of the neural tube, in the
region of rhombencephalon, enlarges in diameter, bulges and opens
dorsally. As a result, dorsal parts of rhombencephalon shift laterally.
Dorsal (sensory) horns of rhombencephalon, which correspond to the
dorsal horns of the spinal cord, occupy lateral position in fossa
rhomboidea. Ventral horns of rhombencephalon, which correspond to the

49
ventral horns of the spinal cord, with motor somatic nuclei occupy in fossa
rhomboidea medial position. In substantia alba between motor and
sensory nuclei lie nuclei of autonomous (vegetative) nervous system.
In substantia grisea of myelencephalon and pons (in/beneath fossa
rhomboidea) lie nuclei of cranial nerves (V-XII pairs).
In upper triangle of fossa rhomboidea lie nuclei of V, VI, VII and
VIII pairs of cranial nerves.
V pair, n. trigeminus, has 4 nuclei.
1. Nucleus motorius nervi trigeminalis is located in upper part of fossa
rhomboidea, in the region of fovea superior. Fibers from this nucleus
form radix motorius n. trigeminalis.
2. Sensory nucleus, to which reach fibers of radix sensorius n.
trigeminalis, has 3 parts:
a) nucleus pontinus nervi trigeminalis lies laterally and backward
from nucleus motorius nervi trigeminalis; projection of nucleus
pontinus corresponds to locus caeruleus;
b) nucleus spinalis (inferior) nervi trigeminalis, is a continuation of
the previous nucleus, has elongated shape and lies along all the
length of myelencephalon, enters to upper (I-V) segments of
medulla spinalis;
c) nucleus [tractus] mesencephalici nervi trigeminalis lies above
(cranially) from nucleus motorius nervi trigeminalis, close to
aqueductus mesencephalici.
VI pair, n. abducens, has one nucleus – nucleus (motorius) nervi
abducentis, which is located in the loop of fibers of n. facialis, beneath
colliculus facialis.
VII pair, n. facialis, has 3 nuclei.
1. Nucleus (motorius) nervi facialis, is a motor nucleus, large, lies deep
in reticular formation of pons, laterally from colliculus facialis.
Fibers from this nucleus form radix motorius. Initially they go inside
pons dorso-medially, bend around nucleus (motorius) nervi
abducentis and then go ventero-laterally.

50
 2. Nucleus solitarius, sensory, common for VII, IX, X pairs of cranial
nerves, projects laterally from sulcus limitans. Cells, forming this
nucleus, are found in tegmentum pontis starting just above the level
of striae medullares ventriculi quarti, extend along all the length of
myelencephalon until the I cervical segment. On neurons of nucleus
solitarius end sensory neurons conveying taste information.
3. Nucleus salivarius cranialis [superior], vegetative
(parasympathetic), is located in formatio reticularis pontis, a little
more dorsally and laterally from nucleus motorius nervi facialis.
VIII pair, n. vestibulocochlearis, has 2 groups of nuclei: 2 cochlear
(auditory) and 4 vestibular, all of which lie in lateral parts of pons and are
projected to area vestibularis fossae rhomboideae.
 Nucleus cochlearis dorsalis [posterior] et nucleus cochlearis
ventralis [anterior]. On neurons of these nuclei synapse axons of
neurons from ganglion cochlearis (ganglion spirale cochleae),
which form pars cochleare n. vestibulocochlearis. These nuclei lie
one above another, laterally from nuclei vestibulares.
 a) nucleus vestibularis medialis (Shwalbe), b) nucleus vestibularis
lateralis (Deiters), c) nucleus vestibularis cranialis [superior]
(Behterev), d) nucleus vestibularis caudalis [inferior] (Roller).
Nuclei vestibulares receive impulses from sensory fields (cristae
ampullares, maculae) of labyrinthus membranaceus of the inner ear.
Nuclei of IX, X, XI, XII pairs of cranial nerves lie in lower triangle
of fossa rhomboidea, which is formed by dorsal surface of
myelencephalon.
IX pair, n. glossopharyngeus, has 3 nuclei, one of which (motor somatic)
is common for IX and X pairs of cranial nerves.
1. Nucleus ambiguus (motor somatic) is located in formatio reticularis,
in lower triangle of fossa rhomboidea, projects to fovea inferior.
2. Nucleus solitarius (sensory), common for VII, IX, X pairs of of
cranial nerves.
3. Nucleus salivatorius caudalis [inferior], vegetative (motor
parasympathetic). It is located in formatio reticularis of

51
 myelencephalon between nucleus olivaris inferior et nucleus
ambiguus.
X pair, n. vagus, has 3 nuclei: motor somatic, sensory and motor
parasympathetic.
1. Nucleus ambiguus (motor somatic) is common for IX and X pairs of
cranial nerves.
2. Nucleus solitarius (sensory), common for VII, IX, X pairs of of
cranial nerves.
3. Nucleus dorsalis n. vagi, motor parasympathetic, projects to
trigonum n. vagi.
XI pair, n. accessories, has nucleus (motorius) nervi accessorii. It lies
lower then nucleus ambiguus and extends in grey matter of medulla
spinalis in 5-6 cervical segments (between anterior and posterior horns,
closer to anterior).
XII pair, n. hypoglossus, has nucleus (motorius) nervi hypoglossi, which
projects to trigonum n. hypoglossi. Neurons of this nucleus innervate
muscles of the tongue and, together with the nerves from plexus
cervicalis, infrahyoid muscles of the neck.

52
 Fig. 6. Projections of nuclei of cranial nerves to fossa rhomboidea.
1 – nucleus motorius nervi trigeminalis; 2 – nucleus motorius nervi
facialis; 3 – nucleus motorius nervi abducentis; 4 – nucleus ambiguus; 5
– nucleus motorius nervi hypoglossi; 6 – nucleus pontinus nervi
trigeminalis; 7 – nucleus mesencephalici nervi trigeminalis; 8 – nucleus
spinalis nervi trigeminalis; 9 – nuclei n. vestibulocochlearis; 10 – nucleus
salivarius cranialis [superior]; 11 - nucleus salivarius caudalis [inferior];
12 – nucleus dorsalis n. vagi.

Questions for self-control

1. Name all the nuclei in the cross section of myelencephalon.
2. Name all the nuclei in the cross section of pons.
3. Name all the nuclei in the cross section of cerebellum.
4. Identify anatomical structures, which serve function of the
borderlines of myelencephalon.
5. Identify anatomical structures, which serve function of the
borderlines of pons.
53
6. Identify anatomical structures, by which cerebellum communicates
with the rest of the CNS.
7. Explain the term “arbor vitae cerebelli”.
8. Name all the nuclei, which belong to cranial nerves in
myelencephalon.
9. Name all the nuclei, which belong to cranial nerves in pons.
10. Name all the parasympathetic nuclei in the pons.
11. Name all the motor somatic nuclei in the pons.
12. Name all the sensory nuclei in the pons.
13. Describe the structure of the floor of IV ventricle.
14. Describe formation of the roof of IV ventricle.
15. Identify communications of IV ventricle.
16. Identify where tela choroidea enters into IV ventricle.

54
 Practical Lesson 4
Mesencephalon. Diencephalon.

Purpose of the lesson:

- to study anatomy of mesencephalon;
- to study anatomy of diencephalon.
After studying this topic, students have to:
know:
- topography of the mesencephalon and diencephalon;
- external and internal morphology of mesencephalon and diencephalon.
be able to:
- competently use anatomical terminology;
- show all the details of external structure of mesencephalon and
diencephalon on anatomical preparations;
- draw the scheme of cross section of mesencephalon and explain
structure.

Questions
1. What is the upper and the lower border of myelencephalon?
2. What is the upper and the lower border of pons?
3. External features of myelencephalon.
4. External features of pons.
5. External features of cerebellum.
6. Distribution of grey matter in the cross section of myelencephalon.
7. Distribution of white matter in the cross section of myelencephalon.
8. Distribution of grey matter in the cross section of pons.
9. Distribution of white matter in the cross section of pons.
10. Distribution of grey matter in the cross section of cerebellum.
11. Structure of fossa rhomboidea.
12. Structure of IV ventricle.
55
 all forms
specially location of
Brief information and obligatory terms
Mesencephalon

Topography. Mesencephalon is located between pons below and

diencephalon above. Lower border dorsally pass through radices n.
trochlearis, which exit on each side from frenulum velli medullare
superior and ventrally corresponds to emergence of pedunculi cerebri.
Upper border dorsally runs along pulvinar thalamii, ventrally – along
posterior surface of corpora mammillaria et tractus opticus.
Morphologia externa. On the dorsal surface of mesencephalon is
visible tectal plate (lamina tecti), which is made by two inferior colliculus
(colliculi inferiores) and two superior colliculus (colliculi superiores)
separated between themselves by transverse sulcus. Colliculi by
longitudinal sulcus are also divided into right and left symmetrical sets.
From each colliculus superior laterally pass brachium of superior
colliculus (brachium colliculi superioris), which is located behind
thalamus and reaches corpus geniculatum laterale. From each colliculus
inferior laterally pass brachium of inferior colliculus (brachium colliculi
inferioris), which reaches corpus geniculatum mediale.
Below lamina tecti mesencephalon has two thick bundles emerging
from pons and diverging at sharp angle into hemispheri cerebri - cerebral
peduncles (pedunculi cerebri). Depression between diverging pedunculi
cerebri on ventral surface is named interpeduncular fossa (fossa
interpeduncularis). At the depth of fossa interpeduncularis numerous
vessels pass into brain forming posterior perforated substance (substantia
perforata interpeduncularis s. posterior). On the medial surface
pedunculi cerebri have longitudinal oculomotor sulcus (sulcus nervi
oculomotorii), where exit radices n. oculomotorii (III pair of cranial
nerves).

56
 Fig. 7. Mesencephalon in cross section at the level of colliculi
inferiores. 1 - tectum mesencephalici; 2 – tegmentum mesencephalici; 3
– basis pedunculi cerebri; 4 - pedunculus cerebellaris media; 5 –
substantia grisea centralis; 6 – nucleus motorius n. trochlearis; 7 –
decussatio fibrarum nervorum trochlearium; 8 – nucleus tractus
mesencephalici n. trigemini; 9 – substantia nigra; 10 – nucleus
cuneiformis (of nuclei reticulares); 11 – nucleus raphes posterior; 12 –
nucleus raphes centralis; 13 – nucleus tegmentalis pedunculopontinus (of
nuclei reticulares); 14 - lemniscus medialis; 15 – lemniscus trigeminalis;
16 – lemniscus spinalis; 17 – lemniscus lateralis; 18 – fasciculus
longitudinalis medialis; 19 – tractus rubrospinalis; 20 – tractus
frontopontinus; 21 – tractus occipitotemporoparitopontinus; 22 – tractus
corticonuclearis et corticospinalis; 23 – decussatio peduncululorum
cerebellarium superiorum; 24 - nuclei colliculi inferiores.

Morphologia interna. In the cross sections mesencephalon is

divided into tectum of midbrain (tectum mesencephalici) and pedunculi
57
cerebri by aqueduct of midbrain (aqueductus mesencephalici s. cerebri).
In addition, pedunculi cerebri are further divided into tegmentum of
midbrain (tegmentum mesencephalici) and base of peduncle (basis
pedunculi cerebri) by thick transverse layer of melanin containing
dopaminergic neurons – substantia nigra (substantia nigra). Basis
pedunculi cerebri can be also referred as crus cerebri.
In the frontal section of mesencephalon tectum mesencephalici is
formed by nuclei of inferior and superior colliculus (nuclei colliculi
inferiores et superiores), which are surrounded by thin layer of white
mater. From colliculi inferiores et superiores are emerging descending
tectospinal tracts (tractus tectospinalis), which fibers decussate in dorsal
portion of tegmentum mesencephalici in posterior tegmental decussation
(decussatio tegmentalis posterior).

Fig. 8. Mesencephalon in cross section at the level of colliculi

superiores. 1 - tectum mesencephalici; 2 – tegmentum mesencephalici; 3
– basis pedunculi cerebri; 4 - - nuclei colliculi superioris; 5 - nucleus
tractus mesencephalici n. trigemini; 6 – substantia grisea centralis; 7 –

58
aqueductus mesencephalici; 8 – nucleus motorius n. oculomotorii; 9 –
nucleus accessorius n. oculomotorii; 10 – n. oculomotorius; 11 –
decussatio tegmenti mesencephalici ventralis; 12 – nucleus ruber; 13 –
tractus rubrospinalis; 14 - lemniscus medialis; 15 – lemniscus
trigeminalis; 16 – lemniscus spinalis; 17 – fasciculus longitudinalis
medialis; 18 – substantia nigra; 19 – tractus frontopontinus; 20 – tractus
occipitotemporoparitopontinus; 21 – tractus corticonuclearis et
corticospinalis; 22 – formatio reticularis.

Aqueductus mesencephalici is a narrow canal about 1,5 cm. long

communicating III and IV ventricles. By its origin aqueductus
mesencephalici is derived from the cavity of middle brain vesicle. Around
aqueductus mesencephalici is present layer of grey mater – periaqueductal
grey substance (substantia grisea centralis), which anatomically belongs
to tegmentum mesencephalici. Ventrally, slightly embedded into
substantia grisea centralis, at the level of colliculi superiores are located
nuclei nervi oculomotorii, which are represented by motor nuclei of
oculomotor nerve (nucleus motorius n. oculomotorii) and accessory
nuclei of oculomotor nerve (nucleus accessorius n. oculomotorii). The
later nuclei historically has name – Edinger-Westphal nucleus. Ventrally
and rostrally from nuclei nervi oculomotorii is located one of the
prominent nuclei of formatio reticularis – interstitial nucleus (nucleus
interstitialis), which takes part in formation of tractus reticulospinalis et
fasciculus longitudinalis posterior. At the level of colliculi inferiores into
ventral part of substantia grisea centralis are embedded nuclei of trochlear
nerve (nucleus motorius n. trochlearis). Axons of nucleus motorius n.
trochlearis pass dorsally to exit as radix n. trochlearis on opposite side,
because before leaving they form decussation of trochlear nerve fibers
(decussatio fibrarum nervorum trochlearium). From mesencephalon
radix n. trochlearis exits dorsally at the border between mesencephalon
and pons just behind colliculi inferiores on each side from frenulum velli
medullare superior. Laterally from substantia grisea centralis along all
mesencephalon extends mesencephalic nucleus of trigeminal nerve
(nucleus mesencephalicus nervi trigemini).

59
 The biggest nuclei in tegmentum mesencephalici is red nucleus
(nucleus ruber), which lies above substantia nigra and extends from the
level of colliculi inferiores until diencephalon, where it occupies regio
subthalamica. From nucleus ruber starts rubrospinal tract (tractus
rubrospinalis), which immediately decussates to opposite side in anterior
tegmental decussation (decussatio tegmentalis anterior). Laterally and
above nucleus ruber lie fibers of lemniscus medialis. Between lemniscus
medialis and substantia grisea centralis are located nuclei of formatio
reticularis.
Basis pedunculi cerebri is formed by descending pathways. Medial
1/5 is occupied by tractus frontopontinus, lateral 1/5 – tractus
occipitotemporoparitopontinus, middle 3/5 – tractus corticonuclearis et
corticospinalis.
Substantia nigra, nucleus ruber, nucleus interstitialis of
mesencephalon belong to extrapyramidal system, which regulates
muscular tone and responsible for automatic unconscious movements.
Among fibers of white mater in mesencephalon special place and
role belongs to lemniscus medialis, which is formed by fibrae arcuatae
internae arising from nucleus gracilis et cuneatus. Lemniscus medialis
convey proprioceptive sensory information from medulla oblongata to
thalamus. Laterally to fibers of lemniscus medialis joins spinal lemniscus
(lemniscus spinalis), responsible for general sensitivity (pain and
temperature). Even more dorsolaterally in tegmentum mesencephalici are
present fibers from sensory nuclei of n. trigeminus forming trigeminal
lemniscus (lemniscus trigeminalis) and going to nuclei thalamii.

Diencephalon

Topography. Diencephalon is located between mesencephalon

below and telencephalon above. Lower border dorsally runs along
pulvinar thalamii, ventrally – along posterior surface of corpora
mammillaria et tractus opticus. Upper border dorsally runs along stria

60
terminalis thalamii, ventrally – along chiasma opticum et anterior surface
of tractus opticus.
Morphologia externa. On whole preparation of human brain, it is
impossible to see diencephalon because hemispheri cerebri hang above
and close the view. There is only a small portion of diencephalon, which
can be shown on ventral surface belonging to hypothalamus. There can be
discerned chiasma opticum, tractus opticus, tuber cinereum,
infundibulum, hypophysis et corpora mammillaria.
Morphologia interna. Diencephalon is formed primarily by grey
matter, which is represented by different nuclei – centers for most types
of sensitivity, autonomous nervous system, extrapyramidal system,
reticular formation, endocrine activity. White matter of diencephalon is
represented by projective fibers, forming ascending and descending tracts,
which enable bidirectional communication of subcortical centers with
cortex cerebri and nuclei of medulla spinalis. Besides diencephalon
includes 2 endocrine glands – hypophysis et epiphysis (glandula
pinealis).
Diencephalon is divided into thalamus, metathalamus,
hypothalamus, epithalamus, regio subthalamica et ventriculus tertius.
Thalamus is paired ovoid structure, which lies laterally from
ventriculus tertius. In front, thalamus has a pointed end called anterior
thalamic tubercle (tuberculum anterius thalamii). Behind thalamus
widens to form pulvinar (pulvinar thalamii). 2 surfaces of thalamus are
free: medial surface directed to III ventricle and forming it`s lateral wall
and superior surface, which forms inferior wall of pars centralis ventriculi
lateralis. These 2 surfaces are separated by thin strip of white matter called
stria medullaris of thalamus (stria medullaris thalamica). 2 thalami are
connected on medial surface by interthalamic adhesion (adhesio
interthalamica). Lateral surface of thalamus is adjacent to capsula interna
and ventero-posteriorly it borders with tegmentum mesencephalici.
Thalamus is formed by nuclei thalamii, which are separated by thin
layers of white matter internal and external medullary lamina (lamina
medullaris medialis et lateralis). As a result, about 40 different nuclei
thalamii can be discerned in thalamus, which are further grouped into
61
nuclei anteriores, mediales et posteriores. Nuclei thalamii receive sensory
information coming from all sensory pathways except olfactory, taste and
auditory. That is why thalamus is viewed as subcortical sensory center.
Some axons from nuclei thalamii extend to corpus striatum (that is why
thalamus is accepted as sensory center for extrapyramidal system), some
– fasciculi thalamocorticales – to cortex cerebri. Beneath thalamus is
located subthalamic region (regio subthalamica), which downwards
continues into tegmentum mesencephalici. From the side of ventriculus
tertius regio subthalamica is separated from thalamus by sulcus
hypothalamicus. The same sulcus can be also viewed as border between
lateral and inferior wall of ventriculus tertius. Regio subthalamica is
formed by projection of nucleus ruber et substantia nigra from
mesencephalon. Laterally from substantia nigra is placed subthalamic
nucleus or Luis`s nucleus (nucleus subthalamicus).
Metathalamus is represented by paired corpora geniculatum
laterale et mediale, which look like elongated oval bodies connecting to
colliculi tectum mesencephalici by means of brachii colliculi superiores
et inferiores. Lateral geniculate body (corpus geniculatum laterale) is
located on inferolateral surface of thalamus, laterally from pulvinar.
Corpus geniculatum laterale can be easily found, if you follow tractus
opticus leading to it.
Somewhat medially and backwards (below) from corpus
geniculatum laterale, beneath pulvinar is located medial geniculate body
(corpus geniculatum mediale), on which end fibers of lemniscus laterale.
Corpora geniculatum laterale et colliculi superiores mesencephalici are
subcortical visual centers. Corpora geniculatum mediale et colliculi
inferiores mesencephalici are subcortical auditory centers.
Epithalamus includes corpus pineale, which by habenula
(habenulae) connects with medial surfaces of right and left thalamii.
Passage of habenula to thalamus forms triangular widening, called
habenular trigone (trigonum habenulare). Anterior portions of habenulae
before entering into corpus pineale form habenular commissure
(commissura habenularum). In front and below of corpus pineale is
located bundle of transverse fibers – posterior commissure (commissura
epithalamica s. posterior). Between commissura habenularum et
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commissura epithalamica into corpus pineale, into it`s base, enters a
pocket from ventriculus tertius – pineal recess (recessus pinealis).
Hypothalamus forms lower part of diencephalon and participates
in formation of floor of ventriculus tertius. Hypothalamus includes into
it`s structure chiasma opticum, tractus opticus, tuber cinereum with
infundibulum and corpora mammillaria.
Optic chiasma (chiasma opticum) looks like transverse bundle,
formed by fibers of nervus opticus (II pair of cranial nerves), which
partially cross to opposite side (form decussation). This bundle on each
side laterally and backwards continues into optic tract (tractus opticus).
Tractus opticus is located medially and behind from substantia perforata
anterior, bends pedunculus cerebri from lateral side and ends with two
roots in subcortical visual centers. The bigger lateral root (radix lateralis)
reaches corpus geniculatum laterale, thinner medial root (radix medialis)
goes to colliculus superior mesencephalici.
To anterior surface of chiasma opticum is adjacent and fuses with it
element of telencephalon – lamina terminalis (lamina terminalis). It
terminates anterior end of fissura longitudinalis cerebri and is composed
of thin layer of grey matter, which laterally continues into lobus frontalis.
Behind of chiasma opticum is located tuber cinereum (tuber
cinereum), behind which lie corpora mammillaria and laterally – tractus
optici. Downwards tuber cinereum continues into infundibulum
(infundibulum), which connects with hypophysis. Walls of tuber cinereum
are formed by thin plate of grey matter containing tuberal nuclei (nuclei
tuberales). From ventriculus tertius into tuber cinereum and further into
infundibulum protrudes infundibular recess (recessus infundibuli s.
infundibularis).
Mammillary bodies (corpora mammillaria) are located between
tuber cinereum in front and substantia perforata posterior behind. They
look like two small, 0.5 cm in diameter spheroid bodies in white colour.
White matter lines corpora mammillaria only from outside, inside they are
made by grey matter, which forms medial and lateral nuclei of
mammillary body (nuclei corporis mammillaris medialis et lateralis s.

63
nuclei mammillaris medialis et lateralis). In corpora mammillaria end
columnae fornicis.
In hypothalamus can be discerned 3 main regions or 7 areas, where
different by shape and size groups of neurons are collected. For the
simplicity reason we will use division into regions. There are regio
hypothalamica anterior, regio hypothalamica intermedia et regio
hypothalamica posterior. All in all, in 3 abovementioned regions are
present about 30 nuclei of hypothalamus.
Some neurons of hypothalamus are capable of producing hormones,
which by means of axonal transport are carried into posterior lobe of
hypophysis. Nuclei containing such neurons received name of
neurosecretory nuclei. In regio hypothalamica anterior is present supra-
optic nucleus (nucleus supraopticus) and paraventricular nucleus (nucleus
paraventricularis). Neuronal axons from these nuclei form hypothalamo-
hypophyseal bundle, which ends in posterior lobe of hypophysis. Among
nuclei of regio hypothalamica posterior the biggest ones are medial and
lateral nuclei of mammillary body (nuclei corporis mammillaris medialis
et lateralis s. nuclei mammillaris medialis et lateralis), posterior nucleus
of hypothalamus (nucleus posterior hypothalami). To nuclei of regio
hypothalamica intermedia belong venteromedial nucleus of hypothalamus
(nucleus venteromedialis hypothalami) and dorsomedial nucleus (nucleus
dorsomedialis), dorsal nucleus (nucleus dorsalis hypothalami),
infundibular nucleus (nucleus infundibularis), tuberal nuclei (nuclei
tuberales).
Nuclei of hypothalamus are connected by intricate system of
afferent and efferent pathways. Because of that hypothalamus regulates
multiple different vegetative function of the organism. Neurosecretion of
hypothalamus effects functioning of secretory cells of hypophysis,
stimulating or depressing secretion of hormones, which in turn regulate
activity of other endocrine glands.
Presence of neural and humoral relations between nuclei
hypothalamici et hypophysis lead to their connection into hypothalamo-
hypophyseal system.

64
 Ventriculus tertius occupies central position in diencephalon.
Cavity of the ventricle is like narrow sagittal fissure bounded by 6 walls:
two lateral, superior, inferior, anterior and posterior. Lateral walls of
ventriculus tertius are represented by medial surfaces of thalamuses and
by regio subthalamica below sulcus hypothalamicus.
Inferior wall or floor of III ventricle is formed by hypothalamus, by it`s
dorsal surface directed to cavity of III ventricle. On inferior wall are
present two recessuses: infundibular recess (recessus infundibuli s.
infundibularis) and supra-optic recess (recessus supraopticus s. opticus).
The last one is located in front of chiasma optica, between it`s anterior
surface and lamina terminalis.
Anterior wall of III ventricle is formed by lamina terminalis,
columnae fornicis et commissura anterior. On each side columna fornicis
in front and tuberculum anterius thalamii behind limit interventricular
foramen (foramen interventriculare), by which III ventricle
communicates with ventriculus laterales.
Posterior wall of III ventricle is formed by commissura
epithalamica, beneath which is located opening for aqueductus cerebri.
Above commissura epithalamica is located protrusion of the cavity of III
ventricle –suprapineal recess (recessus suprapinealis). All the walls of III
ventricle inside are lined by ependymal cells. Superior wall is formed by
choroid membrane (tela choroidea), which is made by duplicature of
vascular lining entering into ventriculus tertius beneath splenium corporis
callosi et fornix. Superior lamina of tela choroidea fuses with inferior
surface of fornix. At the level of foramina intervertebrale superior lamina
of tela choroidea bends down and goes backwards forming inferior lamina
of tela choroidea, which is the actual superior wall of ventriculus tertius.
Then backwards this lamina covers corpus pineale and lies onto superior
surface (tectum) of mesencephalon.
Superior and inferior lamina of pia mater encephali with vessels in
between them enter into cavity of lateral ventricles through fissura
choroidea, which is formed between dorsal surface of thalamus and
inferior surface of fornix.

65
 Between superior and inferior lamina of tela choroidea ventriculi
tertii in connective tissue are present two vv. cerebri internae. These two
veins after fusion form v. cerebri magna. From the side of the cavity of
ventriculus tertius tela choroidea is lined by epithelial layer – remnant of
posterior wall of second brain vesicle. Protrusions of inferior lamina of
tela choroidea together with epithelial lining hang into cavity of
ventriculus tertius, where they form choroid plexus (plexus choroideus).
Plexus choroideus of ventriculus tertius connects with plexus choroideus
of ventriculus laterales through foramina intervertebrale.

Questions for self-control

1. Name all the nuclei in the cross section of mesencephalon.
2. Name all the nuclei, which belong to cranial nerves in
mesencephalon.
3. Identify anatomical structures, which serve function of the
borderlines of mesencephalon.
4. Identify anatomical structures, which serve function of the
borderlines of diencephalon.
5. Describe macroscopical features of mesencephalon.
6. Describe macroscopical features of diencephalon.
7. Describe microscopical features of mesencephalon.
8. Describe structure and function of thalamus.
9. Describe structure and function of epithalamus.
10. Describe structure and function of hypothalamus.
11. Describe structure and function of regio subthalamica.
12. Describe the walls of III ventricle.
13. Identify communications of III ventricle.
14. Identify decussations in mesencephalon.
15. Identify subcortical visual centers in mesencephalon and
diencephalon.

66
 Practical Lesson 5
Telencephalon. Meninges of the brain.

Purpose of the lesson:

- to study anatomy of telencephalon;
- to study anatomy of meninges of the brain.
After studying this topic, students have to:
know:
- topography of the telencephalon;
- external and internal morphology of telencephalon;
- structure and functions of meninges of the brain.
be able to:
- competently use anatomical terminology;
- show all the details of external structure of telencephalon and meninges
of the brain on anatomical preparations.

Questions
1. What is the lower border of telencephalon?
2. Structure of facies superolateralis hemispheri cerebri.
3. Structure of facies medialis hemispheri cerebri.
4. Structure of facies inferior hemispheri cerebri.
5. Nuclei basales.
6. Corpus callosum.
7. Fornix.
8. Associative fibers of white matter in hemispheri cerebri.
9. Commissural fibers of white matter in hemispheri cerebri.
10. Cortical analizers.
11. Dura mater.
12. Production, circulation and drainage of cerebrospinal fluid.

67
 Brief information and obligatory terms

Telencephalon
Telencephalon if formed by two hemispheri cerebri, which are
divided by fissura longitudinalis and connected by corpus callosum,
commissura anterior et posterior, and also by commissura fornicis. Cavity
of telencephalon forms ventriculus lateralis dexter et sinister, each located
in corresponding hemisphere. Hemispherium cerebralis consists of outer
covering – cortex, white matter beneath and collections of grey matter
inside white matter – nuclei basales. Border between telencephalon and
diencephalon passes at the junction of capsula interna to lateral surface of
thalamus.
Hemispherium cerebralis outside is covered by thin layer of grey
matter – cortex cerebri. Each hemispherium cerebralis has 3 surfaces: the
most convex superolateral surface of cerebral hemisphere (facies
superolateralis [hemispherii]), flat surface directed to neighboring
hemispherium cerebralis medial surface of cerebral hemisphere (facies
medialis [hemispherii]) and inferior surface of cerebral hemisphere
(facies inferior [hemispherii]). The last one has complex layout, which
corresponds to basis cranii interna. Surfaces of hemispherium cerebralis
are separated one from another by borders: superior margin (margo
superior), inferolateral margin (margo inferior s. inferolateralis) and
inferomedial margin (margo medialis s. inferomedialis). The most
prominent forward and backward points of hemispherium cerebralis are
called poles: frontal pole (polus frontalis), occipital pole (polus
occipitalis) and temporal pole (polus temporalis). The layout of surfaces
of hemispheri cerebri is complex because of presence of multiple different
by depth sulci and located between them gyri. The depth, length, shape
and direction of sulci et gyri are variable.
Facies superolateralis hemispherii. In each hemispherium
cerebralis anterior portion is occupied by frontal lobe (lobus frontalis),
which in front ends with polus frontalis, bounded below by lateral sulcus
(sulcus lateralis) (Sylvian sulcus, described by Franciscus Sylvius) and
behind – by central sulcus (sulcus centralis). Sulcus centralis lies in
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frontal plane. It begins from superior portion of facies medialis
hemispherii, cuts margo superior, descends without interruption on facies
superolateralis hemispherii and ends just above sulcus lateralis.
In front of sulcus centralis, almost parallel to it lies precentral sulcus
(sulcus precentralis). It also, as sulcus centralis, does not reach sulcus
lateralis. Sulcus precentralis often interrupts in the middle and consists by
two separate sulci. From sulcus precentralis forward project superior and
inferior frontal sulcuses (sulci frontales superior et inferior). They are
located almost parallel one to another and divide facies superolateralis
lobus frontalis to gyri. Between sulcus centralis behind and sulcus
precentralis in front is located precentral gyrus (gyrus precentralis).
Above sulcus frontalis superior lies superior frontal gyrus (gyrus frontalis
superior), occupying superior portion of lobus frontalis. Between sulci
frontales superior et inferior extends middle frontal gyrus (gyrus frontalis
medius). Below sulcus frontalis inferior is located inferior frontal gyrus
(gyrus frontalis inferior). Into gyrus frontalis inferior from below
penetrate branches of sulcus lateralis: ascending ramus (ramus ascendens)
and anterior ramus (ramus anterior), which divide inferior portion of
lobus frontalis hanging above anterior part of sulcus lateralis into 3 parts.
Opercular part (pars opercularis s. operculum frontale) is located
between ramus ascendens and inferior portion of sulcus precentralis. This
part of lobus frontalis received that name because it covers insulae,
located at the depth of sulcus lateralis, like a cap (operculum – cap,
covering flap). Triangular part (pars triangularis) is located between
ramus ascendens behind and ramus anterior in front. Orbital part (pars
orbitalis) lies beneath ramus anterior and extends to inferior surface lobus
frontalis. In this place, sulcus lateralis widens and can be called lateral
cerebral fossa (fossa lateralis [cerebralis]).
Behind sulcus centralis is located parietal lobe (lobus parietalis).
Posterior border of lobus parietalis is parieto-occipital sulcus (sulcus
parietooccipitalis). This sulcus runs on facies medialis hemispherii,
deeply cuts margo superior and passes to facies superolateralis
hemispherii, where it disappears. So, posterior border of lobus parietalis
on facies superolateralis is mostly imaginary – possible continuation of
sulcus parietooccipitalis downwards. Inferior border of lobus parietalis is
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sulcus lateralis (it`s posterior portion), which separates it from lobus
temporalis.
Within the limits of lobus parietalis can be found postcentral sulcus
(sulcus postcentralis). It begins from sulcus lateralis below and ends
above not reaching margo superior. Sulcus postcentralis lies behind sulcus
centralis almost parallel to it. Between sulcus centralis and sulcus
postcentralis is located postcentral gyrus (gyrus postcentralis). Above it
passes to facies medialis hemispherii, where it connects with gyrus
precentralis of lobus frontalis forming paracentral lobule (lobulus
paracentralis). On facies superolateralis, gyrus postcentralis also
connects with gyrus precentralis, embracing from below sulcus centralis.
From sulcus postcentralis backwards extends intraparietal sulcus (sulcus
intraparietalis). It is parallel to margo superior hemispherii. Above sulcus
intraparietalis is located a group of small gyri, which collectively are
called superior parietal lobule (lobulus parietalis superior).
Below sulcus intraparietalis lies inferior parietal lobule (lobulus
parietalis inferior), within the limits of which are present two gyri:
supramarginal gyrus (gyrus supramarginalis) and angular gyrus (gyrus
angularis). Gyrus supramarginalis embraces the end of sulcus lateralis,
gyrus angularis - the end of sulcus temporalis superior. Inferior portion of
lobulus parietalis inferior, adjacent to it inferior portion of gyrus
postcentralis forms parietal operculum (operculum parietale). Inferior
portion of lobulus parietalis inferior, adjacent to it inferior portion of
gyrus postcentralis and inferior portion of gyrus precentralis together form
fronto-parietal operculum (operculum frontoparietale), hanging above
insula.
Occipital lobe (lobus occipitalis) is located behind sulcus
parietooccipitalis and behind it`s imaginary continuation on facies
superolateralis hemispherii. In comparison with other lobes it has small
size. Lobus occipitalis behind ends with occipital pole (polus occipitalis).
Sulci et gyri on facies superolateralis lobus occipitalis are very variable.
Most frequently, there is present transverse occipital sulcus (sulcus
occipitalis transversus), which in a sense a continuation of sulcus
intraparietalis backwards.

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 Temporal lobe (lobus temporalis) occupies inferolateral part of
hemispherium cerebralis and separates from lobus frontalis et lobus
parietalis by deep sulcus lateralis. Edge of lobus temporalis, which hangs
above insula, received the name of temporal operculum (operculum
temporale). Anteriorly lobus temporalis protrudes to form temporal pole
(polus temporalis). On facies superolateralis lobus temporalis can be
viewed superior and inferior temporal sulcuses (sulci temporales superior
et inferior), which run almost parallel to sulcus lateralis. Gyri of lobus
temporalis orient themselves along sulci. Superior temporal gyrus (gyrus
temporalis superior) is located between sulcus lateralis above and sulcus
temporalis superior below. On superior surface of that gyrus at the depth
of sulcus lateralis are located 2-3 short transverse temporal gyri (gyri
temporales transversi) (Heschl's gyri or Heschl's convolutions), separated
one from another by transverse temporal sulcuses (sulci temporales
transversi). Between sulcus temporalis superior et sulcus temporalis
inferior stretches middle temporal gyrus (gyrus temporalis medius).
Inferolateral edge of lobus temporalis is occupied by inferior temporal
gyrus (gyrus temporalis inferior), which is bounded above by sulcus
temporalis inferior. Posterior end of this gyrus continues to lobus
occipitalis.
Insular lobe (lobus insularis (insula) is located at the depth of sulcus
lateralis. This lobe can be seen only after pulling operculum frontale,
operculum parietale et operculum temporale one from another after
removing them. Deep circular sulcus of insula (sulcus circularis insulae)
separates insula from neighboring parts of the brain. On the surface of
insula are present insular gyri (gyri insulae), represented by long gyrus of
insula (gyrus longus insulae) and short gyri of insula (gyri breves insulae).
Gyrus insulae longus is located at posterior part of insula and runs
downwards and forward. Gyri insulae breves occupy antero-superior part
of insula. Between gyrus insulae longus gyri insulae breves is located
central sulcus of insula (sulcus centralis insulae). Antero-inferior portion
of insula is devoid of sulci et gyri and thickens to form limen insulae
(limen insulae).
Facies medialis hemispherii. All lobes, except insula, take part in
formation of facies medialis hemispherii. Above corpus callosum runs
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sulcus of corpus callosum (sulcus corporis callosi), separating if from
other parts of hemispherium. This sulcus behind bends around splenium
(splenium (corporis callosi)), then goes down and forward and continues
into hippocampal sulcus (sulcus hippocampi s. hippocampalis). Above
sulcus corporis callosi runs cingulate sulcus (sulcus cinguli). This sulcus
begins in front and below from rostrum (rostrum (corporis callosi)),
ascends, bends backward, runs parallel to sulcus corporis callosi and ends
above and behind from splenium corporis callosi as subparietal sulcus
(sulcus subparietalis). At the level of splenium corporis callosi from
sulcus cinguli upward branches marginal branch or marginal sulcus
(ramus marginalis s. sulcus marginalis), which goes up and backwards to
margo superior hemispherii. Between sulcus corporis callosi et sulcus
cinguli is located cingulate gyrus (gyrus cinguli), which embraces corpus
callosum in front, above and behind. Behind and downwards from
splenium corporis callosi gyrus cinguli narrows forming isthmus of
cingulate gyrus (isthmus gyri cinguli). Then isthmus gyri cinguli widens
downward and forward and continues as parahippocampal gyrus (gyrus
[hippocampi] parahippocampalis), which is limited above by sulcus
hippocampi. Gyrus cinguli, isthmus gyri cinguli et gyrus
parahippocampalis together are called as gyrus fornicatus. At the depth of
sulcus hippocampi is located thin grey strip – dentate gyrus (gyrus
dentatus), which is divided by small transverse sulci. Portion of facies
medialis hemispherii, which is located between sulcus cinguli and margo
superior hemispherii belongs to lobus frontalis et lobus parietalis.
In front of superior end of sulcus centralis is located facies medialis
gyrus frontalis superioris and immediately to this end of sulcus centralis
is adjacent paracentral lobule (lobulus paracentralis), which is bounded
behind by ramus marginalis sulcus cinguli. Between ramus marginalis in
front and sulcus parietooccipitalis behind is located precuneus
(precuneus), which belongs to lobus parietalis. On facies medialis lobus
occipitalis at a sharp angle open backward join sulcus parietooccipitalis
and calcarine sulcus (sulcus calcarinus). Sulcus calcarinus starts on
medial surface of polus occipitalis, goes forward until isthmus gyri
cinguli. Portion of lobus occipitalis, lying between sulcus
parietooccipitalis and sulcus calcarinus, has shape of triangle, with apex
directed to joining of these sulci, is called cuneus (cuneus). Sulcus
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calcarinus limits from above lingual gyrus (gyrus lingualis), which
extends from polus occipitalis behind until inferior part of isthmus gyri
cinguli. Below gyrus lingualis is located sulcus collateralis, which
belongs to facies inferior hemispherii.
Facies inferior hemispherii. The layout of facies inferior
hemispherii is very complex. Anterior portion of this surface is formed by
lobus frontalis, behind which projects polus temporalis and are located
inferior surfaces of lobus temporalis et lobus occipitalis, which pass one
from another without any visible borders.
On facies inferior lobus frontalis somewhat laterally and parallel to
fissura longitudinalis cerebri lies olfactory sulcus (sulcus olfactorius). It
lodges olfactory bulb and olfactory tract (bulbus olfactorius et tractus
olfactorius). Tractus olfactorius continues backwards into olfactory
trigone (trigonum olfactorius), which has medial and lateral olfactory stria
(striae olfactoriae medialis et lateralis). Portion of lobus frontalis
between fissura longitudinalis cerebri et sulcus olfactorius is called
straight gyrus (gyrus rectus). The surface of lobus frontalis laterally from
sulcus olfactorius is cut by multiple shallow orbital sulci (sulci orbitales)
onto several variable in size and shape orbital gyri (gyri orbitales).
At posterior portion of facies inferior hemispherii is well visible
sulcus collateralis, which lies on inferior surface of lobus temporalis et
lobus occipitalis below and laterally from gyrus lingualis, laterally from
gyrus parahippocampalis. A little in front of anterior end of sulcus
collateralis is positioned sulcus rhinalis. It limits from lateral side bent
ending of gyrus parahippocampalis – uncus (uncus). Laterally from sulcus
collateralis runs medial occipitotemporal gyrus (gyrus occipitotemporalis
medialis). Between this gyrus and located laterally from it lateral
occipitotemporal gyrus (gyrus occipitotemporalis lateralis) lies
occipitotemporal sulcus (sulcus occipitotemporalis). The border between
gyrus occipitotemporalis lateralis et gyrus temporalis inferior is not
sulcus, but margo inferolateralis hemispherii.
Some parts of the brain, primarily located on facies medialis
hemispherii, form substrate for formation of emotions, sleep,
wakefulness, motivations and collectively called as “limbic system”.
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Most of these reactions are formed in close relation with primary centers
of olfaction, so the morphological base for them is represented by
structures of the brain developing from inferolateral portion of brain
vesicle and belongs to rhinencephalon. Limbic system is made by bulbus
olfactorius, tractus olfactorius, trigonum olfactorius, substantia perforata
anterior (located on inferior surface of lobus frontalis), gyrus fornicatus –
gyrus cinguli et gyrus parahippocampalis (together with uncus), gyrus
dentatus, hippocampus and some other structures. Inclusion of these
structures into limbic system became possible because of their common
structure and development, presence of connections between one another
and similarities in functional reactions.

Structure of cortex cerebri

Cerebral cortex (cortex cerebri (pallium)) is made by grey matter
lying on the periphery of hemispheri cerebri. The surface area of one
hemispherium cerebralis in adults in average is about 220000 mm2, 1/3 of
which is convex parts of gyri (visible), 2/3 are formed by lateral walls and
bottoms of sulci (invisible). Thickness of cortex cerebri is uneven and
varies from 1.5 to 5 mm. The thickest cortex is found in upper parts of
gyrus precentralis, gyrus postcentralis et lobulus paracentralis. Usually
thickness of cortex is higher on surfaces of gyri and thinner in lateral walls
and bottoms of sulci.
As it is showed in researches of V.A. Betz, not only type of neurons,
but also their interrelation varies in different parts of cortex cerebri.
Distribution of neurons in cortex cerebri is termed “cytoarchitectonics”.
More or less morphologically similar neurons tend to position in separate
layers. Even without microscope one in the sections of occipital lobes
cortex can see interchanging distribution of grey strata (neurons) and
white matter (fibers). In each cellular strata besides neurons and glial cells
are present fibers – branches of cells from given strata or from other
cellular strata or even other regions of brain (pathways, or tracts).
Structure and density of fibers is uneven in different regions of cortex
cerebri. Distribution of fibers in cortex cerebri is termed
“myeloarchitectonics”. Myeloarchitectonics usually corresponds to
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cytoarchitectonics of cortex cerebri. It is typical for neocortex (neocortex)
of human adult brain to have cells arranged in 6 layers. On facies medialis
et inferior hemispherii cerebri are present remnant parts of archicortex and
paleocortex (archicortex et paleocortex), which have 2-3 layered
structure. Structure of different parts of cortex cerebri is described in more
detail in textbooks of histology. Here are listed only the names of 6 layers:
1) molecular layer (lamina molecularis (plexiformis)), 2) external
granular layer (lamina granularis externa), 3) external pyramidal layer
(lamina pyramidalis externa), 4) internal granular layer (lamina
granularis interna), 5) internal pyramidal layer (lamina pyramidalis
interna), 6) multiform layer (lamina multiformis). Researches carried out
in different countries at the end of XIX, at the beginning of XX century
enabled production of cytoarchitectonic maps of human and animals
cortexes of hemispheri cerebri. Depending on author, number of different
cytoarchitectonic or myeloarchitectonic areas ranges greatly from 50 to
400.
Location of functions in cortex cerebri
Experimental data proved that damage or dissection of particular
area of cortex cerebri in animals leads to loss of certain functions. These
data also confirmed by clinical observation of patients with traumas and
malignancies of cortex cerebri. All that resulted in conclusion that in
cortex cerebri are present different distinct cortical centers regulating
certain functions. Morphological prove of this conclusion is gained from
studies of different cytoarchitectonic or myeloarchitectonic areas of the
cortex. Physiologically cortex cerebri can be viewed as a map, summing
all the cortical ends of different analyzers, responsible for analysis of all
types of information coming from external and internal environment.
However, cortical analyzers are not fixed and limited to a certain
area. Cortical analyzers have nucleus and dispersed elements. Nucleus of
cortical analyzer is an area of cortex, where neurons are forming precise
map of projections from peripheral receptors, analyze the information and
integrate the functions. Dispersed elements of cortical analyzer can be
located on the periphery of nucleus or at significant distance from it. In
dispersed elements of cortical analyzer undergo simpler processes of
analysis and synthesis. Presence of dispersed elements of cortical analyzer
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enable partial recovery of functions after damage of nucleus of cortical
analyzer. Areas, which are occupied by dispersed elements of different
cortical analyzers, can overlap one another. Overall, cortex cerebri can
pictured as map of nucleuses of different cortical analyzers with dispersed
elements in between.
Here are some examples of nucleuses of cortical analyzers with brief
description of function and location.
1. In the cortex of gyrus postcentralis and lobulus parietalis superior
lie neurons forming nucleus of cortical analyzer of general
sensitivity (temperature, pain, touch) and proprioception. It also can
be called primary somatosensory area. Sensory pathways going to
cortex cerebri decussate at the level of different segments of medulla
spinalis (temperature, pain, touch) or at the level of medulla
oblongata (proprioception). By this means, each gyrus postcentralis
is connected with opposite half of the body. In gyrus postcentralis
all receptor fields from different parts of human body project in a
special way, so that uppermost position is occupied by cortical ends
from lower extremities and the lowermost position – by head and
upper extremities.
2. Nucleus of primary motor cortical analyzer is located in gyrus
precentralis and lobulus paracenralis. In the 5th layer of cortex
cerebri lie gigantic pyramidal cells (Betz cells), which from nucleus
of primary motor cortical analyzer start corticonuclear and
corticospinal tracts. Pattern of distribution of neurons in motor
cortical analyzer is similar to the one in the primary somatosensory
area. Neurons responsible for somatic motor activity of lower
extremities lie in upper part of gyrus precentralis, for head and upper
extremities – in lower part of gyrus precentralis. By this means, all
human body parts are projected onto gyrus precentralis upside
down. Pyramidal (corticonuclear and corticospinal tract) pathways
beginning from primary motor cortical analyzer decussate almost
completely. Decussation can occur in the brain stem (corticonuclear
tract), or at the border between brain stem and medulla oblongata
(lateral corticospinal tract), or in the segments of medulla spinalis
(anterior corticospinal tract). Because of decussation of pyramidal
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 pathways, each primary motor cortical analyzer is connected with
the skeletal muscles of the opposite side of the body. Skeletal
muscles of extremities receive completely decussated fibers, but
muscles of larynx, pharynx have connections with both
hemispheres.
3. Nucleus of cortical analyzer responsible for coordinated moving of
neck (head) and eyes into opposite side is located in posterior part
of gyrus frontalis medius, so called premotor zone. Simultaneous
movement of head and eyes is regulated only in the presence of
proprioceptive signaling from muscles of the eye and signals from
retina (in occipital lobe, close to the nucleus of primary visual
cortical analyzer).
4. In lobulus parietalis inferior, in gyrus supramarginalis is located
nucleus of motor analyzer, responsible for synthesis of all voluntary
complicated movements. This nucleus is developed asymmetrically.
In right-handed persons it lies in left hemisphere, in left-handed –
right hemisphere. Ability to coordinate complex voluntary
movements is acquired by person during lifetime as a result of
practical experience and accumulating skills. Voluntary
complicated movements become possible by forming temporary
links between cells located in gyrus precentralis et gyrus
supramarginalis. Damage of gyrus supramarginalis does not lead to
paralysis, but it results in loss of ability to produce complex
coordinated voluntary movements, like practical skills. That is why,
this condition is described as apraxia.
5. In lobulus parietalis superior is located nucleus of sensory analyzer,
responsible for stereognosis – ability to recognize objects by touch.
Cortical end of this analyzer in right hemispherium cerebralis
represents projection of receptor fields from upper left extremity, for
the left hemispherium cerebralis – vice versa. Damage of superficial
layers of this cortical area leads to loss of stereognosis, but other
types of general sensation remain intact.
6. At the depth of sulcus lateralis, in the middle part of gyrus
temporalis superior on the surface directed to insula (Heschl's gyri)
lies nucleus of primary auditory cortical analyzer. Neurons of each
primary auditory cortical analyzer receive signals from auditory
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 receptors of each side, right and left. That is why, damage of primary
auditory cortical analyzer on one side does not lead to deafness, but
damage on both side – does. The last condition is called “cortical
deafness”.
7. Nucleus of primary visual cortical analyzer lies on facies medialis
hemispherii, on sides of sulcus calcarinus of lobus occipitalis.
Nucleus of primary visual cortical analyzer of hemispherium
cerebralis dexter connects with lateral half of retina of right eye and
with medial half of retina of left eye. In cortex of lobus occipitalis
of hemispherium cerebralis sinister correspondingly are projected
receptors from lateral half of retina of left eye and from medial half
of retina of right eye. Similarly as in the case of auditory cortical
analyzer, only 2 sided damage of primary visual cortical analyzer
will lead to “cortical blindness”. Close to primary visual cortical
analyzer are located separate areas responsible for visual memory
and for ability to orient in unknown environment.
8. On facies inferior of lobus temporalis, in the region of uncus,
partially of hippocampus is located nucleus of olfactory cortical
analyzer. These regions of cortex, from phylogenetic point of view,
are considered to be the most ancient parts of the cortex. The sense
of olfaction and taste are closely interrelated because of close
proximity of nucleuses of these 2 senses. It is also known, that taste
diminishes after damage of lowermost parts of gyrus postcentralis.
Nucleuses of olfactory and taste cortical analyzers of both
hemispherium cerebralis are connected with receptors of right and
left sides of the body.
Some of the abovementioned cortical analyzers are also present in
hemispheres of the animal’s brain. These cortical analyzers are
specialized on reception, analysis and synthesis of signals coming
from external and internal environment, forming first signaling
system. These signals (except speech, written or heard) are accepted
from outside world, including social environment, in which humans
live, and are transformed into impressions, sensations and
imaginations. So, the first signaling system represents reality in the
form of sensations and perceptions.

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 Second signaling system is present only in humans and develops
with speech. So, in humans in addition to the first signaling system
is present second signaling system, which enables generalization
with words the countless signals of this system. A word becomes a
signal of signals. The analysis and synthesis performed by the
cerebral cortex when a second signaling system is present relate not
only to individual, concrete stimuli but also to their generalization
in the form of words. The ability for the generalized reflection of
ideas and objects gave humans unlimited ability to orient in the
surrounding world and enabled creation of knowledge and science.
In human cortex hemispheri cerebri can be discerned several cortical
analyzers for analysis of speech.
9. Nucleus of motor writing cortical analyzer (analyzer for voluntary
movements, needed for writing letters and symbols) is located in
posterior portion of gyrus frontalis medius. This cortical analyzer is
in a close proximity to gyrus precentralis, which regulates motor
activity of upper extremity, and also close to premotor zone –
cortical analyzer of coordinated moving of head and eyes. Damage
of nucleus of motor writing cortical analyzer leads to loss of ability
to produce fine, accurate movements during writing, which is called
agraphia. Nucleus of motor writing cortical analyzer is located in
right hemispherium cerebralis for left-handed persons and in left
hemispherium cerebralis for right-handed persons.
10. Nucleus of motor cortical analyzer for articulation of speech
lies in posterior portion of gyrus frontalis inferior. This nucleus is
adjacent to parts of gyrus precentralis, which are responsible for
contractions of muscles of head and neck. That is understandable, if
we take into account that in cortical analyzer for articulation of
speech are regulated muscles of lips, cheeks, tongue, larynx, all of
which participate in articulation of sounds during speaking. Damage
of this cortical analyzer leads to inability to speak – aphasia. In the
case of aphasia there is no loss of ability to pronounce sounds, or
sing, muscles involved into speaking are functional, but the person
can not speak.
11. In the central part of gyrus frontalis inferior is located nucleus
of cortical analyzer of singing. Damage of this analyzer leads to
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 amusia (inability to form and reproduce musical phrases) and
agramatism (loss of ability to form conscious sentences from
separate words). Speech of such patients consists of words, which
are not connected by logic, grammar or meaning.
12. Nucleus of cortical analyzer of oral speech lies in posterior
portion of gyrus temporalis superior, in the close proximity to
primary auditory cortical analyzer. Damage of cortical analyzer of
oral speech does not disturb ability to hear sounds, but ability to
understand words, speech disappears (sensory aphasia). This
cortical analyzer is needed not only to understand the speech, but
also to control own speech.
13. In the middle third of gyrus temporalis superior lies nucleus of
cortical analyzer of music. It`s damage leads to “musical deafness”,
when musical phrases are perceived as unmeaning collection of
noises.
14. In the close proximity to primary visual cortical analyzer lies
nucleus of cortical analyzer for written speech. It occupies gyrus
angularis. Damage of this cortical analyzer leads to alexia – loss of
ability to understand written text and read.

Basal nuclei and white matter of telencephalon

Besides cortex cerebri, grey matter of telencephalon is present in
basal nuclei (nuclei basales). They are located inside white matter, closer
to the base of the brain. Nuclei basales include corpus amygdaloideum
and corpus striatum, composed of nucleus caudatus et nucleus lentiformis.
Corpus striatum received it`s name because in horizontal and
frontal sections it looks like striations made by interchanging strips of
grey and white matter. Most medially and anteriorly is located caudate
nucleus (nucleus caudatus). It lies in front of thalamus, from which (in
horizontal sections) it is divided by strip of white matter – genu capsulae
internae. Anterior part of nucleus caudatus thickens to form caput (nuclei
caudati), which forms lateral wall of cornu anterius ventriculi lateralis.
Caput nuclei caudati is located within lobus frontale, from below it is
adjacent to substantia perforata anterior. There caput nuclei caudati joins
with nucleus lentiformis. Backwards caput nuclei caudati narrows and
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continues into corpus (nuclei caudati), which lies at the floor of pars
centralis ventriculi lateralis and is separated from thalamus by a strip of
white matter. Posterior part of nucleus caudatus gradually thins, bends
downwards, participates in formation of superior wall of cornu inferius
ventriculi lateralis and reaches corpus amygdaloideum, which lies inside
anteromedial part of lobus temporalis, behind substantia perforata
anterior. Laterally from caput nuclei caudati is located layer of white
matter – crus anterius (genu) capsulae internae, after which more laterally
lies nucleus lentiformis.
Lentiform nucleus (nucleus lentiformis) received it`s name
because by shape it resembles the seed of lentis. Nucleus lentiformis lies
laterally from thalamus and nucleus lentiformis. From thalamus nucleus
lentiformis is separated by crus posterius (genu) capsulae internae.
Inferior surface of anterior portion of nucleus lentiformis is adjacent to
substantia perforata anterior and connects with nucleus caudatus. Medial
side of nucleus lentiformis in horizontal sections narrows, enters into an
angle of genu capsulae internae, which is formed between thalamus and
caput nuclei caudati. Lateral surface of nucleus lentiformis is convex and
directed to the base of insula. On the frontal section of the brain nucleus
lentiformis has a shape of triangle, apex of which is directed medially,
base – laterally. Two parallel vertical plates of white matter, which are
located almost in sagittal plane, divide nucleus lentiformis into 3 parts.
Most laterally lies putamen (putamen), which has darker colour. Medially
from putamen lie 2 plates – laminae medullares medialis et lateralis,
which can be called commonly as globus pallidus (globus pallidus).
Lamina medullaris medialis, in that case will be called globus pallidus
medial segment (globus pallidus medialis) and lamina medullaris lateralis
– globus pallidus lateral segment (globus pallidus lateralis). Nucleus
caudatus and putamen from phylogenetic point of view are new, so they
belong to neostriatum (striatum). Globus pallidus, in other hand, is older
and belongs to paleostriatum (pallidum).
Claustrum is located inside white matter, laterally from putamen,
between putamen and insula. Claustrum is made by thin plate of
substantia grisea. From putamen it is separated by plate of substantia alba
– capsula externa, from cortex insulae – by capsula extrema.
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 Corpus amygdaloideum is located inside white matter of lobus
temporalis, 1.5-2 cm. behind from polus temporalis.
White matter of hemispheri cerebri is represented by associative,
commissural and projective fibers.
a. Associative fibers are located within each hemispherium cerebralis
(right or left) and connect different cortical areas (analyzers)
between one another. Associative fibers can be divided into short
and long. Short associative fibers, arcuate fibers (fibrae arcuatae
cerebri), connect between one another grey matter of neighboring
gyri. They are usually bent like arches, so that similarity became the
basis for the term. Long associative fibers connect between one
another more distant cortical areas. There are several bundles of
long associative fibers. Cingulum (cingulum) – is a bundle of long
associative fibers, which passes inside gyrus fornicatus (beneath
cortex of this gyrus) and connects different cortical areas of gyrus
cinguli with neighboring gyri of facies medialis hemispherii
cerebralis. Superior longitudinal fasciculus (fasciculus
longitudinalis superior) connects cortex of lobus frontalis with
cortex of lobulus parietalis inferior, lobus occipitalis and with
posterior portion of lobus temporalis. Inferior longitudinal
fasciculus (fasciculus longitudinalis inferior) connects cortex of
lobus temporalis with cortex of lobus occipitalis. Uncinate
fasciculus (fasciculus uncinatus) connects cortex of orbital surface
of lobus frontalis with cortex of polus temporalis.
b. Commissural fibers connect neurons of cortical analyzers between
two hemispherium cerebralis. The biggest structure, made by
commissural fibers is corpus callosum (described later). To
commissural fibers also belong commissura anterior, commissura
fornicis. Anterior commissure (commissura anterior) connects
symmetrical cortical areas of rhinencepalon, gyri
parahippocampales. Hippocampal commissure (commissura
hippocampi s. commissura fornicis) connects symmetrical
hippocampii.
c. Projective fibers are formed by ascending or descending pathways,
which connect cortex cerebri with other parts of CNS. Projective
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 fibers inside white matter, closer to cortex form corona radiata
(corona radiata). Then major portion of corona radiata converge to
form capsula interna.
Internal capsule (capsula interna) is a thick bent plate of white
matter. Laterally it is bounded by nucleus lentiformis, medially – by caput
nuclei caudati (in front) and thalamus (behind). Capsula interna is divided
into 3 parts. Between nucleus caudatus et nucleus lentiformis lies anterior
limb of internal capsule (crus anterius capsulae internae), between
thalamus et nucleus lentiformis – posterior limb of internal capsule (crus
posterius capsulae internae). Place of junction between two crura forms
an angle open laterally, called genu of internal capsule (genu capsulae
internae).
In capsula interna pass all projective fibers, which connect cortex
cerebri and other parts of CNS. In genu capsulae internae are located
fibers of corticonuclear tract (tractus corticonuclearis s. fibrae
corticonucleares), which descends from gyrus precentralis to nuclei
motorii nervi craniales. In anterior portion of crus posterius capsulae
internae, immediately after genu capsulae internae, pass fibers of
corticospinal tract (tractus corticospinalis). This fibers descends from
gyrus precentralis to nuclei motorii in cornu ventrales medullae spinalis.
Further back in crus posterius capsulae internae pass fibers of tractus
thalamocorticalis. This ascending pathway connects nuclei thalamii with
gyrus postcentralis. Tractus thalamocorticalis contains fibers carrying
signals from receptors of all types of general senses (pain, temperature,
proprioception, tactile and pressure sensation). Even more further back,
in the middle portion of crus posterius capsulae internae pass temporo-
parieto-occipito-pontine fibers. These fibers begin from different areas of
cortex cerebri of lobus occipitalis, parietalis, temporalis, and descend to
nuclei pontinus, located in pars basilaris pontis. In posterior portion of
crus posterius capsulae internae pass fibers, carrying signals from
auditory and visual sense organs. Crus anterius capsulae internae holds
fibers of tractus fronto-pontinus.
Fibers of ascending pathways, which pass in capsula interna to
different area of cortex cerebri form corona radiata (corona radiata).

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Fibers of descending pathways, which pass in capsula interna downwards
compactly occupy basis pedunculi cerebri.
Corpus callosum (corpus callosum) contains commissural fibers,
which pass from one hemispherium cerebralis into another, connecting
right and left cortical analyzers for coordination, integration of functions
of two halves of the brain into one entity. Corpus callosum is a thick bent
plate made by transverse fibers. Free upper surface of corpus callosum is
directed to fissura longitudinalis cerebri and lined by thin layer of grey
matter, called induseum griseum (induseum griseum). On sagittal section
of the brain can be discerned several parts of corpus callosum: genu
(genu), which continues downwards into rostrum (rostrum) and then into
lamina terminalis (lamina terminalis). Middle portion of corpus callosum
is called truncus (corporis callosi). Behind it continues into splenium
(splenium). Transverse fibers of corpus callosum in each hemispherium
cerebralis form radiation of corpus callosum (radiatio corporis callosi).
Fibers of genu corporis callosi bend around anterior end of fissura
longitudinalis cerebri and connect cortex of right and left lobus frontalis.
Fibers of truncus corporis callosi connect cortex of right and left lobus
parietalis et temporalis. In splenium corporis callosi, which embraces
posterior end of fissura longitudinalis cerebri pass fibers connecting
cortex lobus occipitalis dexter et sinister.
Beneath corpus callosum is located fornix (fornix). Fornix consists
from two bent bundles, which in the middle are connected between
themselves by commissura. Middle portion of fornix is called corpus
(fornicis); anteriorly and downwards it continues into paired columnae
(fornicis). Columnae fornicis are directed down and slightly laterally, they
descend and end in corpora mammillaria. Backwards corpus fornicis
continues into paired crura fornicis, which are fused with inferior surface
of corpus callosum. Crura fornicis on right and left side gradually go
laterally and downwards, thicken and by one side fuse with hippocampus
forming fimbria (fimbria hippocampi). Other side of fimbria hippocampi
is free and directed to the cavity of cornu inferius ventriculi lateralis.
Fimbria hippocampi ends in uncus, successfully anatomically joining
lobus temporalis and diencephalon.

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 In front of fornix, in sagittal plane is located septum pellucidum,
composed of two parallel plates – laminas of septum pellucidum (laminae
septi pellucidi). Each lamina septi pellucidi stretches between corpus et
columna fornicis behind, corpus callosum above, genu et rostrum corporis
callosi in front and below. Between laminae septi pellucidi is located
narrow gap-like cavity – cave of septum pellucidum (cavum septi
pellucidi), which contains translucent liquid. Lamina septi pellucidi forms
medial wall of cornu anterius ventriculi lateralis. In front of columnae
fornicis pass transverse fibers of commissura rostralis (anterior). In
sagittal sections commissura rostralis has oval shape. Anterior part of
commissura rostralis is thin and connects substantia grisea of trigonum
olfactoria. Larger posterior part of commissura rostralis connects cortex
of anteromedial parts of right and left lobus temporales.

Ventriculus lateralis
Lateral ventricle (ventriculus lateralis) is located inside each
hemispherium cerebralis. Ventriculus lateralis sinister can be also referred
as I ventricle and ventriculus lateralis dexter as II ventricle. Shape of
ventriculus lateralis is complex because parts of ventriculus lateralis are
located inside each lobe of hemispherium cerebralis, except insula. To
lobus parietalis belongs pars centralis, lobus frontalis – cornu anterius,
lobus occipitalis – cornu posterius, lobus temporalis – cornu inferius.
Central part of lateral ventricle (pars centralis ventriculi lateralis)
is a gap-like cavity, which is bounded from above by transverse fibers of
corpus callosum. The floor of pars centralis is made by corpus nuclei
caudati and partially by dorsal surface of thalamus et stria terminalis.
Medial wall of pars centralis ventriculi lateralis is made by corpus
fornicis. Between corpus fornicis above and thalamus below is located
fissura choroidea, to which is linked plexus choroideus ventriculi lateralis.
Laterally the roof and the floor of pars centralis ventriculi lateralis join at
an angle. By this means, actual lateral wall in pars centralis ventriculi
lateralis is absent.
Anterior or frontal horn of lateral ventricle (cornu anterius
(frontalis) ventriculi lateralis) looks like wide gap, bent downwards and
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laterally. Medial wall of cornu anterius ventriculi lateralis is made by
lamina septi pellucidi. Lateral and partially inferior wall is made by caput
nuclei caudati. Anterior, superior and partially inferior wall are formed by
fibers of corpus callosum.
Inferior or temporal horn of lateral ventricle (cornu inferius
(temporalis) ventriculi lateralis) forms cavity of lobus temporalis. Lateral
and superior walls are formed by white matter of hemispherium
cerebralis. Superior wall is also made by cauda nuclei caudati. At the floor
of cornu inferius ventriculi lateralis is visible collateral eminence
(eminentia collateralis) – impression made into cavity of cornu inferius
by sulcus collateralis. Medial wall is formed by hippocampus, which
extends to the anterior tip of cornu inferius, where it ends with a
thickening. This thickening of hippocampus is cut by multiple shallow
sulci, which as a result form separate elevations – hippocampal digitations
(digitationes hippocampi). On medial side with hippocampus fuses
fimbria (fimbria hippocampi) – continuation of crus fornicis. To fimbria
hippocampi is attached plexus choroideus ventriculi lateralis descending
from pars centralis ventriculi lateralis.
Posterior or occipital horn of lateral ventricle (cornu posterius
(occipitalis) ventriculi lateralis enters into lobus occipitalis
hemispherium cerebralis. Superior and lateral walls are made by fibers of
corpus callosum, inferior and medial walls – by protruding white matter
of lobus occipitalis into cavity of cornu posterius. On medial wall are
visible two elevations. Upper one – bulb of occipital horn (bulbus cornu
occipitalis) is formed by fibers of corpus callosum on their way to lobus
occipitalis, which in given place circumvent deep sulcus
parietooccipitalis. Lower elevation – calcer avis is formed by impression
of brain matter beneath sulcus calcarinus into cavity of cornu posterius.
On inferior wall of cornu posterius is present slightly bulging collateral
trigone (trigonum collaterale) – imprint of brain matter beneath sulcus
collateralis into cavity of ventriculus lateralis.
In pars centralis et cornu inferius ventriculi lateralis is present
choroid plexus of lateral ventricle (plexus choroideus ventriculi lateralis).
This plexus is fixed to taenia choroidea below and to taenia fornicis above.

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Plexus choroideus descends into cornu inferius, where it fixes to fimbria
hippocampi.
Plexus choroideus ventriculi lateralis is formed by vessels of pia
mater, entering into ventriculus lateralis through choroidal fissure (fissura
choroidea). Pia mater from the side of ventriculus is covered by internal
(epithelial) plate (remnant from medial wall of first brain vesicle).
Anteriorly plexus choroideus ventriculi lateralis through interventricular
foramen (foramen interventriculare) communicates with plexus
choroideus ventriculi tertii.

Meninges of the brain

Encephalon, as well as medulla spinalis is covered by 3 meninges.
These are layers formed by connective tissue, which after covering the
brain at the level of foramen magnum continue into meninges of medulla
spinalis. The outermost covering is dura mater, beneath it is arachnoidea
mater and deeper still pia mater.
Cranial dura mater (dura mater encephali s. cranialis) is thick,
strong covering, made by collagen and elastic fibers. It lines cranium from
inside and serves function of periosteum for inner surface of bones of
neurocranium. Dura mater encephali does not attach to the bones of
calvaria strongly and can be easily separated. However, on basis cranii
fixation of dura mater encephali is more secure, especially to the sutures
between bones and to the edges of foramina for the passage of cranial
nerves. Dura mater encephali for some distance envelops nerves forming
connective tissue vaginae for them and fuses with the edges of foramina,
through which nerves leave the cranium.
On basis cranii interna (at the level of medulla oblongata) dura mater
encephali fuses with the edges of foramen magnum and continues to the
dura mater spinalis. Internal surface of dura mater, which is directed to
the brain, is smooth. In some places dura mater encephali splits and it`s
internal plate (duplicature) deeply penetrates into fissurae, which divide
parts of the brain between one another. In the places, where projections of
dura mater stem (begin) and also in the places, where dura mater fixes to
the bones of basis cranii interna, in the splits of dura mater encephali, are
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formed triangular in shape canals lined by endothelium from inside –
sinus durae matris.
The biggest projection of dura mater encephali is falx cerebri or
cerebral falx (falx cerebri). It is located in sagittal plane and penetrates
into fissura longitudinalis cerebri between hemispherium cerebralis
dexter et sinister. Falx cerebri represents thin duplicature of dura mater
bent in a sickle shape. It does not reach corpus callosum and separates
hemispheri cerebri between one another. Along the split base of falx
cerebri, which by it`s location and direction corresponds to sulcus sinus
sagittalis superior, lies sinus sagittalis superior. Along the lower free edge
of falx cerebri between two layers of duplicature of dura mater runs sinus
sagittalis inferior. In front, falx cerebri is fixed to crista galli ossis
ethmoidalis. Behind falx cerebri at the level of protuberantia occipitalis
interna fuses with tentorium cerebelli. Along the fusion line between
posteroinferior edge of falx cerebri and tentorium cerebelli, inside the split
of dura mater encephali runs sinus rectus, which connects sinus sagittalis
inferior with sinus sagittalis superior, sinus transversus et sinus
occipitalis.
Tentorium cerebelli or cerebellar tentorium (tentorium
cerebelli) hangs over fossa cranii posterior with cerebellum inside.
Tentorium cerebelli looks like two-sloped tent occupying fissura
transversa cerebri, by this means tentorium cerebelli divides cerebellum
from lobus occipitales cerebri. Anterior edge of tentorium cerebelli is
uneven. It forms tentorial notch (incisura tentorii), to which in front
adjoins the brain stem.
Lateral edges of tentorium cerebelli attach to margo superior partis
petrosae ossis temporalis. Behind tentorium cerebelli continues into
periosteum ossis occipitalis. In the place of transition from tentorium
cerebelli to periosteum ossis occipitalis forms sinus transversus, adjacent
to sulcus sinus transversi ossis occipitalis.
Falx cerebelli or cerebellar falx (falx cerebelli) lies in sagittal
plane and divides two hemispheres of cerebellum. Anterior edge of falx
cerebelli is free. Posterior edge of falx cerebelli descends from

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protuberantia occipitalis interna to posterior edge of foramen magnum. At
the base of falx cerebelli lies sinus occipitalis.
Diaphragma sellae or sellar diaphragm (diaphragma sellae)
(turcicae) looks like horizontal plate with a hole in the middle.
Diaphragma sellae stretches above fossa hypophysialis and forms it`s
roof. Beneath diaphragma sellae in the center is located hypophysis.
Through the hole in the diaphragma sellae hypophysis joins with
hypothalamus by infundibulum.
Dural venous sinuses (sinus durae matris). Sinus durae matris are
formed as a result of splitting of dura mater encephali onto two plates,
between which pass canals carrying venous blood from the brain to vv.
jugulares internae. Plates of dura mater, which form sinus durae matris,
are tightly stretched. That is why, on the section sinuses gape; they also
lack valves. This structure guarantees free uninterrupted flow of venous
blood, which is not affected by changes in intracranial pressure. On
internal surface of ossa neurocranii, at the places where sinus durae matris
adjoin to the bones are located corresponding sulci. There can be
visualized next sinus durae matris.
1. Superior sagittal sinus (sinus sagittalis superior) lies along superior
edge of falx cerebri from crista galli to protuberantia occipitalis
interna. In front, sinus sagittalis superior anastomoses with veins of
cavum nasi. Behind this sinus drains into sinus transversus. On the
right and on the left sinus sagittalis superior anastomoses with lateral
lacunae (lacunae laterales), which represent small variable in
number and size cavities located between internal and external
plates of dura mater encephali. Lacunae laterales communicate with
cavity of sinus sagittalis superior, into them drain veins of dura
mater encephali, veins of the brain and vv. diploicae.
2. Inferior sagittal sinus (sinus sagittalis inferior) lies along inferior
free edge of falx cerebri; it is substantially smaller then sinus
sagittalis superior. At the posterior end sinus sagittalis inferior
drains into sinus rectus.
3. Straight sinus (sinus rectus) lies sagittally inside splitting of
tentorium cerebelli along the line of fusion of falx cerebri to
tentorium cerebelli. Sinus rectus connects posterior ends of sinus
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 sagittalis superior et sinus sagittalis inferior. Into anterior end of
sinus rectus also drains v. cerebri magna. Behind sinus rectus drains
into sinus confluens sinuum.
4. Transverse sinus (sinus transversus) lies along the origin of
tentorium cerebelli on ossis occipitalis and corresponds by location
with sulcus sinus transversi. The place, where it joins with sinus
sagittalis superior, sinus occipitalis et sinus rectus enlarges and
receives the name confluens of sinuses (confluens sinuum). On the
right and on the left sinus transversus continues into sinus
sigmoideus.
5. Occipital sinus (sinus occipitalis) lies along the base of falx
cerebelli. It begins at the level of protuberantia occipitalis interna,
descends down to posterior edge of foramen magnum, divides into
two branches embracing behind and laterally foramen magnum.
Each branch of sinus occipitalis drains into sinus sigmoideus on it`s
side and superior end of sinus occipitalis drains into sinus
transversus.
6. Sigmoid sinus (sinus sigmoideus), paired, is located in sulcus sinus
sigmoidei on basis cranii interna and has S-letter shape. At the level
of foramen jugulare sinus sigmoideus continues into v. jugularis
interna.
7. Cavernous sinus (sinus cavernosus), paired, located on basis cranii
interna, laterally from sella turcica. Through this sinus pass several
nn. craniales et a. carotis interna. Sinus cavernosus has very
complicated structure; it is made by communicating caverns, which
gave the name to sinus. Between sinus cavernosus dexter et sinus
cavernosus sinister are present anastomoses in the form of anterior
intercavernous sinus and posterior intercavernous sinus (sinus
intercavernosus anterior et sinus intercavernosus posterior), which
are located in front and behind infundibulum hypophysis, inside
diaphragma sellae turcica. Into anterior portion of sinus cavernosus
drain sinus sphenoparietalis et v. ophthalmica superior.
8. Sphenoparietal sinus (sinus sphenoparietalis), paired, located inside
splitting of dura mater, which adjoins to the free posterior edge of
ala minor ossis sphenoidalis.

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 9. Superior petrosal sinus and inferior petrosal sinus (sinus petrosus
superior et sinus petrosus inferior), paired, lie along margo superior
et margo inferior partis petrosae ossis temporalis. Both sinuses take
part in formation of drainage pathway for venous blood from sinus
cavernosus to sinus sigmoideus. Sinus petrosus inferior dexter et
sinister have communications with veins of plexus basilaris lying in
the splitting of dura mater at the level of pars basilaris ossis
occipitalis. Veins of plexus basilaris through foramen magnum
communicate with plexus venosus vertebralis internus.
In some places sinus durae matris encephali form anastomoses with
external veins of the head through emissary veins (vv. emissariae). Vv.
emissariae leave the cranium through several openings, like foramen
parietale, foramen mastoideum, canalis condylaris et all. The same role
take some veins on basis cranii, which exit cranium together with nerves
through foramen ovale, foramen rotundum and canalis hypoglossalis.
Sinus durae matris encephali also anastomose with diploic veins (vv.
diploicae), which are located in spongy part (diploe – between lamina
compacta externa et interna) of bones of neurocranium and drain into
external veins of the head.
As a result, venous blood from the brain drains through systems of
superficial and deep veins into sinus durae matris encephali and then into
v. jugularis interna dextra et sinistra. Important to remember, that by
means of anastomoses of sinuses with vv. diploicae, vv. emissariae and
venous plexuses (vertebralis, basilaris, suboccipitalis, pterygoideus et all.)
venous blood from the brain can drain into superficial veins of head and
neck.
Arachnoid mater (arachnoidea mater) (encephali) [cranialis] is
located beneath dura mater encephali. Arachnoidea mater is thin,
translucent and, unlike pia mater, does not enter into fissurae and sulci
encephali. It covers the brain, passes from one part of the brain to another
and steps over sulci. From pia mater encephali arachnoidea mater is
separated by subarachnoid space (cavitas [spatium] subarachnoidalis
[subarachnoideum]), which is filled by cerebrospinal fluid (liquor
cerebrospinalis). In the places, where arachnoidea mater passes over wide

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and deep sulci, cavitas subarachnoidalis enlarges and forms subarachnoid
cisterns (cisternae subarachnoideae).
Above bulging parts of the brain and on the surfaces of gyri
arachnoidea et pia mater tightly adjoin one to another. In these places
cavitas subarachnoidalis considerably narrows, becoming a capillary gap.
There are present next bigger (1-4, 10) and smaller (5-9) described
only in specialized sources) subarachnoid cisterns.
1. Cerebellomedullary cistern (cisterna cerebellomedullaris) is located
between medulla oblongata ventrally and cerebellum dorsally.
Behind it is bounded by arachnoidea mater. Cisterna
cerebellomedullaris is the biggest among all cisterns. It
communicates with ventriculus quartus through apertura mediana
ventriculi quarti. Cisterna cerebellomedullaris can be also divided
into two topographically separate cisterns: posterior
cerebellomedullary cistern (cisterna cerebellomedullaris posterior
s. cisterna magna) and lateral cerebellomedullary cistern (cisterna
cerebellomedullaris lateralis).
2. Cistern of lateral cerebral fossa (cisterna fossae lateralis cerebri) is
located on inferolateral surface of hemospheri cerebri in anterior
portion of sulcus lateralis.
3. Chiasmatic cistern (cisterna chiasmatis [chiasmatica]) is located on
the base of the brain, in front of chiasma optica. Above it continues
into cisterna laminae terminalis, below – into cisterna
interpeduncularis.
4. Interpeduncular cistern (cisterna interpeduncularis) is located in
fossa interpeduncularis, between pedunculi cerebri, in front of
substantia perforata posterior. Above it continues into cisterna
chiasmatis.
5. Ambient cistern (cisterna ambiens) extends to the lateral side of
pedunculi cerebri. In front it joins with cisterna interpeduncularis,
behind – with cisterna qudrigeminalis.
6. Pericallosal cistern (cisterna pericallosa) is located along the
superior surface of the corpus callosum from splenium to genu. In
front it joins with cisterna laminae terminalis.

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 7. Pontocerebellar cistern (cisterna pontocerebellaris) lies between the
anterior surface of the cerebellum and the lateral surface of the pons.
It communicates with ventriculus quartus through apertura lateralis
ventriculi quarti.
8. Cistern of lamina terminalis (cisterna laminae terminalis) lies in
front of lamina terminalis and commissura anterior, between lobus
frontalis dexter et sinister. Topographically cisterna laminae
terminalis is located between cisterna chiasmatis below and cisterna
pericallosa above.
9. Qudrigeminal cistern (cisterna qudrigeminalis) or cistern of great
cerebral vein (cisterna venae magnae cerebri) is located between
colliculi superiores et inferiores mesencephali, splenium corporis
callosi and the superior surface of the cerebellum.
10. Lumbar cistern (cisterna lumbalis) occupies the space between
conus medullaris and the inferior end of cavitas subarachnoidalis
(SII vertebra level). It is about 1.5 cm anteroposteriorly and 20 cm3
in volume. It is used for procedure of the lumbar puncture.
Cavitas subarachnoidalis encephali at foramen magnum
communicates with cavitas subarachnoidalis medullae spinalis.
Liquor cerebrospinalis, which occupies cavitas subarachnoidalis, is
produced by plexus choroideus ventriculi encephali. From ventriculi
laterales liquor cerebrospinalis drains through foramen interventriculare
dexter et sinister into ventriculus tertius, where also is present plexus
choroideus. From ventriculus tertius liquor cerebrospinalis drains into
ventriculus quartus through aqueductus cerebri, from which it leaks out
through aperturae laterales et apertura mediana into cisterna
cerebellomedullaris of cavitas subarachnoidalis. Because of continuous
nature of cavitas subarachnoidalis, liquor cerebrospinalis fills entirely
cavitas subarachnoidalis encephali et cavitas subarachnoidalis medullae
spinalis. Moreover, because of mesh-like structure of arachnoidea mater,
liquor cerebrospinalis flows between cavitas subarachnoidalis et spatium
subdurale almost freely, without interruption.
Arachnoidea mater connects with pia mater by multiple thin
collagen and elastin fibers, forming arachnoid trabeculae (trabeculae
arachnoideales), which together with liquor cerebrospinalis take part in
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prevention of compression of passing vessels. Arachnoidea mater also
forms arachnoid granulations (granulationes arachnoideae) – protrusions
into sinuses durae matris (mainly into sinus sagittalis superior).
Granulationes arachnoideae penetrate not only sinuses, but also lacunae
laterales. On internal surface of bones of neurocranium we can see
foveolae granulationes – imprints, left by granulationes arachnoideae.
Granulationes arachnoideae are specific structures, which drain liquor
cerebrospinalis into venous blood.
In 1816 italian anatomist Paolo Mascagni described presence of
lymphatic vessels in meninges, but nobody paid much attention and tried
to confirm this finding in later centuries. It was thought that CNS in
general lacks all elements of lymphatic system. But, in 2015
independently from each other in 2 articles were described meningeal
lymphatic vessels in mice and in humans [Aspelund A, 2015; Louveau A,
2015]. Later studies identified precise anatomy and functions of
meningeal lymphatic vessels. Now we can safely assert that, meningeal
lymphatic vessels are capable of drainage of at least part of liquor
cerebrospinalis into deep cervical lymphatic nodes by reaching them
through numerous openings at the base of the cranium (Fig. 9).
Cranial pia mater (pia mater encephali [cranialis]) is the innermost
meninx of the brain. It intimately covers the surface of the organs of CNS,
enters into all fissurae et sulci. Pia mater encephali is made by loose
connective tissue, inside of which pass blood vessels to supply the brain
and the spinal cord. In some places pia mater encephali enters into
ventricles to form choroid plexus (plexus choroideus), which produce
liquor cerebrospinalis.

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Fig. 9. Scheme of circulation and drainage of interstitial fluid and
cerebrospinal liquid from CNS (by Gazizov I.M.).

Glymphatic system – structures that provide filtration of CSF through the

brain parenchyma and the removal of metabolic products of cells from the
central nervous system. The functioning of glymphatic system is based on
the inflow of CSF through the periarterial spaces into the brain
parenchyma and it`s outflow (together with hydrophilic and lipophilic
compounds) through the paravenous spaces into the subarachnoid space.
In addition to removing wastes, the glymphatic system also improoves the
distribution of a number of compounds throughout the brain, including
glucose, lipids, amino acids, growth factors, and neuromodulators.
Functioning of the glymphatic system depends on pressure generated by
pulsation of arterioles, CSF pressure, and relies (at least in part) on the
number of water pores formed by AQP4 (aquaporin 4). The efficiency of
this system increases during sleep.

Questions for self-control

1. Identify location and name cortical analyzers on facies
superolateralis of lobus frontalis.
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2. Identify location and name cortical analyzers on facies
superolateralis of lobus parietalis.
3. Identify location and name cortical analyzers on facies
superolateralis of lobus temporalis.
4. Identify location and name cortical analyzers on facies medialis
hemispheri cerebri.
5. Describe nucleus lentiformis.
6. Describe nucleus caudatus et corpus amygdaloideum.
7. Describe structure and content of capsula interna.
8. Describe formation of capsula interna, externa et extrema.
9. Describe structure and function of corpus callosum.
10. Describe structure of fornix.
11. Describe the walls of cornu anterius ventricli lateralis.
12. Describe the walls of cornu posterius ventricli lateralis.
13. Describe the walls of cornu inferius ventricli lateralis.
14. Describe the walls of pars centralis ventricli lateralis.
15. Identify communications of cerebrospinal liquor and of
plexus choroideus in lateral ventricles.
16. Identify and describe sinuses of dura mater.
17. Identify and describe cysterns of subarachnoid space.
18. Describe formation, circulation and drainage of cerebrospinal
liquor.
19. Identify derivatives of dura mater.
20. Identify and explain function of vv. diploicae et emissariae.
21. Identify and describe associative pathways.
22. Identify and describe commissural pathways.

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 Practical Lesson 6
Check point of Central Nervous System

Purpose of the lesson:

- to assess knowledge of theoretical and practical skills of central
nervous system, check the ability to quickly focus on the preparations,
confidently demonstrate morphological elements on cadaver, accurately
set forth theoretical issues.

Теst
«Central nervous system »

Select one correct answer.

1. Specify the formation of the dura mater of the brain that separates the
occipital lobes of the cerebral hemisphere from the cerebellum
1) the sickle of the large brain
2) outline the cerebellum
3) cerebellar sickle
4) seat diaphragm
5) a small sickle process
2. cranial nerves which nuclei are located in the pons:
1) V
2) XI
3) XII
4) IX
5) X
3. Identify the part of the brain where the motor somatic nucleus of the
trigeminal nerve is located:
1) medulla oblongata
2) pons
3) mesencephalon
4) diencephalon
5) cerebellum

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4. Specify the anatomical structure dividing the pons into the dorsal and
basilar part:
1) lemniscus medialis
2) corpus trapezoideum
3) lemniscus spinalis
4) substantia nigra
5) striae medullares
5. Name the cavity of the brain, which communicates with the
subarachnoid space through the lateral and median apertures:
1) IV ventricle
2) III ventricle
3) I, II ventricles
4) aqueductus cerebri
5) canalis centralis
6. Name the part of the brain, to which belong pedunculi cerebri:
1) telencephalon
2) diencephalon
3) mesencephalon
4) metencephalon
5) rhombencephalon
7. Name the part of the brain, in which is located nucleus salivtorius
superior:
1) medulla oblongata
2) pons
3) mesencephalon
4) diencephalon
5) cerebellum
8. Name the cranial nerve, which exits between pons et medulla
oblongata:
1) III
2) IV

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 3) VI
4) IХ
5) Х
9. Name the cranial nerve, which exits between pyramis et oliva:
1) ХI
2) XII
3) VIII
4) IХ
5) Х
10. Name the cranial nerve, which exits between pyramis et pons:
1) ХI
2) XII
3) VIII
4) IХ
5) VI
11. Identify which parts of the brain form the floor of IV ventricle?
1) pons et medulla oblongata
2) mesencephalon et pons
3) medulla oblongata et cerebellum
4) mesencephalon et diencephalon
5) pons et cerebellum
12. Identify with which parts of the brain cerebellum is connected by
means of pedunculli cerebellares inferiores?
1) medulla oblongata
2) mesencephalon
3) thalamus
4) pedunculi cerebri
5) pons
13. Identify morphological element, which communicates III and I, II
ventricles:
1) aqueductus cerebri
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 2) apertura Lushka
3) apertura Magendi
4) substantia perforate posterior
5) foramen interventriculare
14. Identify morphological element, which takes part in formation of
anterior wall of III ventricle:
1) dorsal surface of chiasma opticum
2) truncus fornicis
3) crura fornicis
4) columnae fornicis
5) plexus choroideus of III ventricle
15. Identify tract, which passes through genu capsulae internae:
1) tectospinalis
2) frontopontinus
3) rubrospinalis
4) corticonuclearis
5) pyramidalis lateralis
16. Identify morphological element, which takes part in formation of
posterior wall of III ventricle:
1) corpora mamillaria
2) dorsal surface of chiasma opticum
3) crura fornicis
4) adhesion interthalamica
5) commissura posterior
17. Identify morphological element, which takes part in formation of
inferior wall of III ventricle:
1) tuber cinereum
2) медиальfacies medialis thalamii
3) commissura habenularum
4) lamina terminalis
5) commissura posterior
18. Identify number of segments in cervical part of medulla spinalis:
1) 7
2) 8
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 3) 12
4) 5
5) 6
19. Identify nucleus o cornu lateralis medullae spinalis:
1) nucleus anteromedialis
2) nucleus thoracicus
3) nucleus centralis
4) nucleus собственное proprius
5) nucleus intermediolateralis
20. Identify parts of medullae spinalis, in which are present wider
points:
1) cervical and lumbosacral parts
2) thoracic and sacral parts
3) cervical part
4) lumbar part
5) coccygeal part

Questions for discussion

«Central nervous system»

1. Lateral ventricles, structure, communications.

2. III ventricle, structure, communications.
3. IV ventricle, structure, communications.
4. Pyramidal tracts.
5. Contious proprioceptive pathways.
6. Uncontious proprioceptive pathways.
7. Pathway of general sensitivity.
8. Extrapyramidal tracts.
9. Nuclei basales in telencephalon, structure, functions.
10. Cross section of mesencephalon.
11. Cross section of myelencephalon.
12. Cross section of pons.
13. Cross section of medulla spinalis.
14. Borders of medulla spinalis.
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 15. Borders of pons.
16. Borders of diencephalon.
17. Borders of mesencephalon.
18. Fossa rhomboidea.
19. Sinuses of dura mater.
20. Segmentotopy of spinal cord.
21. Embryological development of the brain.
22. Structure and function of cerebellum.
23. Cortical analyzers.
24. Exit points of cranial nerves on the surface of the brain.

Situational problems
«Central nervous system»

PROBLEM 1. A teenager, diving headfirst into a pond, received a

spinal injury, as a result of which he had complete paralysis of the upper
and lower extremities (lack of movement and sensitivity). Which part of
the spinal cord is damaged? Give an anatomical rationale.
PROBLEM 2. A woman with a closed craniocerebral injury in the
occipital bone was taken to the emergency room of the clinic. On
examination, the doctor discovered a violation of gait and balance, tremor
of the hands. Which part of the brain is most likely to be damaged? Give
an anatomically sound answer.
PROBLEM 3. After a head injury in the accident, the man
experienced loss of vision, although his reaction to light remained. Where,
most likely, can the pathological process be localized? Give an
anatomically sound answer.

Example of check list

Central nervous system №1
Maximum score is 70. Each term gives up to 4 points.
Note: all anatomical terms have to be in latin, absence or incorrect term
cancels 2 points for each term.
Midbrain in latin - 2
102
Identify anatomical structures of hypothalamus, which are visible on
inferior surface of brain:
1 4
2 4
3 4
4 4
5 4
Identify cortical analyzers present in lobus frontalis facies
superolateralis:
1. 4
2. 4
3 4
4 4
Walls of III ventricle:
1. 4
2. 4
3. 4
4. 4
5. 4
Recesses of III ventricle:
1. 4
2. 4
3 4

Human Anatomy Department

CNS
Practical part №1
Write all terms in latin if it is asked. Correct answer will give 3 points
(latin term – 1,5 points; identification and showing – 1,5 or 3 points).
Maximum score for practical part is 30 points.

№ Identify and show show latin

1. Lower border of medulla oblongata -

2. Commissural fibers of diencephalon -

3. Border between parietal and frontal lobe -

4. Trigonum lemniscus lateralis XXX

103
5. End of columna fornicis ventrally -

6. Inferior projection of lateral ventricles -

7. Exit of V cranial nerve -

8. Cavity of midbrain -

9. Primary visual cortical center -

Sinus along posterior edge of ala minor os
sphenoidale –
10.

Number of correct answers:

Result:

Answers to test questions

«Peripheral Nervous System»
1 2 6 3 11 1 16 5
2 1 7 2 12 1 17 1
3 2 8 3 13 5 18 2
4 2 9 2 14 4 19 5
5 1 10 5 15 4 20 1

Standards of answers to situational problems

« Peripheral Nervous System»

Answer to problem 1
The spinal cord has two thickenings - the cervical and the
lumbosacral. It is from the cervical and lumbosacral parts of the spinal
cord that innervation of the upper and lower extremities is carried out,
respectively. If the spinal cord is damaged at a level lower than the
cervical thickening (for example, the thoracic segments of spinal cord are
damaged), then paralysis of only the lower extremities should be

104
 expected; if the injury affects the cervical spine, then paralysis of both the
upper and lower extremities occurs.
Answer to problem 2
In this case, we can talk about damage to the cerebellum, one of the
most important functions of which is maintaining balance and
coordination of movements. Serious damage to the cerebellum or its
connections is often accompanied by disorders of coordination of
movements, muscle tone and balance.
Answer to problem 3
These symptoms suggest the localization of the pathological process in
the occipital lobe of the cerebral cortex (sulcus calcarinus) - the place
where the cortical end of the visual analyzer lies and the analysis and
synthesis of visual information coming from the external environment
takes place. The preservation of only the subcortical centers of vision
makes it possible to preserve only an indicative reflex to light (turning the
head towards light).

Standards of answers to check lists

Central nervous system №1
Maximum score is 70. Each term gives up to 4 points.
Note: all anatomical terms have to be in latin, absence or incorrect term
cancels 2 points for each term.
Midbrain in latin - mesencephalon 2
Identify anatomical structures of hypothalamus, which are visible on
inferior surface of brain:
1 tuber cinerum 4
2 corpora mamillaria 4
3 chiasma opticum 4
4 tractus opticus 4
5 hypophysis 4
Identify cortical analyzers present in lobus frontalis facies
superolateralis:
1 general center for movements 4
2 writing 4
3 speaking 4
4 coordination of movements of eyes, eyes and neck 4
105
Walls of III ventricle:
1. lamina terminalis 4
2. tela choroidea on fornix 4
3. hypothalamus 4
4. thalamus 4
5. commissura habenularum et commissura posterior 4
Recesses of III ventricle:
1. recessus pinealis 4
2. recessus infundibuli 4
3 recessus supraopticus 4

Human Anatomy Department

CNS
Practical part №1
Write all terms in latin if it is asked. Correct answer will give 3 points
(latin term – 1,5 points; identification and showing – 1,5 or 3 points).
Maximum score for practical part is 30 points.

№ Identify and show show latin

Lower border of medulla oblongata – decussatio
1. pyramidum, exit of radices n. spinalis I, foramen
magnum
Commissural fibers of diencephalon – adhesio
2. interthalamica
Border between parietal and frontal lobe – sulcus
3. centralis
4. Trigonum lemniscus lateralis XXX
End of columna fornicis ventrally – corpora
5. mamillaria
Inferior projection of lateral ventricles – cornu
6. inferius
Exit of V cranial nerve – between pons et
7. pedunculi cerebellaris media; linea
trigeminofacialis

106
8. Cavity of midbrain – aqueductus mesencephalici

9. Primary visual cortical center – sulcus calcarinus

Sinus along posterior edge of ala minor os
10. sphenoidale – sinus sphenoparietalis

Number of correct answers:

Result:

CRITERIA FOR EVALUATING THE RESPONSE TO THE

THEORETICAL QUESTION

The mark "excellent" (90-100 points) is set if:

- responding student gives a grounded, consistent (from general to
specific) correct answer to a specific question posed, without leading
questions and with a minimum number (1–3) of changes from the
teacher’s side;
- student demonstrates clear knowledge of anatomical definitions,
concepts, latin anatomical terms of organs and their morphological
structures;
- accurate knowledge of the anatomical preparations is shown;
- when responding, student does not make mistakes in the
anatomical terminology;
- student gives the correct, sensible answers to additional questions
of the teacher;
- student is able to express correctly thoughts, ideas.
The mark "good" (80-89 points) is set if:
- student gives a detailed, but not sufficiently correct, logically
structured answer, which required the teacher to ask students a leading
question and make some clarifications;
- sufficient knowledge of basic concepts and definitions is shown
(single errors, small inaccuracies are allowed);
- some mistakes were made in the anatomical and latin terminology;

107
 - answers to additional and leading questions are generally correct,
but incomplete and not sufficiently clear;
- student answered the question, showed the ability to highlight the
essential and non-essential details, cause-and-effect relationships;
- natural anatomical preparations are used during answering,
morphological elements are correctly demonstrated on them, but there is
some uncertainty;
- speech is literate.
"satisfactory" (70-79 points) is set if:
- answer is incomplete (the topic is not fully disclosed), confused,
there is no logical thinking, requires constant intervention by the teacher
in the form of leading and clarifying questions, hints;
- a large number of mistakes were made in the formulation of the
main anatomical concepts and definitions;
- insufficient knowledge of anatomical preparations;
- errors and inaccuracies in latin terminology;
- answer is ill-conceived, the student can hardly articulate his
thoughts.
The mark of "unsatisfactory" (69 and less points) is given if:
- answer is confused, unsystematic, with a significant amount of
significant morphological errors;
- the student demonstrates a clear misunderstanding of the basic
morphological concepts and definitions;
- during demonstration of morphological elements on natural
anatomical preparations, student shows complete ignorance of the
preparations;
- answers additional and clarifying questions incorrectly or refuses
to answer at all (silent);
- no knowledge of latin anatomical terminology.

108
 CRITERIA FOR THE ASSESSMENT OF THE TEST AND
CHECK LIST

For the correct answer - 1 point, for an incorrect or unspecified

answer - 0 points.
100–90% - “excellent”.
89–80% - “good.”
79–70% - “satisfactory”.
69% or less - "unsatisfactory."

CRITERIA FOR ASSESSMENT OF

SITUATIONAL PROBLEMS

The mark “excellent” (90-100 points) is set if the student is well

oriented in solving specific practical problems and gives a clear
anatomical rationale for the decision made.
The mark “good” (80-89 points) is set if the student solves specific
practical problems, but makes mistakes in the anatomical justification of
the decision made.
The mark “satisfactory” (70-79 points) is given if the student is
partially able to analyze solutions to specific practical problems and
makes gross mistakes in the anatomical rationale for the decision made.
The rating “unsatisfactory” (69 points or less) is set if the student
is not able to analyze the solutions to specific practical problems, to give
an anatomical rationale for the decision made.

CRITERIA FOR FINAL EVALUATION

The overall assessment consists of a set of assessments obtained at

the relevant stages of the survey: discussion, tests, situational problems.
“Excellent” (90-100 points) - test control was passed (the student
gave the correct answer to 90% or more of the test questions), the student
is well oriented in natural anatomical preparations and on cadaver,
109
anatomical latin terms are correctly named; the answer to the question is
clear, short, polite; the answer is complete, competent, consistent and
logical; found the correct solution to the situational problem and given a
clear anatomical rationale for the decision.
“Good” (80-85 points) - test control was passed (the student
answered 80-90% of the test questions correctly), student is well oriented
in natural anatomical preparations and on cadaver, single errors in the
knowledge of anatomical latin terms; the answer to the question is correct,
but not sufficiently clear; the answer is literate, but not consistent; The
case problem is solved correctly, but there are errors in the anatomical
rationale for the decision made.
“Satisfactory” (70-75 points) - test control was passed (student
answered 70-80% of the test questions correctly), student is not confident
enough in anatomical preparations, errors in the knowledge of anatomical
latin terms; the answer to the question is not complete, with some errors;
the story is inconsistent, with errors in particular, the student is partially
able to analyze solutions to specific practical problems, makes gross
errors in the anatomical rationale for the decision.
“Unsatisfactory” (less than 70%) - the test control was not passed
(student answered correctly less than 70% of the test questions); student
does not know natural preparations and cadaver, gross errors in the
knowledge of anatomical latin terms are made, the answer to the question
is inconsistent, fuzzy or incorrect, the solution of the situational problem
was not found.

List of used sources

LITERATURE
Main
1. 1. Анатомия человека [Текст] : [учебник] / М. Г. Привес, Н. К.
Лысенков, В. И. Бушкович. - Изд. 12-е, перераб. и доп. - Санкт-
Петербург : СПбМАПО, 2011. - 720 с. 380 экз.
2. Human Anatomy [Text] : [Textbook] / М. G. Prives, N. К. Lysenkov,
V. I. Bushkovich. – 12th edition - Saint-Peterburg : SpbMAPO, 2010. -
720 p. 179 copies.
110
 Additional
1. Атлас анатомии человека [Текст] : учеб. пособие для студентов
мед. вузов : в 4 т. / Р. Д. Синельников, Я. Р. Синельников, А. Я.
Синельников. - Изд. 7-е, перераб. - Москва : Новая Волна :
Издатель Умеренков, 2016 - Т. 1 : Учение о костях, соединении
костей и мышцах. - 2016. - 348 с.
2. Атлас анатомии человека [Текст] : учеб. пособие для студентов
мед. вузов : в 4 т. / Р. Д. Синельников, Я. Р. Синельников, А. Я.
Синельников. - Изд. 7-е, перераб. - Москва : Новая Волна :
Издатель Умеренков, 2016 - Т. 2 : Учение о внутренностях и
эндокринных железах. - 2016. - 247, [1] с.
3. Атлас анатомии человека [Текст] : учеб. пособие для студентов
мед. ин-тов : В 4 т / Р. Д. Синельников, Я. Р. Синельников. - М. :
Медицина, 1989 - Т. 3 : Учение о сосудах. - 1992. - 231 с.
4. Атлас анатомии человека [Текст] : учеб. пособие : В 4 т. / Р. Д.
Синельников, Я. Р. Синельников. - М. : Медицина, 1994 - Т. 4 :
Учение о нервной системе и органах чувств. - 1994. - 319 с. 969 экз.
5. Aspelund A, Antila S, Proulx ST, Karlsen TV, Karaman S, Detmar
M, et al. A dural lymphatic vascular system that drains brain interstitial
fluid and macromolecules. J Exp Med 2015; 212: 991-999.
6. Louveau A, Smirnov I, Keyes TJ, Eccles JD, Rouhani SJ, Peske JD, et
al. Structural and functional features of central nervous system
lymphatic vessels. Nature 2015 ; 523: 337.

Recommended internet links

1. Electronic library: http://www.book.ru/;
2. ООО «ИВИС»: http://www.ebiblioteka.ruhttp://
online.ebiblioteka.ru
3. Wiley: http://www.interscience.wiley.com
4. Documents at Department: http://kgmu.kcn.ru/j3/anatomiya-
normalnaya/uchebnaya-rabota.html

111
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