Wednesday, March 01, 2006

What are the pathways of the cranial nerves?

The Optic Nerve (II cranial) consists chiefly of coarse fibers which arise from the ganglionic layer of the retina. They constitute the third neuron in the series composing the visual path and are supposed to convey only visual impressions. A number of fine fibers also pass in the optic nerve from the retina to the primary centers and are supposed to be concerned in the pupillary reflexes. There are in addition a few fibers which pass from the brain to the retina; they are supposed to control chemical changes in the retina and the movements of the pigment cells and cones. Each optic nerve has about 1.0 - 1.2 million fibers. In the optic chiasm, the nerves from the medial half of each retina cross to enter the opposite optic tract, while the nerves from the lateral half of each retina pass into the optic tract of the same side. The crossed fibers tend to occupy the medial side of each optic nerve, but in the chiasma and in the optic tract they are more intermingled. The optic tract is attached to the tuber cinereum and lamina terminalis and also to the cerebral peduncle as it crosses obliquely over its under surface. These are not functional connections. A small band of fibers from the medial geniculate body joins the optic tract as the latter passes over it and crosses to the opposite tract and medial geniculate body in the posterior part of the chiasma. This is the commissure of Gudden and is probably connected with the auditory system. Most of the fibers of the optic tract terminate in the lateral geniculate body, some pass through the superior brachium to the superior colliculus, and others either pass over or through the lateral geniculate body to the pulvinar of the thalamus. These end-stations are often called the primary visual centers. The lateral geniculate body consists of medium-sized pigmented nerve cells arranged in several layers by the penetrating fibers of the optic tract. Their axons pass upward beneath the longer fibers of the optic tract, the tænia semicircularis, the caudate nucleus and the posterior horn of the lateral ventricle where they join the optic radiation of Gratiolet. They pass backward and medially to terminate in the visuo-sensory cortex in the immediate neighborhood of the calcarine fissure of the occipital lobe. This center is connected with the one in the opposite side by commissural fibers which course in the optic radiation and the splenium of the corpus callosum. Association fibers connect it with other regions of the cortex of the same side. Scheme showing central connections of the optic nerves and optic tracts. The region of the pulvinar in which optic tract fibers terminate resembles in structure the lateral geniculate body. Its axons also have a similar course though in a somewhat more dorsal plane. The superior colliculus receives fibers from the optic tract through the superior brachium. Some enter by the superficial white layer (stratum zonale), others appear to dip down into the gray cap (stratum cinereum) while others probably decussate across the midline to the opposite colliculus. Other fibers from the superior brachium pass into the stratum opticum (upper gray-white layer). Some of these turn upward into the gray cap while others terminate among the cells of this layer. Since the superior colliculi appear to be the central organs concerned in the control of eye-muscle movements and eye-muscle reflexes we should expect to find them receiving fibers from other sensory paths. Many fibers pass to the superior colliculus from the medial fillet as the latter passes through the tegmentum bringing the superior colliculus into relation with the sensory fibers of the spinal cord. Fibers from the central sensory path of the trigeminal probably pass with these. Part of the ventral spinocerebellar tract (Gowers) is said to pass up through the reticular formation of the pons and mid-brain toward the superior colliculus and the thalamus. The superior colliculus is intimately connected with the central auditory path (the lateral lemniscus), as part of its fibers pass the inferior colliculus and terminate in the superior colliculus. They are probably concerned with reflex movements of the eyes depending on auditory stimuli. The superior colliculus is said to receive fibers from the stria medullaris thalamis of the opposite side which pass through the commissura habenulæ and turn back to the roof of the mid-brain, especially to the superior colliculus. By this path both the primary and cortical olfactory centers are brought into relation with the eye-muscle reflex apparatus. The fibers which pass to the nuclei of the eye muscles arise from large cells in the stratum opticum and stratum lemnisci and pass around the ventral aspect of the central gray matter where most of them cross the midline in the fountain decussation of Meynert, and then turn downward to form the ventral longitudinal bundle. This bundle runs down partly through the red nucleus, in the formatio reticularis, ventral to the posterior longitudinal bundle of the mid-brain, pons and medulla oblongata into the ventral funiculus of the spinal cord where it is known as the tectospinal fasciculus. Some of the fibers are said to pass down with the rubrospinal tract in the lateral funiculus. Some fibers do not decussate but pass down in the ventral longitudinal bundle of the same side on which they arise unless possibly they come from the opposite colliculus over the aqueduct. From the ventral longitudinal bundle collaterals are given off to the nuclei of the eye muscles, the oculomotor, the trochlear and the abducens. Many collaterals pass to the red nucleus, and are probably concerned with the reflexes of the rubrospinal tract. The fibers of the tectospinal tract end by collaterals and terminals either directly or indirectly among the motor cells in the anterior column of the spinal cord. The superior colliculus receives fibers from the visual sensory area of the occipital cortex; they pass in the optic radiation. Probably no fibers pass from the superior colliculus to the visual sensory cortex.

The Oculomotor Nerve (III cranial) contains somatic motor fibers to the Obliquus inferior, Rectus inferior, Rectus superior, Levator palpebræ superioris and Rectus medialis muscles and sympathetic efferent fibers (preganglionic fibers) to the ciliary ganglion. The postganglionic fibers connected with these supply the ciliary muscle and the sphincter of the iris. The axons arise from the nucleus of the oculomotor nerve and pass in bundles through the posterior longitudinal bundle, the tegmentum, the red nucleus and the medial margin of the substantia nigra in a series of curves and finally emerge from the oculomotor sulcus on the medial side of the cerebral peduncle.
The oculomotor nucleus lies in the gray substance of the floor of the cerebral aqueduct subjacent to the superior colliculus and extends in front of the aqueduct a short distance into the floor of the third ventricle. The inferior end is continuous with the trochlear nucleus. It is from 6 to 10 mm. in length. It is intimately related to the posterior longitudinal bundle which lies against its ventro-lateral aspect and many of its cells lie among the fibers of the posterior longitudinal bundle. The nucleus of the oculomotor nerve contains several distinct groups of cells which differ in size and appearance from each other and are supposed to send their axons each to a separate muscle. Much uncertainty still exists as to which group supplies which muscle. There are seven of these groups or nuclei on either side of the midline and one medial nucleus. The cells of the anterior nuclei are smaller and are supposed to give off the sympathetic efferent axons. The majority of fibers arise from the nucleus of the same side some, however, cross from the opposite side and are supposed to supply the Rectus medialis muscle. Since oculomotor and abducens nuclei are intimately connected by the posterior longitudinal bundle this decussation of fibers to the Medial rectus may facilitate the conjugate movements of the eyes in which the Medial and Lateral recti are especially involved. Many collaterals and terminals are given off to the oculomotor nucleus from the posterior longitudinal bundle and thus connect it with the vestibular nucleus, the trochlear and abducens nuclei and probably with other cranial nuclei. Fibers from the visual reflex center in the superior colliculus pass to the nucleus. It is also connected with the cortex of the occipital lobe of the cerebrum by fibers which pass through the optic radiation. The pathway for voluntary motor impulses is probably similar to that for the abducent nerve.

The Trochlear Nerve (IV cranial) contains somatic motor fibers only. It supplies the superior oblique muscle of the eye. Its nucleus of origin, trochlear nucleus, is a small, oval mass situated in the ventral part of the central gray matter of the cerebral aqueduct at the level of the upper part of the inferior colliculus. The axons from the nucleus pass downward in the tegmentum toward the pons, but turn abruptly dorsalward before reaching it, and pass into the superior medullary velum, in which they cross horizontally, to decussate with the nerve of the opposite side, and emerges from the surface of the velum, immediately behind the inferior colliculus. The cells of the trochlear nucleus are large, irregular and yellowish in color. The nuclei of the two sides are separated by the raphé through which dendrites extend from one nucleus to the other. They receive many collaterals and terminals from the posterior longitudinal bundle which lies on the ventral side of the nucleus. There are no branches from the fibers of the pyramidal tracts to these nuclei; the volitional pathway must be an indirect one, as is the case with other motor nuclei.

The Trigeminal Nerve (V cranial) contains somatic motor and somatic sensory fibers. The motor fibers arise in the motor nucleus of the trigeminal and pass ventro-laterally through the pons to supply the muscles of mastication. The sensory fibers arise from the unipolar cells of the semilunar ganglion; the peripheral branches of the T-shaped fibers are distributed to the face and anterior two-thirds of the head; the central fibers pass into the pons with the motor root and bifurcate into ascending and descending branches which terminate in the sensory nuclei of the trigeminal.
The motor nucleus of the trigeminal is situated in the upper part of the pons beneath the lateral angle of the fourth ventricle. It is serially homologous with the facial nucleus and the nucleus ambiguus (motor nucleus of the vagus and glossopharyngeal) which belong to the motor nuclei of the lateral somatic group. The axons arise from large pigmented multipolar cells. The motor nucleus receives reflex collaterals and terminals, (1) from the terminal nucleus of the trigeminal of the same and a few from the opposite side, via the central sensory tract (trigeminothalamic tract); (2) from the mesencephalic root of the trigeminal; (3) from the posterior longitudinal bundle; (4) and probably from fibers in the formatio reticularis. It also receives collaterals and terminals from the opposite pyramidal tract (corticopontine fibers) for voluntary movements. There is probably a connecting or association neuron interposed between these fibers and the motor neurons.
The terminal sensory nucleus consists of an enlarged upper end, the main sensory nucleus, and a long more slender descending portion which passes down through the pons and medulla to become continuous with the dorsal part of the posterior column of the gray matter especially the substantia gelatinosa of the spinal cord. This descending portion consists mainly of substantia gelatinosa and is called the nucleus of the spinal tract of the trigeminal nerve. 41 The main sensory nucleus lies lateral to the motor nucleus beneath the superior peduncle. It receives the short ascending branches of the sensory root. The descending branches which form the tractus spinalis, pass down through the pons and medulla on the lateral side of the nucleus of the tractus spinalis, in which they end by collaterals and terminals, into the spinal cord on the level of the second cervical segment. It decreases rapidly in size as it descends. At first it is located between the emergent part of the facial nerve and the vestibular nerve, then between the nucleus of the facial nerve and the inferior peduncle. Lower down in the upper part of the medulla it lies beneath the inferior peduncle and is broken up into bundles by the olivocerebellar fibers and the roots of the ninth and tenth cranial nerves. Finally it comes to the surface of the medulla under the tubercle of Rolando and continues in this position lateral to the fasciculus cuneatus as far as the upper part of the cervical region where it disappears.
The cells of the sensory nucleus are of large and medium size and send their axons into the formatio reticularis where they form a distinct bundle, the central path of the trigeminal (trigeminothalamic tract), which passes upward through the formatio reticularis and tegmentum to the ventro-lateral part of the thalamus. Most of the fibers cross to the trigeminothalamic tract of the opposite side. This tract lies dorsal to the medial fillet; approaches close to it in the tegmentum and terminates in a distinct part of the thalamus. From the thalamus impulses are conveyed to the somatic sensory area of the cortex by axons of cells in the thalamus through the internal capsule and corona radiata. Many collaterals are given off in the medulla and pass from the trigeminothalamic tract to the motor nuclei, especially to the nucleus ambiguus, the facial nucleus and the motor nucleus of the trigeminal. 43 The somatic sensory fibers of the vagus, the glossopharyngeal and the facial nerves probably end in the nucleus of the descending tract of the trigeminal and their cortical impulses are probably carried up in the central sensory path of the trigeminal. 44 The mesencephalic root (descending root of the trigeminal) arises from unipolar cells arranged in scattered groups in a column at the lateral edge of the central gray matter surrounding the upper end of the fourth ventricle and the cerebral aqueduct. They have usually been considered as motor fibers that join the motor root, but Johnston claims that they join the sensory root of the trigeminal, that they develop in the alar, not in the basal lamina, and that the pear-shaped unipolar cells are sensory in type.

The Abducens Nerve (VI cranial) contains somatic motor fibers only which supply the lateral rectus muscle of the eye. The fibers arise from the nucleus of the abducens nerve and pass ventrally through the formatio reticularis of the pons to emerge in the transverse groove between the caudal edge of the pons and the pyramid. The nucleus is serially homologous with the nuclei of the trochlear and oculomotor above and with the hypoglossal and medial part of the anterior column of the spinal cord below. It is situated close to the floor of the fourth ventricle, just above the level of the striæ medullares. Voluntary impulses from the cerebral cortex are conducted by the pyramidal tract fibers (corticopontine fibers). These fibers probably terminate in relation with association neurons which control the coördinated action of all the eye muscles. This association and coördination mechanism is interposed between the terminals and collaterals of the voluntary fibers and the neurons within the nuclei of origin of the motor fibers to the eye muscles. The fibers of the posterior longitudinal bundle are supposed to play an important role in the coördination of the movements of the eyeball. Whether it is concerned only with coördinations between the vestibular apparatus and the eye or with more extensive coördinations is unknown. Many fibers of the posterior longitudinal bundle have their origin in the terminal nuclei of the vestibular nerve and from the posterior longitudinal bundle many collaterals and terminals are given off to the abducent nucleus as well as to the trochlear and oculomotor nuclei. The abducens nucleus probably receives collaterals and terminals from the ventral longitudinal bundle (tectospinal fasciculus); fibers which have their origin in the superior colliculus, the primary visual center, and are concerned with visual reflexes. Others probably come from the reflex auditory center in the inferior colliculus and from other sensory nuclei of the brain-stem.

The Facial Nerve (VII cranial) consists of somatic sensory, sympathetic afferent, taste, somatic motor and sympathetic efferent fibers. The afferent or sensory fibers arise from cells in the geniculate ganglion. This portion of the nerve is often described as the nervus intermedius.

(1) The somatic sensory fibers are few in number and convey sensory impulses from the middle ear region. Their existence has not been fully confirmed. Their central termination is likewise uncertain, it is possible that they join the spinal tract of the trigeminal as do the somatic sensory fibers of the vagus and glossopharyngeal.

(2) The sympathetic afferent fibers are likewise few in number and of unknown termination.

(3) Taste fibers convey impulses from the anterior two-thirds of the tongue via the chorda tympani. They are supposed to join the tractus solitarius and terminate in its nucleus. The central connections of this nucleus have already been considered.
(4) Somatic motor fibers, supplying the muscles derived from the hyoid arch, arise from the large multipolar cells of the nucleus of the facial nerve. This nucleus is serially homologous with the nucleus ambiguus and lateral part of the anterior column of the spinal cord. Voluntary impulses from the cerebral cortex are conveyed by terminals and collaterals of the pyramidal tract of the opposite side, indirectly, that is with the interpolation of a connecting neuron, to the facial nucleus. This nucleus undoubtedly receives many reflex fibers from various sources, i. e., from the superior colliculus via the ventral longitudinal bundle (tectospinal fasciculus) for optic reflexes; from the inferior colliculus via the auditory reflex path; and indirectly from the terminal sensory nuclei of the brain-stem. Through the posterior longitudinal bundle it is intimately connected with other motor nuclei of the brain-stem.
(5) Sympathetic efferent fibers (preganglionic fibers) arise according to some authors from the small cells of the facial nucleus, or according to others from a special nucleus of cells scattered in the reticular formation, dorso-medial to the facial nucleus. This is sometimes called the superior salivatory nucleus. These preganglionic fibers are distributed partly via the chorda tympani and lingual nerves to the submaxillary ganglion, thence by postganglionic (vasodilator) fibers to the submaxillary and sublingual glands. Some of the preganglionic fibers pass to the sphenopalatine ganglion via the great superficial petrosal nerve.


Blogger dcrwiesbaden said...

go to "the oculomotor nerve (III cranial)" in this chapter...
everything is fine.
bat only parasympathetic preganglionic nervefibers of the cranial neve III function with ciliary ganglion.

dr. kai patrick lindstrom
diagnostic radiologist, wiesbaden, germany

10:59 PM  
Blogger Unknown said...

By the way, the right visual field is incorrectly colored/oriented.

9:03 AM  
Blogger Unknown said...

Robert, right field is allright.

9:10 PM  

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