Contents
I
J. C. Tamraz, Y. G. Comair
Atlas of Regional Anatomy of the Brain Using MRI
Softcover Edition
Contents
III
J. C. Tamraz, Y. G. Comair
Atlas of
Regional Anatomy
of the Brain
Using MRI
With Functional Correlations
Foreword by Hans Otto Lüders
With 458 Figures in 817 Separate Illustrations
123
1234
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Contents
Jean C. Tamraz, MD, PhD
Professor and Chairman
Department of Neuroradiology
Hotel-Dieu de France Hospital
Saint-Joseph University
Beirut, Lebanon
Youssef G. Comair, MD, FRCSC
Professor and Chief
Division of Neurosurgery
American University of Beirut
Consultant Neurosurgeon
The Cleveland Clinic Foundation
44122 Cleveland, Ohio, USA
ISBN 3-540-27876-1 Springer-Verlag Berlin Heidelberg New York
ISBN 978 3-540-27876-4 Springer-Verlag Berlin Heidelberg New York
Library of Congress Cataloging-in-Publication Data
Tamraz, J. C. (Jean Chucri), 1954Atlas of regional anatomy of the brain using MRI : with functional
correlations / J.C. Tamraz and Y.G. Comair.
p. ; cm.
Includes bibliographical references and index.
ISBN 3540640991 (hardcover; alk. paper) ISBN 3540278761 (softcover; alk. paper)
1. Brain--Anatomy--Atlases. 2. Brain--Magnetic resonance imaging--Atlases. I.
Comair, Y. G. (Youssef G.)
[DNLM: 1. Brain--anatomy & histology--Atlases. 2. Magnetic Resonance
Imaging--Atlases. WL 17 T159a 2000]
QM455.T35 2000
611’.81’0222--dc21
99-044535
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Contents
V
Foreword
The anatomical dissections of Mundini dei Luzzi in 1316, mark the beginning of
an era extending over more than 5 centuries in which the study of the brain was
limited, almost exclusive1y, to description of its gross anatomy derived from the
inspection of gross anatomical specimens. In the 19th century, new techniques
like histology and electrical stimu1ation were developed allowing the first correlation studies of cortical anatomy and brain function. Shortly thereafter, the
development of recording techniques of evoked potentials and spontaneous brain
waves (EEG) further enhanced our understanding of brain function as a function
of its anatomical correlation. One major limitation of all these studies was that at
that time no technique was available to define the anatomy of the brain without
its direct visualization. In other words, precise anatomo-functional correlation
studies were only possible in experimental studies in animals, the unusual setting
of human craniotomies and by careful clinico-pathological studies. These last
studies also shed some light on the functions of structures that had been affected
by a pathological process, and in the late 19th century and early 20th century,
research efforts of clinical neuroscientists focused on anatomo-functional correlation studies making brain anatomy one of their pillars. However, soon these
research techniques reached a limit and, progressively research efforts focused
on pathogenesis, therapeutics and the development of clinical diagnostic techniques. Clinicians soon realized that precise knowledge of brain anatomy was not
necessarily an essential clinical tool and brain anatomy classes in neuroscience
curricula became only of secondary importance.
However, technological advances that had its beginnings in the early 1950’s
eventually lead to a reversal of this trend. A pioneer role in this development was
played by the French school lead of Talairach and Bancaud. Taking advantage of
newly developed imaging techniques, Talairach realized that angiography could
be used effectively to define “non-invasively” the sulcal anatomy of the brain. This
led to the development of the “Talairach Atlas”, which even today, can be applied
practically. Equally important, however, was the collaboration of Talairach with
Bancaud that established functional correlations of the anatomical studies of
Talairach. These pioneer studies of Talairach and Bancaud certainly led to significant contributions of our understanding of human anatomy and its physiological
correlates. Unfortunately, the studies had only a limited impact in the general
clinical neurosciences since they were only applicable to a very selected number
of patients.
Recent neuroimaging developments, particularly high resolution MRI, provided the tools necessary to make detailed brain anatony available to all neuroscientist on a routine basis. This availability, and the expanded understanding of human anatomo-neurophysiological correlates, has led to a resurgence of
the interest of clinical neurophysiologist in gross human brain anatomy and its
functional corre1ates.
Tamraz and Comair’s book on regional anatomy of the human brain using
MRI, is certainly a welcome addition that fulfills our growing need for books
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correlating anatomy, function and MRI. There are two facts that make this book
particularly appealing for clinicians. Both authors are busy clinicians who, on a
daily basis, apply the information provided in the book to their clinical practice.
This assures that all the information provided has immediate clinical relevance.
In addition, the book is greatly influenced by Professor Tamraz and Professor
Comair’s exposure to the Paris and Montreal’s schools, respectively, both stressing brain anatomy and its relationship to neurophysiology. The immediate clinical practicality of the book and the stress on correlating anatomy and function,
make this book a unique and valuable contribution to the clinical neuroscience
community, and should become a standard textbook for trainees in the clinical
neurosciences. The clinical neurosciences will greatly profit from the practical
approach to gross neuroanatomy, neuroimaging and correlative neurophysiology
offered in this book.
Hans O. Lüders
Chairman and Professor
Department of Neurology
The Cleveland Clinic Foundation
Contents
VII
Preface
To Claire, Caroline and Eve
JC T
To Liliane, Andréa and Marc Elie
YG C
Imaging of the human nervous system has traditionally attracted clinicians
interested specifically in the fields of neurology, neurosurgery and radiology.
However, interest has suddenly widened to include neurophysiologists, computer
scientists, biophysicists and developers of biomedical technology. Several factors
are responsible for this phenomenon. We believe that the most important is the
development of magnetic resonance imaging (MR).
Angiography and ventriculography visualized brain cavities and computer
tomography offered uni-dimensional views of structures. With MR, however,
structures came to life. Suddenly patients could walk out of the machine with an
atlas-like image of their brain. This advance revived the interest in correlating
morphology with function.
Progress in reformatting techniques has facilitated the study of morphology.
Details of the sulcal and gyral anatomy of the brain and its individual variations
can be seen thanks to surface- and volume-rendering techniques that have allowed us to extract the brain out of its envelopes. The functional areas can therefore be readily identified by the trained eye. The core brain structures are visually
dissected given the high contrast between gray and white matter.
Activation studies have traditionally been performed by expensive, labor-intensive techniques that do not visualize the details of morphology. Functional MR
has the capability of combining morphology and function in a process similar
to the mapping performed in the operating room by pioneering neurosurgeons
who identified eloquent cortical areas.
In less than two decades a remarkable evolution in brain science has occurred
and impacted on the diagnosis, natural history and treatment of disease processes. MR is presently a tool used for diagnosis and treatment.
The purpose of this book is to facilitate the study of brain anatomy by formulating a methodological analysis of functionally oriented morphology. Since the
study of the human cortex has not received much attention in radiological or
neurosurgical atlases, we have devoted a large part of this work to the study of the
surface anatomy of the brain. Following an introductory chapter on the gyral and
sulcal development and organization, functional areas are studied separately in
four chapters, each devoted to essential cortical function. Primary motor cortex,
speech, limbic system and vision are discussed individually. In addition to the
standard sectioning methods, imaging of functional areas relied on extensive use
of 3-D rendering and the introduction of innovative oblique sections displaying the temporalization process of the cerebral surface and core brain structures.
These oblique cuts have the advantage of displaying in few images important cortical areas such as the primary motor-sensory cortex, the speech-related perisylvian areas and the amygdalar-hippocampal memory structures.
In order to appreciate the temporal evolution of brain imaging the first chapter
reviews the progression in visual depiction of brain structures from rudimentary
to cross-sectional and finally to realistic and precise illustrations, reminiscent of
the progress in neuroimaging. This introduction is followed by an overview of
VIII
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the major referential brain systems and a proposal for a sylvian reference plane
that is, in our view, the most natural way of studying brain structures in cross
section.
The final chapters include three new MR atlases. The first comprises coronal
sections acquired perpendicular to the proposed sylvian orientation. This is followed by two oblique approaches acquired along the forniceal plane and the ventricular plane.
The study of brain anatomy stands as a linking factor in the multidisciplinary
effort to understand brain function. We hope that this book can contribute towards this crucial task.
Jean C. Tamraz
Youssef G. Comair
Acknowledgments
It is obvious that this volume could not have been finished without the published findings and
morphological, functional and imaging materials derived from collaborative works developed
over the past 20 years by highly specialized teams in Paris, Montreal and Cleveland.
I am deeply indebted to my mentors in Paris for their invaluable teaching and encouragement. They had a profound influence on my academic course in neuroanatomy and neuroradiology: Professors André Delmas, Chairman of Anatomy at the Institut d’Anatomie;
Emmanuel A. Cabanis, Head of Neuroradiology at the Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts who trained me in neuroradiology; and Roger Saban, Honorary
Professor at the Museum National d’Histoire Naturelle, who introduced me to the fields of
comparative anatomy and anthropology. The anatomical material included is part of a previous work developed under the leadership of E.A. Cabanis at the Institut d’Anatomie, and
the primate brains and teratologic specimens are derived from the historical collections obtained from the Laboratory of Comparative Anatomy of the Museum in Paris. I would also
like to express my deep gratitude to Professor Alex Coblentz, Director of the Centre Universitaire Scientifique et Biomédical des Saints-Pères, for his major support and counseling,
and to Professors Georges Salamon, Ugo Salvolini, Henri Duvernoy, Marie-Germaine Bousser
and Olivier Lyon-Caen who greatly contributed to our training in the fields of neuroimaging,
neuroanatomy and clinical neurological sciences. Finally, I am extremely grateful for the collaborative work of Dr. Claire Outin-Tamraz at Trad Hospital, who provided us with part of
the MR material to complete this book, and I have also benefited in the last few years from
discussions at Hôtel-Dieu de France with my colleagues in the Departments of Neuroscience
and Imaging.
JCT
Essential contributions to human brain morphology, function and structural organization were made by successive generations of functional neurosurgeons. I was fortunate
enough to train at the Montreal Neurological Institute, where some of these essential advances were made. It was a pleasure to train under Professor André Olivier, a master neurosurgeon and anatomist. Long before MR allowed us to see sulcal and gyral anatomy in vivo,
Professor Olivier’s teaching of stereoangiography made these structures visible and allowed
us to comprehend the complex three-dimensional anatomy of the structures and the various pathologies that were subsequently dealt with in the operating room. The unique milieu
of the Montreal Neurological Institute and the close collaboration between neuroradiology
and neurosurgery was a model followed in this book. The content of this book stems from a
desire to apply brain anatomy to our clinical practice. At the Cleveland Clinic Foundation, I
was priviledged to be associated with Professor Hans Lüders. Our frequent discussions and
his profound knowledge of applied electrophysiology and functional localization encouraged
us to go ahead with this project. Finally, I am particularly indebted to my colleagues in the
epilepsy and neuroradiology programs in Montreal and Cleveland, in particular, Professors
Romeo Ethier, Denis Melanson and Paul Ruggieri.
YGC
The authors express their sincere gratitude to the publisher, Springer-Verlag, especially Dr.
Ute Heilmann and her co-workers, Mrs. Wilma Mc Hugh, Dr. Catherine Ovitt and Mr. Kurt Teichmann, for their help and unfailing patience during the preparation and publication of this
atlas.
Contents
IX
Contents
1 Historical Review of Cross-Sectional Anatomy of the Brain . . . . . . . . . . . .
1
2 Cephalic Reference Lines Suitable for Neuroimaging. . . . . . . . . . . . . . . . . . 11
I
Cranial Reference Lines and Planes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A Historical Background and Overview . . . . . . . . . . . . . . . . . . . . . . . . .
B The Need for a Consensus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C Classification of the Cephalic Reference Planes . . . . . . . . . . . . . . . . .
D The Choice of a Nomenclature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
11
12
13
13
II Brain Horizontal Reference Lines and Planes . . . . . . . . . . . . . . . . . . . . .
A The Bicommissural Reference Plane. . . . . . . . . . . . . . . . . . . . . . . . . . .
1 Biometric Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . .
B The Delmas and Pertuiset Reference Plane. . . . . . . . . . . . . . . . . . . . .
1 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . .
2 Topometric Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C The Neuro-ocular Plane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . .
2 Topometric and Biometric Findings . . . . . . . . . . . . . . . . . . . . . . . . .
D The Callosal Plane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E The Chiasmatico-Commissural Plane . . . . . . . . . . . . . . . . . . . . . . . . .
1 Biometric Findings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . .
F Anatomic and Physiologic Reference Planes. . . . . . . . . . . . . . . . . . . .
1 The “Plan Vestibulaire Horizontal” . . . . . . . . . . . . . . . . . . . . . . . . . .
2 The “Plan des Axes Orbitaires” . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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III Brain Vertical Reference Lines and Planes . . . . . . . . . . . . . . . . . . . . . . . .
A The Anterior Commissure-Mamillary Planes . . . . . . . . . . . . . . . . . . .
1 The Commissuro-Mamillary Reference Line. . . . . . . . . . . . . . . . . .
2 The Commissuro-Mamillary Plane . . . . . . . . . . . . . . . . . . . . . . . . . .
B The Commissural-Obex Reference Plane . . . . . . . . . . . . . . . . . . . . . .
1 Biometric Findings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Anatomic and Imaging Correlations. . . . . . . . . . . . . . . . . . . . . . . . .
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References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
3 Brain Cortical Mantle, Ventricles and White Matter Core . . . . . . . . . . . . . . 51
I
Historical Notes and Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
II Cytoarchitecture and Brain Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
A Gross Morphology and Fissural Patterns of the Brain . . . . . . . . . . . 56
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Contents
B
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F
1 Gross Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Brain Sulcation: Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Sulcal and Gyral Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Lateral Surface of the Cerebral Hemisphere . . . . . . . . . . . . . . . .
1 Lateral Fissure of Sylvius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Central Sulcus (Rolando) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Inferior Frontal Sulcus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Superior Frontal Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Precentral Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 The Intraparietal Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Superior Temporal Sulcus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Frontomarginal Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gyri of the Lateral Surface of the Cerebral Hemisphere. . . . . . . . . .
1 The Frontal Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a Inferior Frontal Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Middle Frontal Gyrus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Superior Frontal Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d Precentral Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 The Parietal Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a Postcentral Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Inferior Parietal Gyri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Superior Parietal Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 The Temporal Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a Superior Temporal Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Middle Temporal Gyrus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Inferior Temporal Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 The Occipital Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 The Insula of Reil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Mesial Surface of the Cerebral Hemisphere . . . . . . . . . . . . . . . .
1 Cingulate Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Parieto-occipital Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Calcarine Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Rostral Sulci . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Gyri of the Mesial Surface of the Cerebral Hemisphere . . . . . . . .
a The Gyrus Rectus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b The Cingulate Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c The Medial Frontal Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d The Paracentral Lobule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e The Precuneus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f The Cuneus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
g The Lingual Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Basal Surface of the Cerebral Hemisphere . . . . . . . . . . . . . . . . .
1 The Frontal Orbital Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a Olfactory Sulcus and Gyrus Rectus . . . . . . . . . . . . . . . . . . . . . . . .
b Orbital or Orbitofrontal Sulci and Gyri . . . . . . . . . . . . . . . . . . . .
2 The Temporal Basal Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a Collateral Sulcus and Parahippocampal Gyrus . . . . . . . . . . . . . .
b Occipitotemporal Sulcus and Fusiform Gyrus . . . . . . . . . . . . . .
White Matter Core and Major Association Tracts . . . . . . . . . . . . . . .
56
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III Vascular Supply of the Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
A The Arterial Supply of the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
1 The Internal Carotid Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Contents
XI
a The Ophthalmic Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
b The Posterior Communicating Artery . . . . . . . . . . . . . . . . . . . . . 102
c The Anterior Choroidal Artery. . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
d The Anterior Cerebral Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
e The Middle Cerebral Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
2 The Arterial Circle of Willis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
B Vascular Supply of the Posterior Fossa . . . . . . . . . . . . . . . . . . . . . . . . 110
1 The Posterior Inferior Cerebellar Artery . . . . . . . . . . . . . . . . . . . . . 110
2 The Anterior Inferior Cerebellar Artery. . . . . . . . . . . . . . . . . . . . . . 111
3 The Superior Cerebellar Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
C The Cerebral Venous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
4 Central Region and Motor Cortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
I
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
II Embryology of the Sensorimotor Cortex . . . . . . . . . . . . . . . . . . . . . . . . . 117
III Morphology and Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
A The Central Sulcus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
B The Precentral Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
C The Postcentral Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
D Topographical and Functional Anatomy and Imaging . . . . . . . . . . . 121
1 The Primary Sensorimotor Cortex or Central Cortex . . . . . . . . . . . 121
a The Primary Motor Cortex or Precentral Gyrus . . . . . . . . . . . . . . 122
b The Postcentral Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
c Motor and Sensory Representation in the Primary
Sensorimotor Cortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
2 The Premotor Cortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
3 The Supplementary Motor Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
V The Pyramidal Tract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
VI Vascular Supply of the Sensorimotor Cortex . . . . . . . . . . . . . . . . . . . . . . 133
A Arterial Supply of the Sensorimotor Cortex . . . . . . . . . . . . . . . . . . . . 133
1 Arterial Supply of the Lateral Aspect of the Hemisphere . . . . . . . 133
2 Arterial Supply to the Mesial Aspect of the Hemisphere . . . . . . . 134
B Venous Drainage of the Sensorimotor Cortex . . . . . . . . . . . . . . . . . . 134
1 The Lateral Venous Drainage System . . . . . . . . . . . . . . . . . . . . . . . . 134
2 The Mesial Venous Drainage System . . . . . . . . . . . . . . . . . . . . . . . . 135
VII Imaging Approaches for the Localization of the Central Sulcus . . . . . 135
References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136
5 Perisylvian Cognitive Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
I
The Lateral Fissure and the Perisylvian Opercula. . . . . . . . . . . . . . . . . . 139
II The Insula of Reil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
A The Preinsular Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
B The Insular Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
C The Anatomic Relationships of the Insula. . . . . . . . . . . . . . . . . . . . . . 142
D Vascular Relationships of the Insula. . . . . . . . . . . . . . . . . . . . . . . . . . . 144
XII
Contents
E Function of the Insula. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
III The Anterior Speech Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
A Sulcal Anatomy of the Anterior Speech Region . . . . . . . . . . . . . . . . . 146
1 The Horizontal Ramus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
2 The Vertical Ramus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
3 The Inferior Precentral Sulcus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
B Gyral Anatomy of the Anterior Speech Region. . . . . . . . . . . . . . . . . . 149
1 The Pars Triangularis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
2 The Pars Opercularis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
IV The Posterior Speech Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
A Sulcal Anatomy of the Posterior Speech Area. . . . . . . . . . . . . . . . . . . 151
1 The Third Segment of the Lateral Fissure . . . . . . . . . . . . . . . . . . . . 151
2 The Inferior Parietal Sulci. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
3 Posterior Extent of the Parallel Sulcus . . . . . . . . . . . . . . . . . . . . . . . 152
B Gyral Anatomy of the Posterior Speech Area . . . . . . . . . . . . . . . . . . . 153
1 Anatomy of Heschl’s Gyrus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
2 Anatomy of the Temporal Planum . . . . . . . . . . . . . . . . . . . . . . . . . . 156
3 Imaging of the Posterior Speech Area . . . . . . . . . . . . . . . . . . . . . . . 156
V The Cerebral Asymmetries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
6 Limbic Lobe and Mesial Temporal Region . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
I
The Limbic Lobe or “Grand Lobe Limbique”. . . . . . . . . . . . . . . . . . . . . . 161
A Morphology and Topographical Anatomy. . . . . . . . . . . . . . . . . . . . . . 161
B Imaging of the Limbic Lobe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
1 The “Forniceal Plane” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
II Anatomy of the Mesial Temporal Region . . . . . . . . . . . . . . . . . . . . . . . . . 163
A The Temporal Polar Cortex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
B The Entorhinal Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
C The Perirhinal Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
D The Amygdala. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
1 Morphology, Topographical Anatomy and Imaging
of the Amygdala . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
a The Basolateral Group of Nuclei . . . . . . . . . . . . . . . . . . . . . . . . . . 168
b The Corticomedial Group of Nuclei . . . . . . . . . . . . . . . . . . . . . . . 169
c The Central Group of Nuclei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
d Boundaries of the Amygdaloid Bodies . . . . . . . . . . . . . . . . . . . . . 170
2 Functional and Clinical Considerations . . . . . . . . . . . . . . . . . . . . . . 171
3 Clinical Considerations and Targeting . . . . . . . . . . . . . . . . . . . . . . . 171
E The Hippocampal Formation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
1 Embryology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
The Choroid Plexus, Tela, Taenia, and Lamina Affixa . . . . . . . . . . 173
2 Morphology and Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
3 Anatomy of the Hippocampal Formation . . . . . . . . . . . . . . . . . . . . 174
a The Hippocampus Proper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
b The Hippocampal Head. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
c The Hippocampal Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
d The Hippocampal Tail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
4 Cytoarchitectonics and Intrinsic Circuitry . . . . . . . . . . . . . . . . . . . 177
5 Vascular Supply of the Mesial Temporal Region. . . . . . . . . . . . . . . 179
Contents
XIII
6 Functional and Clinical Considerations . . . . . . . . . . . . . . . . . . . . . . 179
7 Clinical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
F The Uncus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
7 The Basal Forebrain, Diencephalon and Basal Ganglia . . . . . . . . . . . . . . . . 185
I
Regional Anatomy and Imaging of the Interbrain . . . . . . . . . . . . . . . . . 185
II The Basal Forebrain and Related Structures . . . . . . . . . . . . . . . . . . . . . . 186
A The Septal Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
1 Morphology and Topographical Anatomy and Imaging . . . . . . . . 187
2 Functional and Clinical Considerations . . . . . . . . . . . . . . . . . . . . . . 188
B The Substantia Innominata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
1 Morphology and Topographical Anatomy and Imaging . . . . . . . . . . 190
2 Functional and Clinical Considerations. . . . . . . . . . . . . . . . . . . . . . . . 191
III The Thalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
A Topographical and Nuclear Organization . . . . . . . . . . . . . . . . . . . . . . 193
B Functional Aspects and Clinical Considerations . . . . . . . . . . . . . . . . 199
The Thalamic Radiations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
C The Vascular Supply to the Thalamus . . . . . . . . . . . . . . . . . . . . . . . . . 200
IV The Epithalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
A The Pineal Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
B The Habenula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
C The Posterior Commissure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
V The Hypothalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
A Cytoarchitecture of the Hypothalamus . . . . . . . . . . . . . . . . . . . . . . . . 203
1 The Medial Hypothalamic Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
2 The Lateral Hypothalamic Region. . . . . . . . . . . . . . . . . . . . . . . . . . . 203
B Connections of the Hypothalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
C Functional Aspects and Clinical Considerations . . . . . . . . . . . . . . . . 205
D Vascular Supply to the Hypothalamus . . . . . . . . . . . . . . . . . . . . . . . . . 205
VI The Subthalamic Region, Subthalamus, or Ventral Thalamus. . . . . . . . 205
A The Subthalamic Nucleus (Corpus Luysi) . . . . . . . . . . . . . . . . . . . . . . 206
1 Morphology and Topographical Anatomy . . . . . . . . . . . . . . . . . . . . 206
2 Functional and Clinical Considerations . . . . . . . . . . . . . . . . . . . . . . 206
B The Zona Incerta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
C The Prerubral Field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
D Vascular Supply to the Subthalamic Region . . . . . . . . . . . . . . . . . . . . 207
VII The Basal Ganglia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
A Morphology and Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
B Topographical Anatomy of the Lenticular Nucleus . . . . . . . . . . . . . . 209
C Topographical Anatomy of the Caudate Nucleus . . . . . . . . . . . . . . . . 209
D Functional Aspects and Clinical Considerations . . . . . . . . . . . . . . . . 212
E Functional Neurosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
F Arterial Supply to the Basal Ganglia . . . . . . . . . . . . . . . . . . . . . . . . . . 214
VIII
A
B
C
The Internal Capsule and Corona Radiata . . . . . . . . . . . . . . . . . . . . . 216
Gross Morphology and Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Topographical and Functional Anatomy . . . . . . . . . . . . . . . . . . . . . . . 216
Arterial Supply to the Internal Capsule . . . . . . . . . . . . . . . . . . . . . . . . 217
References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
XIV
Contents
Synoptical Atlas of Cross-Sectional Anatomy of the Interbrain
Using the Commissural-Obex (PC-OB) Reference Plane . . . . . . . . . . . . . . . 220
From the Genu of Corpus Callosum to the Anterior Commissure . . . 220
From the Anterior Commissure to the PC-OB Reference Plane . . . . . . 222
From the PC-OB Plane to the Splenium of Corpus Callosum . . . . . . . 223
Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
8 The Brainstem and Cerebellum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
I
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
II The Brainstem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
A The Midbrain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
1 The Rostral Midbrain: Superior Collicular Level . . . . . . . . . . . . . . 230
2 The Caudal Midbrain: Inferior Collicular Level . . . . . . . . . . . . . . . 230
3 The Midbrain-Diencephalic Junction . . . . . . . . . . . . . . . . . . . . . . . . 231
4 The Red Nuclei and Substantia Nigra. . . . . . . . . . . . . . . . . . . . . . . . 231
a The Red Nucleus: Morphology and Functional Anatomy . . . . . 231
b Functional and Clinical Considerations . . . . . . . . . . . . . . . . . . . . 232
c The Substantia Nigra: Morphology and Functional Anatomy . 232
d Functional and Clinical Considerations . . . . . . . . . . . . . . . . . . . . 234
5 The Cerebral Peduncles or Crus Cerebri . . . . . . . . . . . . . . . . . . . . . 235
B The Pons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
1 Isthmus Rhombencephali: Upper Pons Level . . . . . . . . . . . . . . . . . 236
2 The Pons at the Level of the Trigeminal Nerve Root . . . . . . . . . . . 237
3 The Pons at the Level of the Advent of the Cerebellum. . . . . . . . . 237
C The Medulla Oblongata. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
D The Brainstem Reticular Formation . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
1 Morphology and Topographical Anatomy . . . . . . . . . . . . . . . . . . . . 239
2 Functional and Clinical Considerations . . . . . . . . . . . . . . . . . . . . . . 239
a The Raphe Nuclei or Median Zone . . . . . . . . . . . . . . . . . . . . . . . . 239
b The Medial Reticular Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
c The Lateral Reticular Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
E Vascular Supply to the Brainstem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
1 At the Midbrain Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
2 At the Pontine Level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
3 At the Medullary Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
II The Cerebellum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
A Developmental Anatomy and Phylogenesis. . . . . . . . . . . . . . . . . . . . . 242
1 Morphology and Topographical Anatomy . . . . . . . . . . . . . . . . . . . . 243
a Structural Organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
b The Deep Cerebellar Nuclei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
2 Functional and Clinical Considerations . . . . . . . . . . . . . . . . . . . . . . 249
3 Vascular Supply to the Cerebellum . . . . . . . . . . . . . . . . . . . . . . . . . . 252
References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
9 Optic Pathway and Striate Cortex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
I
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
II Short History of the Anatomy of the Visual Pathways . . . . . . . . . . . . . . 257
III Elements of Ontogenesis, Phylogenesis and Teratology . . . . . . . . . . . . . 260
Contents
XV
A Ontogenesis of the Visual System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
B Phylogenesis of the Anterior Optic Pathways . . . . . . . . . . . . . . . . . . . 261
1 The Eyes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
2 The Optic Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
3 The Chiasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
4 The Lateral Geniculate Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
5 The Visual Cortex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
6 Approach to Evolution Using Magnetic Resonance Imaging . . . . 263
C Elements of Teratology: The Spectrum of Cyclopia. . . . . . . . . . . . . . 264
IV Morphology and Functional Anatomy and Magnetic Resonance
Imaging of the Visual System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
A Cephalic Orientations and Visual Pathway . . . . . . . . . . . . . . . . . . . . . 268
1 The Neuro-ocular Plane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
a Anatomical Imaging Correlations . . . . . . . . . . . . . . . . . . . . . . . . . 268
b Oculo-orbital Topometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
2 The Chiasmatico-Commissural Plane. . . . . . . . . . . . . . . . . . . . . . . . 271
a Anatomic Correlations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
B The Eyes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
C The Optic Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
1 The Intraocular Optic Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
2 The Intraorbital Optic Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
3 The Intracanalicular Optic Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
4 The Intracranial Optic Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
D The Optic Chiasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
E The Optic Tract and the Lateral Geniculate Body . . . . . . . . . . . . . . . 282
F The Geniculocalcarine Tract or Optic Radiation . . . . . . . . . . . . . . . . 285
G The Striate Visual Cortex (Area 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
H The Parastriate (Area 18) and Peristriate (Area 19) Cortex . . . . . . . 289
I The Superior Colliculi as Related to the Visual System. . . . . . . . . . . 289
J Vascular Supply to the Visual Pathway. . . . . . . . . . . . . . . . . . . . . . . . . 293
V Magnetic Resonance Approach to Neuro-ophthalmological
Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
A The Orbital Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
B The Chiasmal Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
C The Optic Radiations and Striate Cortex. . . . . . . . . . . . . . . . . . . . . . . 294
References
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
10 Atlas of Cross-Sectional Anatomy of the Brain . . . . . . . . . . . . . . . . . . . . . . . 299
I
Atlas of Cross-Sectional Anatomy Using the Commissural-Obex
Reference Plane (Figs. 10.1, 10.2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
A From the Frontal Pole to the Genu of the Corpus Callosum
(Figs. 10.3–10.10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
B From the Genu of the Corpus Callosum to the Anterior
Commissure (Figs. 10.11–10.16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
C From the Anterior Commissure to the Commissural-Obex
Reference Plane (Figs. 10.17–10.24) . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
D From the Commissural-Obex Plane to the Splenium of the
Corpus Callosum (Figs. 10.25–10.32) . . . . . . . . . . . . . . . . . . . . . . . . . . 306
XVI
Contents
E Posterior to the Splenium Toward the Occipital Pole
(Figs. 10.33–10.45) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
II Atlas of Cross-Sectional Anatomy Using MR Oriented According
to the Ventricular Reference Plane (Figs. 10.46–10.59) . . . . . . . . . . . . . . . . . 312
III Atlas of Cross-Sectional Anatomy Using the Forniceal Reference
Plane (Figs. 10.60–10.89). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
Subject Index
325