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Neurosurgery > Greenberg's - Gross Anatomy, Cranial & Spinal > Flashcards

Greenberg's - Gross Anatomy, Cranial & Spinal Flashcards

1
Q

Middle Frontal Gyrus

A

More sinuous than IFG or SFG

Connects to pre-central gyrus via thin isthmus

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2
Q

Central Sulcus

A

Joins Sylvian fissure in 2% of cases

  • Subcentral gyrus in 98% of cases
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3
Q

Intraparietal Sulcus

A

Separates the superior & inferior parietal lobules

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4
Q

Inferior Parietal Lobule

A

Angular gyrus

Supramarginal gyrus

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5
Q

Sylvian fissure termination

A

Supramarginal gyrus

Brodmann’s area 40

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6
Q

Superior temporal sulcus termination

A

Angular gyrus

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7
Q

Br. areas 3, 1, 2

A

Primary somatosensory cortex

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8
Q

Br. areas 41 and 42

A

Primary auditory areas

- Transverse gyri of Heschl

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9
Q

Br. area 4

A

Precentral gyrus = primary motor cortex

Large concentration of giant pyramidal cells of Betz

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10
Q

Br. area 6

A

Premotor or supplemental motor area

- Immediately anterior to motor strip, plays a role in contra-lateral motor planning

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11
Q

Br. area 44

A

(Dominant hemisphere) Broca’s area

- Motor speech

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12
Q

Br. area 17

A

Primary visual cortex

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13
Q

Br. areas 40 and 39

A

(Dominant hemisphere) Wernicke’s area

- May also include posterior 1/3 of STG

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14
Q

Br. area 8

A

Frontal eye field

- Initiates voluntary eye movements to the opposite direction

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15
Q

Cingulate sulcus termination

A

pars marginalis

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16
Q

Cingulate sulcus imaging

A

Visible on 95% of CT, 91% of MRI

  • CT: located posterior to the widest biparietal diameter
  • MRI: further posterior

Curves posteriorly in lower slices, anteriorly in higher slices
- Pars bracket: handle bar configuration @ midline

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17
Q

Parieto-occipital sulcus

A

More prominent over medial surface

Longer on axial imaging

More posterior than the pars marginalis

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18
Q

Post central sulcus

A

Bifurcates and forms an arc/parenthesis/lazy-Y cupping the pars marginalis

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19
Q

Hand Knob

A

Alpha motor neuron for hand motor function

  • superior aspect of pre-frontal gyrus
  • projects posterolaterally into the central sulcus
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20
Q

Imaging: Central Sulcus

A

Visible on 93% of CTs and 100% of MRIs

Curves posteriorly as it approaches the interhemispheric fissure (IHF), and often terminates in the paracentral lobule, anterior to the pars marginalis (pM) within the pars bracket.

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21
Q

Surface Anatomy: Pterion

A

Region of approximation of: frontal, parietal, temporal and sphenoid (greater wing).

Estimated as 2 finger-breadths above the zygomatic arch, and a thumb’s breadth behind the frontal process of the zygomatic bone

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22
Q

Surface Anatomy: Asterion

A

Junction of lambdoid, occipto-mastoid and parieto-mastoid sutures.

Usually lies within a few millimeters of the posterior-inferior edge of the junction of the transverse and sigmoid sinuses (not always reliable – may overlie either sinus).

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23
Q

Surface Anatomy: Vertex

A

Topmost point of the skull.

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24
Q

Surface Anatomy: Lambda

A

Junction of the lambdoid and sagittal sutures.

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25
Q

Surface Anatomy: Stephanion

A

Junction of coronal suture and superior temporal line

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26
Q

Surface Anatomy: Glabella

A

Most forward projecting point of the forehead at the level of the supraorbital ridge in the midline

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27
Q

Surface Anatomy: Opisthion

A

The posterior margin of the foramen magnum in the midline

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28
Q

Surface Anatomy: Bregma

A

Junction of the coronal and sagittal sutures

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29
Q

Surface Anatomy: Sagittal suture

A

Midline suture from coronal suture to lambdoid suture.
- Although often assumed to overlie the superior sagittal sinus (SSS), the SSS lies to the right of the sagittal suture in the majority of specimens (but never by >11 mm).

The most anterior mastoid point lies just in front of the sigmoid sinus

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30
Q

Taylor-Haughton Lines

A

Constructed on an angiogram, CT scout film, or skull x-ray, and reconstructed on the patient in the O.R. based on visible external landmarks

Can be used to approximate the Sylvian fissure and motor cortex

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31
Q

Frankfurt Plane

A

Frankfurt plane, AKA baseline: line from inferior margin of orbit through the upper margin of the external auditory meatus (EAM) (as distinguished from Reid’s base line: from inferior orbital margin through the center of the EAM)

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32
Q

Distance from Nasion to Inion

A

measured across the top of the calvaria and is divided into quarters
- can be done simply with a piece of tape which is then folded in half twice

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33
Q

Posterior Ear Line

A

Perpendicular to the baseline through the mastoid process

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34
Q

Condylar Line

A

Perpendicular to the baseline through the mandibular condyle

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35
Q

Approximation of the Sylvian Fissure

A

Line connecting the lateral canthus to the point 3/4 posterior along the arc running from nasion to inion

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36
Q

Approximation of Angular gyrus

A

Just above pinna

Important in dominant hemisphere - part of Wernicke’s area

Significant individual variability in location

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37
Q

Approximation of Angular artery

A

Located 6cm above the EAM

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38
Q

Approximation of Motor Cortex and Central Sulcus

A

Individual variability - motor strip is 4 to 5.4cm behind the coronal suture

Method 1 - superior aspect of the motor cortex is straight up from the EAM near the midline

Method 2 - central sulcus approximated by connecting:

  • the point 2cm posterior to the midposition of the arc extetnding from nasion to inion
  • the point 5cm straight up from the EAM

Method 3 - central sulcus approximated by TH lines:
- point where the posterior ear line intersects the circumference of the skull. Usually 1cm behind the vertex and 3-4 cm behind the coronal suture

Method 4 - line drawn to 45 degrees to Reid’s base line starting at the pterion, points in the direction of the motor strip.

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39
Q

Relationship of Ventricles to Skull

A

Lateral ventricles lie 4-5cm below the outer skull surface
- Centre of the body of the lateral ventricle lies in the midpupillary line

Frontal horn is intersected by a line passing perpendicular to the calvaria along this line.
- Anterior horns extend 2cm anterior to the coronal suture

Midpoint of Twining’s line should lie within the 4th ventricle

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40
Q

Average length of 3rd ventricle

A

2.8cm

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41
Q

Length of frontal horn - anterior to Foramen of Munro

A

25mm

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42
Q

Distance from clivus to floor of 4th ventricle at the level of the fastigium

A

33>36>40mm

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43
Q

Length of 4th ventricle at the level of the fastigium

A

10>14>19mm

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44
Q

Distance from fastigium to opisthion

A

30>32>40mm

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45
Q

Cervical level landmarks: C1-2

A

Angle of mandible

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46
Q

Cervical level landmarks: C3-4

A

1cm above the thyroid cartilage ~ hyoid bone

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47
Q

Cervical level landmarks: C4-5

A

level of thyroid cartilage

48
Q

Cervical level landmarks: C5-6

A

crico-thyroid membrane

49
Q

Cervical level landmarks: C6

A

carotid tubercle

50
Q

Cervical level landmarks: C6-7

A

cricoid cartilage

51
Q

Scapular spine landmark

A

T2-3

52
Q

Inferior scapular pole landmark

A

T6

53
Q

Intercristal line

A

Line drawn between the highest point of the iliac crests across the back will cross the midline at either the L4 and L5 spinous process, or the L4 spinous process itself.

54
Q

Cranial Foramina and their contents: Nasal slits

A

Anterior ethmoidal nerve, artery and vein

55
Q

Cranial Foramina and their contents: Superior Orbital Fissure

A

Cranial nerves III, IV, VI and 3 branches of V1 (nasociliary, frontal, lacrimal)

Superior ophthalmic vein

Recurrent meningieal branch from lacrimal artery

Orbital branch of middle meningeal artery

Sympathetic filaments from ICA plexus

56
Q

Cranial Foramina and their contents: Inferior Orbital Fissure

A

Cranial nerve V2

Zygomatic nerve

Filaments from pterygopalatine branch of maxillary nerve

Infraorbital artery and vein

Vein between inferior ophthalmic vein and pterygoid venous plexus

57
Q

Cranial Foramina and their contents: Foramen lacerum

A

Usually nothing:

  • ICA traverse the upper portion but does not enter
  • 30% have vidian artery
58
Q

Cranial Foramina and their contents: Carotid canal

A

Internal carotid artery

Ascending sympathetic nerves

59
Q

Cranial Foramina and their contents: Incisive foramen

A

Descending septal artery

Nasopalatine nerve

60
Q

Cranial Foramina and their contents: Greater palatine foramen

A

Greater palatine nerve, artery and vein

61
Q

Cranial Foramina and their contents: Lesser palatine foramen

A

Lesser palatine nerves

62
Q

Cranial Foramina and their contents: Internal Acoustic Meatus

A

Cranial nerves VII, VIII

63
Q

Cranial Foramina and their contents: Hypoglossal canal

A

Cranial nerve XII, meningeal branch of ascending pharyngeal artery

64
Q

Cranial Foramina and their contents: Foramen magnum

A

Spinal cord (medulla oblongata)

Cranial nerve XI

Vertebral arteries

Anterior and posterior spinal arteries

65
Q

Cranial Foramina and their contents: Foramen caecum

A

Occasional small vein

66
Q

Cranial Foramina and their contents: Cribiform plate

A

Cranial nerve I

67
Q

Cranial Foramina and their contents: Optic canal

A

Cranial nerve II

Ophthalmic artery

68
Q

Cranial Foramina and their contents: Foramen rotundum

A

Cranial nerve V2

Artery of foramen rotundum

69
Q

Cranial Foramina and their contents: Foramen ovale

A

Cranial nerve V3

portio minor (motor for Cranial nerve V)

70
Q

Cranial Foramina and their contents: Foramen spinosum

A

Middle meningeal artery and vein

71
Q

Cranial Foramina and their contents: Jugular foramen

A

Internal jugular vein

Cranial nerve IX, X, XI

72
Q

Cranial Foramina and their contents: Stylomastoid foramen

A

Stylomastoid artery

Cranial nerve VII

73
Q

Cranial Foramina and their contents: Condyloid foramen

A

Vein from transverse sinus

74
Q

Cranial Foramina and their contents: Mastoid foramen

A

Vein of mastoid sinus

Branch of occipital artery to dura mater

75
Q

Porcus acusticus

A

Internal auditory meatus

Filaments of acoustic portion of VIII penetrate the lamina cribosa of the cochlear area

76
Q

Porcus acusticus: Transverse crest

A

Separates superior vestibular area and facial canal from inferior vestibular area and cochlear canal below

77
Q

Porcus acusticus: Bill’s bar

A

Separates the meatus from the facial canal anteriorly (containing CN VII and nervus intermedius), from the vestibular area posteriorly (containing the superior division of vestibular nerve

Bill’s bar is deeper in the IAC then the Transverse crest

78
Q

5 Nerves of the IAC

A

Facial nerve (7-up)

Nervus intermedius

Acoustic portion of VIII (Coke-down)

Superior branch of vestibular nerve

Inferior branch of vestibular nerve

79
Q

Nervus intermedius

A

Somatic sensory branch of VII primarily innervates:
- mechanoreceptors of hair follicles on inner surface of pinna

  • deep mechanoreceptors of nasal and buccal cavities
  • chemoreceptors in taste buds of anterior 2/3 of tongue
80
Q

Superior branch of vestibular nerve

A

Passes through superior vestibular area to terminate in utricle and ampulla of the superior and lateral semicircular canals

81
Q

Inferior branch of vestibular nerve

A

Passes through the inferior vestibular area to the saccule

82
Q

Most IC lesions are caused by…

A

Vascular accidents

  • Thrombosis
  • Haemorrhage
83
Q

Vascular supply of the internal capsule

A

Anterior choroidal artery

  • retrolenticular part
  • ventral part of posterior limb of internal capsule

Lateral striate branches = capsular branches of MCA
- Most of anterior and posterior limb of internal carotid

Direct branches of ICA
- Genu

84
Q

4 Thalamic subradiations

A

Anterior:
Medial and Anterior thalamic nucleus to frontal lobe

Superior:
Rolandic areas to ventral thalamic nuclei
- General sensory fibres from body and head to terminate in post central gyrus

Posterior:
Occipital and posterior parietal to caudal thalamus

Inferior:
Transverse temporal gyrus of Heschl to medial geniculate body
- includes auditory radiation

85
Q

Ligaments that connect atlas to occiput

A

Anterior atlanto-occipital membrane

Posterior atlanto-occipital membrane

86
Q

Anterior atlanto-occipital membrane

A

Cephalad extension of anterior longitudinal ligament

Extends from anterior margin of foramen magnum to anterior arch of C1

87
Q

Posterior atlanto-occipital membrane

A

Connects posterior margin of foramen magnum to posterior arch of C1

88
Q

Ligaments that connect the axis to the occiput

A

Tectorial membrane

Alar ligaments

Apical odontoid ligament

89
Q

Tectorial membrane

A

Superficial portion

  • Cephalad continuation of the posterior longitudinal ligament
  • strong band connecting the dens to the ventral surface of the foramen magnum above, and dorsal surface of C2 and 3 bodies below

Accessory portion
- located laterally connects C2 to occipital condyles

90
Q

Alar ligaments

A

Occipto-alar portion
- Connects dens to occipital condyle

Atlanto-alar portion
- Connects side of dens to lateral mass of C1

91
Q

Apical odontoid ligament

A

Connects tip of dens to foramen magnum

- little mechanical strength

92
Q

Ligaments that connect the axis to the atlas

A

Transverse (atlanto-axial) ligament

Atlanto-alar portion of the alar ligaments

Descending band of the cruciate ligament

93
Q

Transverse (atlanto-axial) ligament

A

Horizontal component of the cruciate ligament
- Traps the dens against the anterior atlas via strap like mechanism

  • Provides the majority of strength (strongest ligament of the spine)
94
Q

Most important structures in maintaining atlanto-occipital stability

A

Tectorial membrane

Alar ligaments

Without these the remaining cruciate ligament and apical dentate ligament are insufficient

95
Q

Dentate ligament

A

Separates dorsal and ventral nerve roots

The spinal accessory nerve (CN XI) is dorsal to the dentate ligament

96
Q

Anterior corticospinal tract

A

Skilled movement

Contralateral

97
Q

Medial longitudinal fasciulus

A

Ipsilateral

98
Q

Vestibulospinal tract

A

Facilitates extensor muscle tonne

Ipsilateral

99
Q

Medullary (Ventrolateral) reticulospinal tract

A

Automatic respirations

Ipsilateral

100
Q

Rubrospinal tract

A

Flexor muscle tone

Ipsilateral

101
Q

Lateral corticospinal (pyramidal) tract

A

Skilled movement

Ipsilateral

102
Q

Descending motor tracts

A

Anterior corticospinal tract

Medial longitudinal fasciulus

Vestibulospinal tract

Medullary (ventrolateral) reticulospinal tract

Rubrospinal tract

Lateral corticospinal (pyramidal) tract

103
Q

Bi-directional tracts

A

Dorsolateral fasciulus (of Lissauer)

Fasiculus proprius

104
Q

Ascending (sensory) tracts

A

Fasciulus gracilis

Fasciulus cuneatus

Posterior spinocerebellar tract

Lateral spinothalamic tract

Anterior spinocerebellar tract

Spinotectal tract

Anterior spinothalamic tract

105
Q

Fasciulus gracilis

A

joint position, fine touch, vibration

ipsilateral

106
Q

Fasciulus cuneatus

A

joint position, fine touch, vibration

ipsilateral

107
Q

Posterior spinocerebellar tract

A

stretch receptors

ipsilateral

108
Q

Lateral spinothalamic tract

A

pain and temperature

contralateral

109
Q

Anterior spinocerebellar tract

A

whole limb position

contralateral

110
Q

Spinotectal tract

A

Unknown ?nociceptive

contralateral

111
Q

anterior spinothalamic tract

A

light touch

contralateral

112
Q

Sensation: Pain and temperature

A

Receptors: free nerve endings

1st order neuron - small, finely myelinated afferents, soma in dorsal root ganglion (no synpase)

Enters cord at dorsolateral tract (zone of Lissauer)

Synapse - substantia gelatinosa

2nd order neuron - axon cross obliquely in the anterior white commissure ascending 1-3 segments while crossing to enter the lateral spinothalamic tract

Synapse - VPL thalamus

3rd order neurons pass through IC to postcentral gyrus (Brodmann’s area 3, 1, 2)

113
Q

Sensation: Fine touch = discriminative touch, deep pressure and proprioception

A

Receptors - Meissner’s corpuscles, Pacinian corpuscles, Merkel’s disc, free nerve endings

1st order neuron - heavily myelinated afferents, soma in dorsal root ganglion (no synapse). Short branches synapse in nucleus proprius of posterior gray, long fibres enter the ipsilateral posterior columns without synapsing

Below T6 - fasiculus gracilis
Above T6 - fasciculus cuneatus

Synapse - nucleus gracilis/cuneatus, just above pyramidal decussation

2nd order neuron axons from internal arcuate fibres, decussate in lower medulla as medial lemniscus

Synapse - VPL thalamus

3rd order neuron pass through IC primarily to post central gyrus

114
Q

Sensation: Light (crude) touch

A

Receptors - Meissner’s corpuscles, Pacinian corpuscles, Merkel’s disc, free nerve endings and peritrichial aborizations

1st order neuron - large, heavily myelinated afferents (type II), soma in dorsal root ganglion (no synapse)
- Ascend uncrossed in post columns (with fine touch)
most synpase in Rexed VI and VII

2nd order neuron - cross in anterior white commissure, enter anterior spinothalamic tract

Synapse - VPL thalamus

3rd order neurons pass through IC primarily to post central gyrus

115
Q

Dermatome

A

Area of the body where sensation is subserved by a single nerve root

Peripheral nerves generally receive contributions from more than one deramtome

Neurosurgery (4 decks)

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