Sem 2 - V - Cranial fossae & cranial nerves - Anterior/middle/posterior cranial fossa, cavernous sinus, annular ring, cranial nerves

Question 1

What is the anterior attachment of the falx cerebri?

Answer 1

Anteriorly, the falx cerebri attaches to the crista galli (superior projection of the perpendicular plate of the ethmoid bone)

Question 2

In the anterior cranial fossa, we have the cribriform plate of the ethmoid bone What cranial nerve travels through this foramen?

Answer 2

The olfactory nerve fibres travels through the cribriform plate of the ethmoid bone to enter the olfactory bulb in the anterior cranial fossa

Question 3

The optic canal, superior orbital fissure, foramen rotundum, foramen ovale, foramen spinosum, foramen lacerum, carotid canal are all found in the middle cranial fossa

• What passes through each of these?
• Label the foramina, start with black box, end with blue

Answer 3

• Optic canal - CN II and ophthalmic artery
• Superior orbital fissure - CN III, CN IV, CN V1, CN VI
• Foramen rotundum - CN V2 (black)
• Foramen ovale - CN V3 (red)
• Foramen spinosum -middle meningeal artery (green)
• Foramen lcaerum - ICA through superior part (blue)
• Carotid canal - ICA

Question 4

Describe the route of the ICA as it enters the skull to the circle of willis?

Answer 4

The ICA will pass in the carotid canal (in the petrous temporal bone) to enter the skull It will emerge next to the foramen lacerum where it will run in the upper parts of the foramen lacerum as it heads towards the cavernous venous sinuses lateral to the sella turcicia It turns back on itself to enter the circle of willis

Question 5

There is a groove between the temporal and occipital bones

• What is this groove for?

Foramina in posterior cranial fossa

• * Internal acoustic meatus
• * Jugular foramen
• * Hypoglossal canal
• * Foramen magnum

What passes through these?

Answer 5

This groove is for the sigmoid dural venous isinus on its way to the jugular foramen

• Internal acoustic meatus - CN VII and CN VIII
• Jugular foramen - CN IX, X, XI (descending)
• Hypoglossal canal - CN XII
• Foramen magnum - Medulla, meninges, vertebral arteries, CN XI (ascending) etc

Question 6

What are the 12 cranial nerves?

Which are sensory, which are motor, which carry parasympathetic fibres?

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Answer 6

• Olfactory - S
• Optic - S
• Oculomotor -M (carries parasympathetics)
• Trochlear - M
• Trigeminal - B
• Abuducent - M
• Facial - B (carries parasympathetics)
• Vestibulocochlear - S
• Glossopharyngeal - B (carries parasympathetics)
• Vagus - B (carries parasympathetics)
• Spinal accessory - M
• Hypoglossal - M

Question 7

Where is the cavernous sinus located? What passes through the cavernous sinus?

Answer 7

Cavernous sinus is located on the greater wing of the sphenoid bone

Contains CN III, IV, V1, V2 and VI which runs through the sinus with the ICA

Question 8

What is the only sensory system that does not synapse in thalamus before reaching the cortex?

Answer 8

Olfaction - smell

Question 9

How do the olfactory nerves enter the skull? and how does it travel to the primary olfactory cortex? Where is the primary olfactory cortex?

Answer 9

The olfactory nerves originate in the olfactory mucosa and pass through the cribriform plate of the ethmoid bone to synapse in the olfactory bulbs

The olfactory tracts then travel back from the bulbs to reach the primary olfactory cortex located in the prepirifirom area of amygdala

Question 10

The olfactory nerves are described as being an extension of the telencephalon (secondary vesicle) What are the optic nerves described as?

Answer 10

The optic nerves are described as being an extension of the diencephalon (secondary vesicle)

Question 11

Where does the optic nerve begin? What % of fibres travel through the thalamus?

Answer 11

The optic nerves begin at the retina of the eye and travel back through the optic canal and meet at the optic chiasm

The chiasm continues as the optic tracts where 90% of fibres head towards the lateral geniculate nucleus of the thalamus 10% of the fibres travel along the medial root (non-geniculate) for unconscious regulation

Question 12

Once the fibres reach the lateral geniculate nucleus, what are the optic fibres known as that head towards the primary visual cortex? Where is the primary visual cortex?

Answer 12

The optic tracts continue after the lateral geniculate nucleus as the optic radiation which heads towards the primary visual cortex located in the striate area of the occipital lobe

Question 13

What is the ring of fibrous tissue surrounding the optic nerve at its entrance at the apex of the orbit? It is the common origin of which 4 extraocular muscles?

Answer 13

The annular ring is a ring of fibrous tissue surrounding the optic nerve at its entrance at the opex of the orbit

Common origin of the superior, medial, inferior and lateral rectus muscles

• Levator palpebrae superioris, superior oblique and inferior oblqiue do not arise fromt he annular ring

Question 14

Which structures pass through the annular ring?

Answer 14

• Optic nerve and ophthalmic artery together
• Superior division of oculomotor nerve
• Nasociliary branch of the ophthalmic nerve (CN V1)
• Inferior division of oculomotor nerve
• Abducent nerve

Question 15

Where does the oculomotor nerve arise? What aspect of the cavernous sinus does it travel through? and how does it enter the orbit?

Answer 15

The oculomotor nerve arises from the midbrain and travels through the lateral wall of the cavernous sinus before passing through the superior orbital fissure to enter the orbit

Question 16

The oculomotor nerve carries somatic motor and parasympathetic (viscercal efferent) fibres Which divisions of the nerve supply what?

Answer 16

• The superior division supplies motor innervation to the levator palpebrae superioris and superior rectus
• The inferior division carries parasympathetic fibres to the sphincter pupillae and the ciliary muscles as well as motor inenrvation to the medial rectus, inferior rectus and inferior oblique muscles

Question 17

Where does the trochlear nerve arise and how does it reach the orbit? Does it pass through the annular ring?

Answer 17

The trochlear nerve arises from the posterior aspect of the midbrain and runs in the lateral wall of the cavernous sinus through the superior orbital fissure to enter the orbit

It travels superiorly to the annular ring

Question 18

What is special about the trochlear nerve? What does the trochlear nerve innervate?

Answer 18

• The trochlear nerve is the only cranial nerve in which all the fibres cross to the opposite side of the nucleus (in brainstem)
• It is the only cranial nerve which arises from the posterior surface of the midbrain and it has the longest intracranial route of the cranial nerves
• Provides motor innervation to superior oblique muscle

Question 19

Where does the trigeminal nerve originate from? What foramen do its 3 divisions pass through and to enter where?

Answer 19

Trigeminal nerve originates from the pons, forms a ganglion and divides into 3 divisions

• Ophthalmic division (CN V1) - passes through the superior orbital fissure to reach the orbit
• Maxillary division (CN V2) - passes through the foramen rotundum to reach the pterygopalatine fossa
• Mandibular division (CN V3) - passes through the foramen ovale to reach the infratemporal fossa

Question 20

What branches from the 3 divisions of the trigeminal nerve allow for the passage of parasympathetic fibres?

Which divisions of the trigeminal nerve run in the lateral wall of the cavernous dural venous sinus?

Answer 20

Carries parasympathetic fibres from facial nerve

• Lacrimal (CN V1),
• Zygomatic (CN V2)
• Lingual (CN V3)

Carries parasympathetic fibres from glossopharyngeal nerve

• Auriculotemporal (CN V3)

CN V1 and CN V2 run in the lateral wall of cavernous dural venous sinus

Question 21

Which division of CN V provides motor innervation to muscles? State the muscles

Answer 21

The mandibular division of CN V CN V3) proides motor innervation to the muscles of mastication

• * Medial pterygoid (nerve gives branches to tensor tympani and tensor veli palatini)
• * Lateral pterygoid
• * Masseter
• * Temporalis
• * Mylohyoid (nerve gives branches to the anterior belly of digastric)

Question 22

State the sensory innervation supplied by each trigeminal nerve division

Answer 22

• CN V1 - general sensory to lacrimal gland, eyebrow, forehead, bridge of nose
• CN V2 - general sensory to skin of cheek, lower eyelid, ala of nose, upper jaw, lip and teeth, mucosa of mouth
• CN V3 - general sensory to lower lip and teeth, ear canal, partoid gland, mandible

Question 23

Where does the abducent nerve originate and what foramina does it pass through? What does it travel through on its way to the orbit?

Answer 23

Abudcent nerve originates from the pons and passes in the middle of the cavernous sinus with the ICA and through the superior orbital fissure to enter the orbit

Question 24

Does the abducent nerve pass through the annular ring and what muscle does it innervate?

Answer 24

Abducent nerve passes through the annular ring and innervates motor to the lateral rectus muscle

Question 25

Where is the cavernous sinus located? What passes through the cavernous sinus?

Answer 25

Cavernous sinus is located on the greater wing of the sphenoid bone * Contains CN III, IV, V1, V2 (all in lateral wall)and VI which runs through the sinus with the ICA

Question 26

The annular ring is the common origin of which 4 extraocular muscles? Which structures pass through the annular ring?

Answer 26

Common origin of the superior, middle, inferior and lateral rectus muscles * Passing through the annular ring is the optic nerve & ophthalmic artery * Superior division of the oculomotor nerve * Nasociliary branch CN V1 * Inferior division of the oculomotor nerve * Abducent nerve

Question 27

Where does the facial nerve originate? What foramina does it pass through? What are the intracranial branches?

Answer 27

Facial nerve originates in the pons It passes through the internal acoustic meatus to travel within the facial canal giving the * \* Greater petrosal nerve * \* Stapedial nerve * \* Chorda tympani nerve Before exiting the skull through the stylomastoid foramen and dividing into more branches

Question 28

What are the extracranial divisions of the facial nerve? WHat muscles does the facial nerve innervate?

Answer 28

Extracranial - * Posterior auricular innervating occipitalis, posterior belly of digastric and stylohyoid * Muscles of facial expresssion innervated by temporal, zygomatic, buccal, marginal mandibular and cervical branches Intracranial - Stapedius innervated by the stapedial nerve

Question 29

Facial nerve gives parasympathetic secretomotor fibres on the greater petrosal nerve to the lacrimal gland and on the chorda tympani nerve to the submandibular/sublingual salviary glands (as well as special sensory on this nerve) * Describe how the facial nerve provides parasympathetic secretomotor innervation to the lacrimal gland?

Answer 29

* Facial nerve gives the greater petrosal nerve * It joins with the deep petrosal nerve (sympathetic) to form the nerve of the pterygoid canal which synapses in pterygopalatine ganglion * Postganglionic fibres then travel on the zygomatic branch of CN V2 to reach the lacrimal nerve which carries these fibres to the lacrimal gland

Question 30

Describe how the facial nerve provides parasympathetic secretomotor innervation to the submandibular and sublingual glands?

Answer 30

* Chorda tympani exits the skull via the petrotympanic fissure to enter the infratemporal fossa * The fibres hitch a ride on the lingual nerve (CN V3) to synapse in submandibular ganglion * Postganglionic fibres supply the submandibular/subingual glands and special sensory taste fibres to the anterior 2/3rds of the tongue

Question 31

Cranial nerves * \* Originating in the forebrain * \* Olfactory (outgrowth of telencephalon) * \* Optic (extension of diencephalon) * Originating in the midbrain * \* Oculomotor and trochlear * Originating in the pons * \* CN V, CN VI, CN VII Where does cranial nerve VIII originate? What foramina does CN VIII pass through?

Answer 31

* The vestibular part of CN VIII originates in the pons * The cochlear part of CN VIII originates in the medulla CN VIII passes through the internal acoustic meatus to reach the inner ear

Question 32

The vestibular system includes the parts of the inner ear and brain that process the sensory information involved with controlling balance and eye movements. Which cranial nerves and parts of the brain are involved in this?

Answer 32

* Vestibular part of CN VIII * CN III, IV, VI * Cerebellum * Spinal tracts

Question 33

The cochlear part of CN VIII is involved in hearing Where do fibres go once reaching the cochlear nuclei?

Answer 33

Once fibres reach the cochlear nuclei, they travel through the pons to the inferior colliculi in the mdibrain where they synapse before travelling to the medial geniculate nucleus of the thalamus Fibres will then travel to the primary auditory cortex in the temporal lobe

Question 34

Where does the glossopharyngeal nerve originate? What foramina does it pass through?

Answer 34

The glossopharyngeal nerve originates from the medualla posterior to the olive and passes through the jugular foramen

Question 35

What does the glossophryngeal nerve supply? (discuss parasympathetic, special sensory and sensory on this card)

Answer 35

CN IX * Supplies parasympathetic secretomotor to the parotid, buccal & labial glands * Supplies special sensory of taste to the posterior 1/3rd of the tongue * Supplies general sensory to posterior 1/3rd of the tongue, soft palate, pharynx, tympanic cavity, membrane, pharyngotympanic tube, external ear and auditory canal

Question 36

What does the glossophryngeal nerve supply? (discuss motor on this card)

Answer 36

CN IX supplies motor innervation to: Pharyngeal plexus and stylopharyngeus (longitduinal muscle of the pharynx)

Question 37

Describe how CN IX supplies parasympathetic secretomotor to the parotid gland?

Answer 37

* CN IX exits the skull via the jugular foramen. * It will give a tympanic branch which will travel to tympanic cavity to form the tympanic plexus. * From here, the lesser petrosal nerve, will emerge and will travel through the foramen ovale to synapse in the otic ganglion. * Postganglionic fibres will then hitch a ride on the auriculotemporal nerve to reach the parotid gland.

Question 38

Where does the vagus nerve originate? What foramina does it pass through? What does it supply motor innervation to?

Answer 38

Vagus nerve originates at the medulla and passes through the jugular foramen It supplies motor innervation to the pharyngeal plexus, soft palate and larynx

Question 39

What does the vagus nerve supply parasympathetic innervation to? What does it supply sensory to?

Answer 39

Vagus nerve supplies parasympathetic innervation to thoracic and abdominal viscera * Sensory to dura (carries C2,3 fibres to posterior cranial fossa), ear, external auditory canal, lower pharynx, laryngeal mucosa, thoracic and abdominal viscera

Question 40

Where are the pressure receptor and chemorecptor centres of the vagus nerve found?

Answer 40

* Pressure receptors found in the aortic arch * Chemoreceptors found in the para-aortic body

Question 41

Where does the spinal accessory nerve originate? How does it enter and exit the skull? What does the cranial root innervate?

Answer 41

The spinal accoessry nerve originates in the spinal cord and enters the foramen magnum to join the cranial root and both then exit the skull via the jugular foramen The cranial root then joins the vagus nerve to innervate the soft palate

Question 42

What does the spinal accessory nerve innervate?

Answer 42

CN XI innervates the trapezius and sternocleidomastoid

Question 43

Where specifically does the hypoglossal nerve arise? How does it exit the skull?

Answer 43

The hypoglossal nerve arises at the medulla anterior to the olives and passes through the hypoglossal canal (on either side of foramen magnum) to exit the skull

Question 44

Where does the hypoglossal nerve enter the root of the tongue? What does it innervate?

Answer 44

The hypoglossal nerve enters the root of the tongue above the hyoid bone It innervates all the intrinsic muscles of the tongue and all the extrinsic muscles (except palatogolossus which is innervated by the vagus nerve)