Osta lectures notes online ENLGISH-RUSSIAN http://vmede.org/sait/?page=1&id=Anatomija_topograficheskaja_i_operativnaja_hirurgija_ravnovesie& menu=Anatomija_topograficheskaja_i_operativnaja_hirurgija_ravnovesie LECTURES OSTA 3. = Lecture 3.

ture 3. Topography and structural features of the temporal region 4. = Lecture 4. Topographic anatomy of the base of the skull and brain

Lecture 4. Topographic anatomy of the base of the skull and brain 1. Fossa on the inner base of the skull are three cranial fossa - front, middle , back (fossa cranii anterior, media et posterior). Front fossa - demarcated edges of the average small wings of the sphenoid bone and roll (limbus sphenoidalis), which lies anterior to the sulcus chiasmatis. Located above the fossa cranii anterior nasal cavity and eye sockets . Within pits located frontal lobes . The sides of the crista gali lie olfactory bulbs (bulbi oltactorii), from the beginning of the olfactory tract . Holes anterior cranial fossa : foramen caecum, opening lamina cribrosa of the ethmoid bone (skip n. Olfactorii, a. Ethmoidalis anterior, vein and nerve of the same name ) . Average fossa - separated from the rear wall of the sella turcica and the upper edges of the pyramid of the temporal bones . The central part of the middle cranial fossa has a recess - fossa of the sella turcica where the pituitary gland is located ; anterior to the sella turcica in the sulcus chiasmatis located optic chiasm . Side sections of the middle cranial fossa formed large sphenoid wing and the front surface of petrous contain the temporal lobes of the brain. At the top of the pyramid is located semilunar node trigeminal nerve. On either side of the sella turcica is the cavernous sinus . Holes middle cranial fossa : canalis opticus ( skips n. Opticus and n. Ophtalmica); fissura orbitalis superior ( skips vv. Ophtalmicae; n. Oculomotorius (III); n. Trochlearis (IV); n. Ophthalmicus; n. Abducents (VI ); foramen rotundum ( skips n. maxillaris), foramen ovale ( skips n. mandibularis), foramen spinosos ( skips a. meningea media), foramen lacerum ( skips n. petrosus major). Rear fossa - contains the bridge , medulla , cerebellum , transverse , sigmoid sinus and the occipital . Holes of the posterior fossa : porus acusticus internus (( internal acoustic opening ) - skips a. Labyrinthi, n. Facialis (VII), n. Statoacusticus (VIII), n. Intermedius); foramen jugularis ( skips n. Glossopharyngeus (IX), n. vagas (X), n. accessorius willisii (XI), v. Jugularis interna); foramen magnum ( the medulla oblongata passes with shells , aa. Vertebralis, plexus venosi vertebrales interna, spinal roots n. accessorius); canalis hypoglossi ( passes n. hypoglossus (XII)).

 4. 1. - , , (fossa cranii anterior, media et posterior). - (limbus sphenoidalis), sulcus chiasmatis. fossa cranii anterior . . crista gali (bulbi oltactorii), . : foramen caecum, lamina cribrosa ( n. olfactorii, a. ethmoidalis anterior, ). - . - , ; sulcus chiasmatis . , . . . : canalis opticus ( n. opticus n. ophtalmica); fissura orbitalis superior ( vv. ophtalmicae; n. oculomotorius (III); n. trochlearis (IV); n. ophthalmicus; n. abducents (VI); foramen rotundum ( n. maxillaris), foramen ovale ( n. mandibularis), foramen spinosos ( a. meningea media), foramen lacerum ( n. petrosus major).

2 . Lining of the brain dura mater (dura mater encepnali) consists of two leaves and a loose fiber between them. On the vault of the skull dura mater associated with the bones loosely , is a slit between the epidural space . Based on the relationship between the skull and the dura mater is very strong bones . In the sagittal direction of the crista gali to protuberantia occipitalis interna stretches upper crescent process dura mater, which separates the cerebral hemispheres from each other. In the posterior part of the brain is connected to another sickle offshoot dura mater - the tent of the cerebellum , which separates the cerebellum from the cerebral hemispheres . Crescent process dura mater contains the superior sagittal venous sinus (sinus sagittalis superior), which is adjacent to the bones of the skull. The lower free edge of the lower brain sickle contains sagittal sinus (sinus sagittalis inferior). Through the connection of brain and sickle tents cerebellum is located straight sinus (sinus rectus). In thicker falcula contains the occipital sinus (sinus occipitalis).

In the middle cranial fossa on either side of the sella turcica is cavernous sinus steam (sinus cavernosus). Through the attachment of the tent is cavernous sinus cerebellum (sinus transversus), which continues into the sigmoid sinus , located on the inner surface of the mastoid portion of the temporal bone. Arachnoid and pia shell . Between the arachnoid (arachnoidea encephali) and dura mater is the subarachnoid space . Arachnoid membrane is thin, does not contain blood vessels, does not go into the furrows , limiting gyrus . Arachnoid forms Pacchionian bodies ( villi ) , perforating dura mater , which penetrates venous sinus. Pia mater (pia mater encephali) rich in blood vessels, comes in all furrows , penetrating into the brain ventricles , where it folds together with the vessels form a vascular plexus.

3 . Subarachnoid space , the space between the brain ventricles and pia arachnoid - contains subarachnoid cerebrospinal fluid. Ventricles ( four) . IV ventricle - one side communicates with the subarachnoid space , the other - goes into the central canal of the spinal cord , through the Sylvian aqueduct IV ventricle communicates with the III. Lateral ventricle of the brain has a central department ( in the parietal lobe ) , front horn ( frontal lobe ) , posterior horn ( in the occipital lobe ) and the lower horn ( in the temporal lobe ) . After 2 holes interventricular anterior horns of the lateral ventricles communicate with the III ventricle. Tanks - several departments expanded subarachnoid space. The most important - cisterna cerebellomeolullaris - bounded above the cerebellum , front - the medulla oblongata . This tank through the middle hole of the IV ventricle communicates with the latter, the bottom goes into the subarachnoid space of the spinal cord .

4 . Major sulci and gyri central sulcus - sulcus elutralis (Rolando) - separates the frontal lobe from the parietal . Lateral sulcus - sulcus lateralis - separates the frontal and parietal lobe from the temporal . Parietal occipital sulcus - sulcus parietooccipitalis - separates the parietal lobe from the occipital . In ascending frontal convolution kernel is the motor analyzer in pozaditsentralnoy - the core of the skin analyzer . Both of these convolutions are connected to the opposite side of the body.

- , , , , . : porus acusticus internus (( ) - a. labyrinthi, n. facialis (VII), n. statoacusticus (VIII), n. intermedius); foramen jugularis ( n. glossopharyngeus (IX), n. vagas (X), n. accessorius willisii (XI), v. Jugularis interna); foramen magnum ( , aa. Vertebralis, plexus venosi vertebrales interna, n. accessorius); canalis hypoglossi ( n. hypoglossus (XII)).

2. (dura mater encepnali) . dura mater , . dura mater . crista gali protuberantia occipitalis interna dura mater, . dura mater - , . dura mater (sinus sagittalis superior), . (sinus sagittalis inferior). (sinus rectus). (sinus occipitalis). (sinus cavernosus). (sinus transversus), , . . (arachnoidea encephali) dura mater . , , , . (), dura mater . (pia mater encephali) , , , . 3. , - . ( ). IV - , - ; IV III. ( ), ( ), ( ) ( ). 2 III . - . - cisterna cerebellomeolullaris - , - . IV , . 4. - sulcus elutralis (Rolando) - . - sulcus lateralis - . - sulcus parietooccipitalis - . , . .

http://www.lhsc.on.ca/Health_Professionals/CCTC/edubriefs/baseskull.htm

Basal Skull Fractures

Where is the "Basal Skull"?
The skull bones surround the entire brain, extending underneath to create the base of the skull. The base of the skull is identified by the red line in Diagram 1. The occipital bone (identified in green at the back of the skull) continues underneath the brain to produce the posterior fossa of the basal skull (Diagram 2). The temporal (pink) and sphenoid bones (yellow) make up the major structures of the middle fossa of the basal skull. The anterior fossa consists primarily of the frontal bone (shown in brown), however, most of the frontal bone is covered in Diagram 2 by the maxilla (roof of the mouth, identified by blue). A small component of the parietal bone (gray) extends under the brain to produce the lateral edge of the base of the skull.

Diagram 2

Diagram 1

How are basal skull fractures diagnosed?

Basal skull fractures are often not detectable with skull x-rays or even CT scan. Basal skull fractures are most frequently diagnosed by clinical findings, making clinical assessment skills critical. CT may reveal suspicious fluid collections near a fracture if bleeding has occurred, or if damage to the dura resulted in a leak of CSF. The base of the skull contains a number of bony channels or foramen that permit the passage of blood

vessels and nerves through the bottom of the skull. Clinical findings consistent with basal skull fracture are generally the result of bleeding or CSF leaks into one or more of these foramen or into the sinuses, or due to damage of the nerve that traverses the bony canals.

What are the signs of basal skull fracture?

Anterior Fossa Fracture - anosmia, epistaxis, rhinorrhea, subconjunctival hemorrhage, periorbital hemorrage (raccoon eyes, visual disturbances, altered eye movement, ptosis, loss of sensation to forehead, cornea and nare Middle Fossa Fracture - loss of sensation to lower face, ottorrhea, deafness, tinnitus, facial palsy, hemotympanium Posterior Fossa Fracture - echymosis behind the ear (battle sign), impaired gag reflex Catastrophic injuries can occur if there is a major disruption of the carotid artery (blood supply to middle and anterior cerebral cortex) or vertebral artery (blood supply to brainstem and posterior cerebral cortex), or if the brain stem is disrupted.

How do the symptoms correlate to the area of injury?

The base or bottom of the skull is continuous, with one large opening for the brainstem (called the foramen magnum) and several small foramens or canals that permit nerves and vessels to travel through the skull bones. The approximate location of some of the major foramen are identified in Diagram 3 (note that in this diagram, the maxilla covers the frontal bone - the frontal bone is the true base of the anterior fossa).

Diagram 3
When the base of the skull is fractured, disruption of the dura can allow CSF to leak into the sinuses or foramen that are close to the injury. Bleeding from surrounding blood vessels can also enter these channels. Symptoms of basal skull fracture include CSF leaks or bleeding into sinuses and canals and/or injuries to adjacent nerves. The following table summarizes the signs and symptoms.

Fossa Anterior Fossa

Foramen
cribiform plate

Structures Contained in Foramen

CN I

Function
CN I olfactory (ipsilateral sense of

Signs/symptoms
anosmia (loss of smell) epistaxis (nose bleed)

smell)

rhinorrhea (CSF from nose) visual loss or impairment impaired pupillary light response (CN II carries the light message to the CN III) periorbital hemorrhage (raccoon eyes) subconjunctival hemorrhage impaired or dysconjugate eye movement ipsilateral ptosis (eyelid droop) ipsilateral pupillary dilation and loss of reaction loss of sensation to forehead, cornea or nare (loss of corneal reflex or nasal tickle response)

optic foramen

CN II (optic nerve) ophthalmic artery retinal artery

CN II - optic (vision)

superior orbital fissure

CN III CN IV CN V1 CN VI

CN III oculomotor (ipsilateral up and down eye movement, eyelid opening, pupillary constrictio n) CN IV trochlear (contra lateral downward and medial eye movement) CN V1 - 1st or ophthalmic division of the trigeminal nerve [V] (ipsilateral sensation of the cornea, nare and forehead) CN VI abducens (ipsilateral movement of the eye

in the temperal or lateral direction)

Middle Fossa

foramen rotundum

CN V2

CN V2 2nd or maxillary division of the trigeminal nerve [CN V] (ipsilateral sensation of the maxillary region of the face) CN V3 - 3rd or mandibular division of the trigeminal nerve [CN V] (ipsilateral sensation of the mandibular region of the face) supply of blood to anterior and middle cerebral cortex and ophthalmic artery

loss of sensation to the mid face

foramen ovale

CN V3

loss of sensation to the mid face ipsilateral weakness of masticator muscles

foramen lacerum

internal carotid artery sympathetic plexus

cerebral cortex injury (upper motor neuron injury with contra lateral loss of motor function to face, upper and/or lower extremity; ipsilateral blindness) temporal lobe injury (impaired hearing, comprehension, memory or seizure activity)

foramen spinosum

middle meningeal artery and vein

blood supply to temporal lobe

epidural hematoma

internal acoustic meatus

CN VII CN VIII labyrinthine artery internal auditory artery

CN VII facial nerve (ipsilateral facial movement, lacrimation , salivation, taste to anterior 2/3 of tongue, sensation around ear) CN VIII vestibuloco chlear nerve (hearing, balance) blood supply to labyrinth drainage of blood from brain CN IX glossophar yngeal nerve (stimulates parotid gland, sensation to pharynx, soft palate, posterior third of tongue, auditory tube, tympanic cavity and carotid sinus) CN X vagal nerve (muscles of soft palate and

ipsilateral facial weakness ipsilateral inability to close the eye ipsilateral dry eye mouth dryness hemotympanium (blood in the ear canal) tinnitus hearing loss

Posteri or Fossa

jugular foramen

jugular vein sigmoid sinus CN IX CN X CN XI

echymosis behind the ear (battles sign) loss of gag reflex bradycardias inability to rotate neck

pharynx, parasympa thetic control of heart and smooth muscles) CN XI accessory (movement of neck and shoulders) CN XII hypoglossa l nerve (movement of tongue) medulla respiration s, blood pressure vertebral arteries brainstem, occipital lobe and cerebellum inability to move tongue

hypoglossal canal

CN XII

foramen magnum

medulla oblongata meninges vertebral arteries meningeal branches of vertebral arteries spinal roots of CN XI

bradypnea, respiratory irregularity hypertension and bradycardia cerebellar infarction (impaired balance or fine motor coordination) occipital lobe injury (loss of vision in the contra lateral visual field of both eye - e.g. right occipital lobe injury can cause loss of visual in the left field of the right and the left eyes)

Brenda Morgan, Clinical Educator November 19, 1999

Fossa Anterio r Fossa

Foramen
cribiform plate

Structures Contained in Foramen

CN I

Function
CN I olfactory (ipsilatera l sense of smell)

Signs/symptoms
anosmia (loss of smell) epistaxis (nose bleed) rhinorrhea (CSF from nose) visual loss or impairment impaired pupillary light response (CN II carries the light message to the CN III) periorbital hemorrhage (raccoon eyes) subconjunctiv al hemorrhage impaired or dysconjugate eye movement ipsilateral ptosis (eyelid droop) ipsilateral pupillary dilation and loss of reaction loss of sensation to forehead, cornea or nare (loss of corneal reflex or nasal tickle response)

optic foramen

CN II (optic nerve) ophthalmic artery retinal artery

CN II optic (vision)

superior orbital fissure

CN III CN IV CN V1 CN VI

CN III oculomot or (ipsilatera l up and down eye movemen t, eyelid opening, pupillary constricti on) CN IV trochlear (contra lateral downwar d and medial eye movemen t) CN V1 1st or ophthalmi c division of the trigeminal nerve [V]

(ipsilatera l sensation of the cornea, nare and forehead) CN VI abducens (ipsilatera l movemen t of the eye in the temperal or lateral direction) CN V2 2nd or maxillary division of the trigeminal nerve [CN V] (ipsilatera l sensation of the maxillary region of the face) CN V3 3rd or mandibul ar division of the trigeminal nerve [CN V] (ipsilatera l sensation of the mandibul ar region of the face) supply of blood to anterior loss of sensation to the mid face

Middle Fossa

foramen rotundum

CN V2

foramen ovale

CN V3

loss of sensation to the mid face ipsilateral weakness of masticator muscles

foramen lacerum

internal carotid artery

cerebral cortex injury (upper motor neuron

sympatheti c plexus

and middle cerebral cortex and ophthalmi c artery

injury with contra lateral loss of motor function to face, upper and/or lower extremity; ipsilateral blindness) temporal lobe injury (impaired hearing, comprehensio n, memory or seizure activity) epidural hematoma

foramen spinosum

middle meningeal artery and vein

blood supply to temporal lobe

internal acoustic meatus

CN VII CN VIII labyrinthin e artery internal auditory artery

CN VII facial nerve (ipsilatera l facial movemen t, lacrimatio n, salivation , taste to anterior 2/3 of tongue, sensation around ear) CN VIII vestibulo cochlear nerve (hearing, balance) blood supply to labyrinth drainage of blood from brain CN IX glossoph

ipsilateral facial weakness ipsilateral inability to close the eye ipsilateral dry eye mouth dryness hemotympaniu m (blood in the ear canal) tinnitus hearing loss

Posteri or Fossa

jugular foramen

jugular vein sigmoid sinus CN IX

echymosis behind the ear (battles sign) loss of gag reflex bradycardias

CN X CN XI

aryngeal nerve (stimulate s parotid gland, sensation to pharynx, soft palate, posterior third of tongue, auditory tube, tympanic cavity and carotid sinus) CN X vagal nerve (muscles of soft palate and pharynx, parasymp athetic control of heart and smooth muscles) CN XI accessor y (moveme nt of neck and shoulders ) CN XII hypoglos sal nerve (moveme nt of tongue) medulla respiratio ns, blood pressure vertebral

inability to rotate neck

hypogloss al canal

CN XII

inability to move tongue

foramen magnum

medulla oblongata meninges vertebral arteries

bradypnea, respiratory irregularity hypertension and

meningeal branches of vertebral arteries spinal roots of CN XI

arteries brainstem , occipital lobe and cerebellu m

bradycardia cerebellar infarction (impaired balance or fine motor coordination) occipital lobe injury (loss of vision in the contra lateral visual field of both eye - e.g. right occipital lobe injury can cause loss of visual in the left field of the right and the left eyes)

http://cnx.org/content/m46355/latest/707_Superior-Inferior_View_of_Skull_Base-01.jpg ^

http://www.infovisual.info/03/img_en/018%20Base%20of%20skull%20(exterior%20view).jpg

http://thesebonesofmine.files.wordpress.com/2011/04/0509_humanskull-infview_1.jpg?w=490&h=344

http://www.rci.rutgers.edu/~uzwiak/AnatPhys/APFallLect9_files/image003.jpg

http://www.infovisual.info/03/img_en/016%20Skull%20(posterior%20view).jpg

http://www.millesoeren.dk/20_du_kan_redde_liv/20a_anatomy_pictures/01_Posterior_Views_of_Skull.jpg

http://www.millesoeren.dk/20_du_kan_redde_liv/20a_anatomy_pictures/02_Lateral_View_of_Skull.jpg

http://dc443.4sharedchina.com/doc/xHub17RW/preview_html_m35424bac.png

http://www.emory.edu/ANATOMY/AnatomyManual/110.jpg

http://upload.wikimedia.org/wikipedia/commons/2/20/Basilar_process_and_palatine_process.jpg

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http://www.thewellingtonneurosurgeryunit.com/images/skullbase1_.jpg

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http://www.rci.rutgers.edu/~uzwiak/AnatPhys/APFallLect9_files/image008.jpg

http://classconnection.s3.amazonaws.com/33/flashcards/602033/jpg/cranial_nerves__skull_foramina1317335789589.jpg

http://d7c2b0wpljtwf.cloudfront.net/var/ezwebin_site/storage/images/media/images/eanatomy/cranial-nerves-anatomy-diagrams/skull-cranial-base-foramen-cranial-nerves-anatomyen/2596747-6-chi-CN/skull-cranial-base-foramen-cranial-nerves-anatomy-en_imagelarge.jpg really good picture but its in Chinese, lol I found the English equivalent at http://lifecaremedi.files.wordpress.com/2012/10/zygomatic_labeled.jpg

http://lifecaremedi.files.wordpress.com/2012/10/zygomatic_labeled.jpg

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http://www3.mdanderson.org/depts/rpi/mmlearn/pmimages/base_of_skull.gif

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http://www.mayfieldclinic.com/Images/PE-AnatBrainFig6.jpg

http://www.drpatriciagrant.com/OccipitalNerveBlock.html

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