AnatomiBrainstem

Thebrainstemdibagimenjaditigabagian:midbrain,pons,andmedulla.
Themidbrainisdividedbyamidlinesagittalplaneintotwocerebralpeduncles.Eachpeduncle
is further divided into three parts: an anterior part, the crus cerebri or basis pedunculi; an
intermediatepart,thetegmentum;andaposteriorpartlocatedbehindtheaqueduct,thetectum.
Thesubstantianigraandlateralmesencephalicsulcusseparatethecruscerebrifromthetegmen
tum. The oculomotor nerves emerge from the medial side of the crura cerebri in the
interpeduncular fossa (see Fig. 25C). The pontomesencephalic sulcus, which separates the
midbrainfromthepons,originatesinthedepthoftheinterpeduncularfossaandrunsaroundthe
inferior margin of the crus cerebri to join the lateral mesencephalic sulcus behind the crus
cerebri. The poste rior aspect of the midbrain contains the superior and inferior colliculi
(quadrigeminalplate).Thetrochlearnerveexitsthebrainstembelowtheinferiorcolliculus.

Midbrain dibagi oleh bidang sagital midline menjadi dua cerebral peduncles. Setiap
peduncle dibagi lagi menjadi tiga bagian: bagian anterior crus cerebri atau basis pedunculi;
bagian intermediate tegmentum; dan bagian posterior terletak di belakang aqueduct, tectum.
Substantia nigra dan sulkus mesencephalic lateral yang memisahkan cerebri crus dari
tegmentum.Sarafoculomotormunculdarisisimedialdaricruracerebridifossainterpeduncular.
Sulkuspontomesencephalic,yangmemisahkanmidbraindaripons,berasaldarikedalaman
fossainterpedunculardanberjalanmengelilingimargininferiorcruscerebriuntukbergabung
dengan sulkus mesencephalic lateral dibelakang crus cerebri. Aspek posterior midbrain
mengandungcolliculisuperiordaninferior(quadrigeminalplate).Saraftrochlearkeluardari
brainstemdibawahdariinferiorcolliculus.

Onthedorsalsurfaceofthemidbrainaretwopairsofbumpscalledthesuperiorcolliculi
andinferiorcolliculi(Figure12.2B).Together,theseformthetecum(meaningroof)of
themidbrain.Theventralsurfaceofthemidbrainisformedbythecerebralpeduncles,
betweenwhichliestheinterpeduncularfossa

Theponsorprotuberancehasaprominentanteriorsurfacethatisconsiderablyconvexfromside
toside,anditconsistsoftransversefibersthatcrossthemedianplaneandconvergeoneach
sidetoformthemiddlecerebellarpeduncles.Thebasilarsulcusisashallowmediangrooveon
theanteriorsurfaceoftheponsandusuallylodgesthebasilarartery;thissulcusisboundedon
eachsidebyaneminencecausedbydescentofthecorticospinalfibersthroughthesubstanceof
thepons.Themiddlecerebellarpeduncleisseparatedfromthebellyoftheponsbyavertical
shallow groove, the lateral pontine sulcus. Just lateral to the lateral pontine sulcus is the
emergence of the trigeminal nerve, with its smaller superomedial motor root and a larger

inferolateral sensory root. From a microneurosurgical standpoint, the apparent origin of the
trigeminalnervecanbeconsideredasthelimitbetweentheponsandthemiddlecerebellar
peduncle.Posteriorly,theponsconstitutestheupperportionofthefloorofthefourthventricle.
Ponsatauprotuberancememilikipermukaananteriormenonjolyangjauhcembungdarisisike
sisi,danterdiridarifiberstransverseyangbersilangdibidangmediandanbertemudisetiapsisi
untukmembentukmiddlecerebellarpeduncles.Sulkusbasilaradalahalurmediandangkalpada
permukaananteriordariponsdanbiasanyamenyampaikanarteribasilar;sulkusinidibatasipada
setiapsisiolehkeunggulanyangdisebabkanolehketurunandariseratkortikospinalismelalui
substansipons.Pedunculuscerebellartengahdipisahkandariperutponsdenganalurdangkal
vertikal,pontinesulkuslateral.Hanyalateralpontinesulkuslateralmunculnyasaraftrigeminal,
denganakarmotorikyanglebihkecilsuperomedialdanakarsensorikinferolaterallebihbesar.
Darisudutpandangmicroneurosurgical,asaljelasdarisaraftrigeminaldapatdianggapsebagai
batasantaraponsdanbatangcerebellartengah.Posterior,ponsmerupakanbagianatasdarilantai
ventrikelkeempat.

The pons is limited dorsally by the fourth ventricle More dorsolaterally, the pons is
attachedtothecerebellumbylargewhitemattertractscalledthesuperior,middle,and
inferiorcerebellarpeduncles.

The medulla has three longitudinal fissures at its anterior aspect, one median and two
paramedian;themedianoneistheanteriormedianfissure,whichcontinuesinferiorlyasthe
anteriormedianfissureofthespinalcord. The paramediansulcioftheanterioraspectofthe
medullaaretheanterolateralsulci.Atthemedulla,theanterolateralsulcusissituatedmedialto
theolive;consequently, it isalsocalled preolivarysulcus. The preolivarysulcusistheupper
continuationoftheanterolateralsulcusofthespinalcord.Therootletsofthehypoglossalnerve,
whichexitfromthepreolivarysulcus,areanalogoustotheventralmotorrootletsthatexitfrom
theanterolateralsulcusofthespinalcord.Thepyramidcharacterizestheanteriorregion,which
islocatedbetweentheanteriormedianfissureandthepreolivarysulcus.
Medula memiliki tiga fissures longitudinal yang di Aspect anterior, salah median dan dua
paramedian; satu median adalah fissure median anterior, yang berlanjut di bagian inferior
sebagaifissuremediananteriordarikordaspinalis.Thesulciparamediandariaspekanterior
medulaadalahsulcianterolateral.Padamedula,sulkusanterolateraladalahmedialterletakuntuk
olive;karenanya,iajugadisebutsulkuspreolivary.Sulkuspreolivarymerupakankelanjutanatas
sulkusanterolateraldarikordaspinalis.Therootletsdarisarafhypoglossal,yangkeluardari
sulkuspreolivary,analogdenganrootletsmotorikventralyangkeluardarisulkusanterolateral
darikordaspinalis.piramidamencirikandaerahanterior,yangterletakdiantarafissuremedian
anteriordansulkuspreolivary.

Ontheventralsurfaceofthemedulla,thepyramidscanbeseendescendingfromthe

pontomedullaryjunctiontothepyramidaldecussation.Itisoftenusefultodividethe
medullaintoarostralportionandacaudalportion.Intherostralmedullatheprominent
bulgesoftheinferiorolivarynucleicanbeseenjustlateraltothepyramids. Inthecaudal
medullatheinferiorolivarynucleiarenolongerseen,buttheposteriorcolumnsand
posteriorcolumnnucleiarevisibleonthedorsalsurface.

The rootlets of theaccessory,vagus,andglossopharyngealnervesexitfromthepostolivary

sulcus,thecontinuation of theposterolateralsulcus of thespinalcordinthemedulla;these
cranialnerverootletsareanalogoustothedorsalspinalrootlets. Therootletsemergefromthe
brainstemandextendalmoststraightlaterallytothejugularforamen.Thepontomedullarysulcus
separates the pons from the medulla, and its junction with the preolivary sulcus marks the
apparentoriginoftheabducensnerve.

The supraolivary fossette is a triangular depression located behind and above the olive,
anteromedialtotheflocculus,andcorrespondstothejunction ofthepons,themedulla,andthe
middleandinferiorcerebellarpeduncles. It islimitedsuperiorlybytheinferioraspect of the
ponsandthemiddlecerebellarpeduncleandposteriorlybytheinferiorcerebellarpeduncle. Th
efossetteresemblesarightangledtrianglewithitsrightanglelocatedbetweenthesuperiorpole
oftheoliveandtheinferioraspectofthepons,thesuperiorlegcorrespondstotheinferiorborder
oftheponsandthemiddlecerebellarpeduncle,theverticallegcorrespondstotheposterior
borderoftheolive,andthehypotenusecorresndstotheinferiorcerebellarpeduncle.Cranial
nervesVI,andVIIIexitfromthebrainstemat.thesuperiorleg,andnervesIX,X,andXlexit
fromthebrainstematthehypotenuse(Fig.28A).
The rootlets dari aksesori, vagus, dan saraf glossopharingeus keluar dari sulkus postolivary,
kelanjutandarisulkusposterolateraldarispinalcorddimedula;inirootletssarafkranialyang
analogdenganrootletstulangbelakangpunggung.Therootletsmunculdaribatangotakdan
memperpanjanghampirluruslateralkeforamenjugularis.Sulkuspontomedullarymemisahkan
ponsdarimedula,danpersimpangandengansulkuspreolivarymenandaiasaljelasdarisaraf
abducens.
The Fossette preolivary adalah depresi segitiga terletak di belakang dan di atas zaitun,
anteromedialuntukflocculus,dansesuaidenganpersimpanganpons,medula,danpeduncles
serebelummenengahdanrendah.Halinidibatasisuperiordenganaspekinferiorponsdanbatang
cerebellartengahdanposteriorolehpedunculuscerebellarinferior.TiaFossettemenyerupai
segitigasikusikudengansudutkananterletakantarakutubsuperiorzaitundanaspekinferior
pons,kakiunggulsesuaidenganbatasinferiorponsdanbatangcerebellartengah,yangvertikal
dengancallegsesuaidenganbatasposteriorzaitun,dansisimiringKoresponndskepedunculus
cerebellarinferior.KranialsarafVI,danVIIIkeluardaribatangotakat.thekakisuperior,dan
sarafIX,X,danXlkeluardaribatangotakdisisimiring(Gambar.28A).

Thefloorofthefourthventricleextendsfromtheponstotherostralhalfofthemedulla.
Alongthefloorofthefourthventricle,severalbumpsarevisible.Theseincludethe
facialcolliculi,formedbytheabducensnucleiandfibersofthefacialnerve(seeFigure
12.2B;seealsoFigure14.1C).Thehypoglossaltrigoneandvagaltrigone(seeFigure
12.2B)areformedbythehypoglossalnucleus(CNXII)andthedorsalmotornucleusof
CNX,respectively.Recallthatrostrally,thefourthventriclejoinsthecerebralaqueduct,
whichrunsthroughthemidbrain(seeFigure12.1).Caudally,thefourthventricledrains
intothesubarachnoidspaceviatheforaminaofLuschka(locatedlaterally)andforamen
ofMagendie(locatedinthemidline).Thefourthventricleendscaudallyattheobex(see
Figure12.2B),markingtheentrytothespinalcordcentralcanal,whichinadultsis
normallyclosed.