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TP 2 Cerveau Antérieur TP 2 Cerveau Antérieur Par les membres du neuroclub : Florian Ruiz Timothy Mathieson Louise Trottet Patrick Jarlborg Et Jozsef Kiss 1 TP 2: Cerveau antérieur Sommaire A) Organisation générale et embryologie B) Cortex cérébral C) Ventricules latéraux D) Substance blanche E) Noyaux gris centraux F) Diencéphale/Ventricule 3 Mode d’emploi des TP : - les TP de neuroanatomie vous permettent de visualiser les concepts appris lors de l’unité Perception, Emotions et Comportement sur des pièces anatomiques et des images radiologiques. - l’interactivité rend les TP moins longs et plus intéressants : participez! Manipulez les pièces, posez vos questions, participez aux dissections. - les guides-TP contiennent suffisamment d’information pour vous dispenser de prendre des notes pendant les TP s. Attention, ils ne sont pas exhaustifs ni exempts d’erreur! Gardez à l’esprit qu’à chaque étape de l’exploration du SNC vous devrez être capable de repérer les structures impliquées dans le contrôle moteur et la perception somatosensorielle. Les TP seront toujours complétés d’une présentation du Pr. Kiss et d’un autre intervenant (Radiologie) afin de montrer ce que nous ne pouvons pas illustrer à l’aide des préparations macroscopiques. Venez préparé à ces TP afin d’en tirer le plus grand bénéfice. Ne soyez cependant pas effrayés par la longueur des guides-TP, dont le rôle est plus d’aider à au suivi et à la bonne compréhension des TPs que d’être appris par cœur. D’autres ressources pour aider à l’apprentissage: - forums de l’unité PEC - moniteurs de neuroanatomie - livres de référence : Duus’ Topical Diagnosis in Neurology; Netter’s atlas of neuroscience - site du neuroclub, polycopié de vascularisation 2 A) ORGANISATION GENERALE ET EMBRYOLOGIE 1. Composition Le cerveau antérieur est constitué des 2 hémisphères cérébraux (télencéphale) et d’une partie diencéphalique impaire et médiane. Télencéphale Substance grise : • Cortex o Néocortex (6 couches corticales) o Paléocortex (cortex primitif, moins de 6 couches p.ex. cortex piriforme) o Archicortex (cortex le plus primitif, 3 ou 4 couches p.ex. hippocampe) • Noyaux gris centraux o corps striés: globus pallidus et striatum (noyau caudé et putamen) o claustrum • Amygdale Substance blanche : • fibres commissurales (p.ex. commissure antérieure) • fibres associatives (p.ex. cingulum) • fibres de projection (p.ex. tractus cortico-spinal) Ventricules latéraux Diencéphale Substance grise • Thalamus • Hypothalamus • Epithalamus • Subthalamus Substance blanche • Tractus optique • Fibres commissurales diencéphaliques (p.ex. chiasma optique) Troisième Ventricule 3 2. Embryologie Fig.1 Développement disproportionné du télencéphale La vésicule prosencéphalique donne deux vésicules latérales, les futurs hémisphères cérébraux. Contrairement aux vésicules latérales, la partie médiane, qui formera le diencéphale, se développe peu. Les hémisphères cérébraux vont progressivement entourer le diencéphale. Les cavités des vésicules télencéphaliques forment les ventricules latéraux. Les cavités télencéphaliques communiquent avec la cavité diencéphalique par le biais de foramens interventriculaires (trous de Monro). Les vésicules s'accolent au diencéphale pour former une unité anatomique. La zone verte indique la zone de « l’accolement » du télencéphale au diencéphale. 1) zone de future inflexion 2) 3e ventricule 3) hypothalamus 4) thalamus 5) éminence ganglionnaire médiane 6) éminence ganglionnaire latérale 7) plexus choroïde dans le foramen interventriculaire et le ventricule lateral 8) pallium (cortex) 9) ventricule lateral 10) cortex de l’hippocampe dorsal (archicortex) Fig.2 Développement des noyaux gris centraux Le pallium ou futur cortex cérébral (8) se développe dans le toit (voûte) des vésicules télencéphaliques, alors que leur plancher ou subpallium (région latéro-ventrale des vésicules) donne naissance aux éminences ganglionnaires médiane (5) et latérales (6) qui formeront les corps striés (qui correspondent au striatum et au pallidum). Ces structures font partie des noyaux gris centraux, également appelés ganglions de la base, et jouent un rôle dans le contrôle moteur et cognitif. Les autres composantes des noyaux gris centraux dérivent de structures diencéphaliques (subthalamus) ou mésencéphaliques (subsance noire). 4 Fig.3 Développement du lobe temporal La surface des hémisphères est initialement lisse, mais l'accroissement de surface et de volume s'accompagne d'un plissement donnant au cerveau son aspect caractéristique composé de sillons (scissures) et de circonvolutions. Les deux tiers de la superficie du cortex cérébral se trouvent enfouis au fond des sillons. Les vésicules télencéphaliques vont se développer premièrement vers le haut, puis vers l'arrière, vers le bas et enfin vers l'avant. Le télencéphale décrit donc une courbure à concavité antéro-interne, à l'intérieur de laquelle se trouve une zone, l’insula (1), se développant moins vite, et qui sera donc enfouie en profondeur. C'est au-dessus du lobe de l'insula que se développe le sillon latéral du cerveau (3) (scissure de Sylvius). 1. insula 2. lobe temporal en développement 3. sillon latéral 4. sillon central 5. sillon pariéto-occipital Fig.4 Développement des structures à concavité antérieure (en « fer à cheval ») Le développement massif des hémisphères cérébraux va significativement modifier la structure des ventricules latéraux. Lorsque les deux vésicules télencéphaliques commencent leur rotation à concavité antéro-interne, elles entraînent avec elles la cavité du ventricule latéral. La cavité ventriculaire va envoyer un prolongement dans le lobe frontal (corne antérieure, 3), puis dans le lobe temporal (corne inférieure, 5), et enfin dans le lobe occipital (corne postérieure, 6). Le noyau caudé (1) est également entraîné dans ce mouvement de rotation. Sa forme en « fer à cheval » explique sa double section sur les coupes frontales du cerveau. Le putamen (7), plus médian, ne participe pas à cette rotation et sera progressivement entouré par le noyau caudé. Ce pattern développemental est à l'origine de la forme en C des différentes structures (grand lobe limbique, ventricules latéraux, noyau caudé). Les plexus choroïdes ne se développent que dans la partie interne (corps, 2) des ventricules latéraux, les cornes antérieure, postérieure et les extrémités des cornes inférieures en sont dépourvues. 5 Fig.5 Coupe coronale générique du télencéphale au niveau du foramen interventriculaire, période foetale plus tardive A cause de leur accroissement massif, les hémisphères vont complètement circonscrire le diencéphale (ligne pointillée verte). La rotation en fer à cheval des hémisphères a entraîné certaines structures proches de la paroi ventriculaire dans les lobes temporaux. L'insula (11) commence à être enterré dans la profondeur du sillon latéral. La croissance importante des corps striés (6A, 6C, 6D, 6B) va épaissir la zone de jonction entre le télencéphale et le diencéphale, mettant les deux structures en continuité. Les feuillets méningés qui séparent ces structures vont fusionner mettant le thalamus en contact avec le plancher des hémisphères cérébraux. Une voie de passage se forme reliant les hémisphères au reste du système nerveux: la capsule interne (16). 1. ligne de fusion du télencéphale et diencéphale 2. 3e ventricule 3. hypothalamus 4. thalamus 5. pallidum (éminence ganglionnaire médiane) 6a. noyau caudé corps 6b. noyau caudé queue 6c. putamen 6d. claustrum 7. plexus choroïde du ventricule latéral 8. pallium (cortex) 9. ventricule latéral 10a. indusium griseum (vestige de l’hippocampe dorsal) 10b. cortex de l’hippocampe ventral 12. corps amygdaloïde 13. corps calleux 14. fornix 15. ventricule latéral corne inf 16. capsule interne 6 Fig.6 Commissures Les commissures télencéphaliques sont des fibres nerveuses qui relient les parties homologues du télencéphale des deux hémisphères droit et gauche. • corps calleux (1 et 2) • commissure du fornix (5) En plus des commissures télencéphaliques, il existe des commissures au niveau du diencéphale. • commissure postérieure (3) • commissure habénulaire (4) • commissure antérieure (6) • chiasma optique (7) 7 B) CORTEX CEREBRAL Il existe plusieurs manières de délimiter les zones du cortex. La première, détaillée dans le TP1, se fonde sur les limites structurelles du cerveau (telles que sillons et gyrus), et est de ce point de vue strictement anatomique. La deuxième manière consiste à cartographier les zones du cerveau selon leur fonction. Les aires fonctionnelles ainsi élaborées ont des limites plus variables, qu’il n’est généralement pas possible d’identifier anatomiquement. Il est donc important de faire la différence entre délimitations fonctionnelle et anatomique. Une zone anatomique peut présenter plusieurs fonctions différentes. On s’imagine donc bien que les aires fonctionnelles n’ont pas de limites précises et qu’elles peuvent se chevaucher. Noter que dans certaines régions, comme le cortex moteur primaire, les frontières anatomiques correspondent aux frontières fonctionnelles. Cependant, cette vision cartographiée du cortex cérébral est largement considérée comme étant dépassée de nos jours. Il faut la contraster avec une autre conception reposant sur le précepte que les fonctions reposent dans des réseaux à large échelle, impliquant plusieurs aires corticales, plutôt que des secteurs isolés du cortex. Cette vision n’exclut pas pour autant l’importance d’aires corticales données pour des fonctions précises ; elle considère ces aires corticales comme des nœuds centraux de réseaux complexes.
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