DOCSLIB.ORG

Section of Neurosurgery, Department of Surgery, University of Michigan Hospital, Ann Arbor, Michigan

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Section of Neurosurgery, Department of Surgery, University of Michigan Hospital, Ann Arbor, Michigan ANATOMIC PATHWAYS RELATED TO PAIN IN FACE AND NECK* JAMES A. TAREN, M.D., AND EDGAR A. KAHN, M.D. Section of Neurosurgery, Department of Surgery, University of Michigan Hospital, Ann Arbor, Michigan (Received for publication May 19, 1961) HE remarkable ability of the higher V is most dorsal in the tract. Fig. 4 is a dia- portions of the central nervous system gram of the medulla 6 mm. below the obex T to readjust to surgical lesions presup- which we believe to be the optimal level for poses the existence of alternate pathways. tractotomy. The operation is done with the This hypothesis has been tested with regard patient in the sitting position to facilitate to a specific localized sensory input, pain exposure. The medullary incision, 4-5 mm. from the face. in depth, extends from the bulbar accessory Our method has been to study the degen- rootlet to a line extrapolated from the pos- eration of nerve fibers by Weil and Marchi terior rootlets of the ~ud cervical nerve root. techniques following various surgical lesions An adequate incision results in complete in man and monkey. The lesions have con- analgesia of all 8 divisions as well as analgesia sisted of total and selective retrogasserian in the distribution of VII, IX, and X except rhizotomy in 3 humans and 3 monkeys, for sparing of the vermilion border of the lips medullary tractotomy in ~ humans and (Fig. 5). A degree of ataxia of the ipsilateral monkeys, and extirpation of the cervical upper extremity usually accompanies effec- portion of the nucleus of the descending tract tive tractotomy and is caused by compromise of V in ~ monkeys. The findings were dupli- of the cuneate and the spinocerebellar sys- cated in all. tems. Too anterior an incision into the al- Degeneration in the descending tract of V ready crossed lateral spinothalamic and ven- following selective retrogasserian rhizotomy tral secondary ascending tract of V may in man and monkey confirms that portions of produce analgesia on the contralateral body all 3 divisions of the trigeminal nerve are and face. Our failure in the past to eliminate represented as far caudally as C4 and that the mandibular, the maxillary, and the ophthalmic divisions have an essentially dorsal to ventral arrangement, respec- tively. 1,4,6 Fig. 1 is a diagram of the first- order neuron for pain and temperature from the face, the descending tract of V, and shows that the most central areas of the face terminate highest on the pars caudalis of the nucleus of the descending tract of V while the most peripheral areas of the face end lowest. Fig. ~ depicts the descending tract of V at various levels. Fig. 3 shows that mandibular * Presented at meeting of the Harvey Cushing So- ciety, Mexico City, Mexico, April 19, 1961. A part of this work was carried out in tile Correlative FIG. 1. Diagram of the origins and terminations of the Neurosurgery Research Unit under U.S.P.tI.S. Grant descending tract of V. The fibers shown are those carry- B-144~(C3). ing impulses of pain and temperature. 116 ANATOMI(" PATHWAYS RELATED TO PAIN IN FACE AND NECK 117 mandibular-division pain was the result of an incision that was not dorsal enough in ex- tent. As further evidence for this latter point we cite a case in which medullary tractotomy 6 mm. below the obex spared the entire mandibular division. Revision of the tractot- omy by extending the incision 1-e rain. dorsally resulted in analgesia of all 3 divisions of V except for sparing of the vermilion bor- der of the lips. Fig. 6 is a diagram ot the usual secondary pathways mediating impulses from pain stimulation of the face or of the eervieal region to the posterior ventral thalamie nucleus. The ventral secondary ascending tract of V subserves the former and the FIG, 3. Cross sections of inedulla of monkey stained by technique of Well. (A) Total degeneration in the de- seen(ling tract of V at level of sensory decussation fol- lowing total retrogasscrian rhizotomy. Note position of the dorsal spinocerebellar tract superficial to the de- scending tract of V and the bulbar accessory rootlet which serves as a landmark for the anterior extent of the traetotomy incision. (B) Level of beginning motor dccussation showing degeneration in descending tract of V following retrogasserian rhizotoiny of mandibular filters only. Note dorsal location of the degeneration and its proximity to fasciculus cuneatus. lateral spincthalamie tract the latter. The nucleus of the spinal tract of V is overlapped by the dorsal-horn gray; consequently the cell bodies of origin of the second-order neurons of these two tracts are in proximity. Each tract has a specific termination in the thalamus where synapses occur and third- order neurons ascend to a specific area of the somesthetic cortex. ~ Degeneration in the ventral secondary ascending tract of V produced by incision into, or excision of, the cervical part of the FIG. ~, Cross sections of human brain stem after total retrogasserian rhizotomy to show the descending tract nucleus of the spinal tract of V shows that of V. (A) The level of cranial nerve XII. (B) A level 6 this ascending tract swings forward to cross ram. below the obex at sensory decussation which we chiefly at medullary levels rather than at the believe to be the optimal site for medullary tractotomy. Note position of the dorsal spinoeerebellar tract super- level of origin of the tract. Fig. 7 from a ficial to tim descending tract of V at this leveh human medullary tractotomy shows the .
Load more

Recommended publications
  • DR. Sanaa Alshaarawy
    By DR. Sanaa Alshaarawy 1 By the end of the lecture, students will be able to : Distinguish the internal structure of the components of the brain stem in different levels and the specific criteria of each level. 1. Medulla oblongata (closed, mid and open medulla) 2. Pons (caudal, mid “Trigeminal level” and rostral). 3. Mid brain ( superior and inferior colliculi). Describe the Reticular formation (structure, function and pathway) being an important content of the brain stem. 2 1. Traversed by the Central Canal. Motor Decussation*. Spinal Nucleus of Trigeminal (Trigeminal sensory nucleus)* : ➢ It is a larger sensory T.S of Caudal part of M.O. nucleus. ➢ It is the brain stem continuation of the Substantia Gelatinosa of spinal cord 3 The Nucleus Extends : Through the whole length of the brain stem and upper segments of spinal cord. It lies in all levels of M.O, medial to the spinal tract of the trigeminal. It receives pain and temperature from face, forehead. Its tract present in all levels of M.O. is formed of descending fibers that terminate in the trigeminal nucleus. 4 It is Motor Decussation. Formed by pyramidal fibers, (75-90%) cross to the opposite side They descend in the Decuss- = crossing lateral white column of the spinal cord as the lateral corticospinal tract. The uncrossed fibers form the ventral corticospinal tract. 5 Traversed by Central Canal. Larger size Gracile & Cuneate nuclei, concerned with proprioceptive deep sensations of the body. Axons of Gracile & Cuneate nuclei form the internal arcuate fibers; decussating forming Sensory Decussation. Pyramids are prominent ventrally. 6 Formed by the crossed internal arcuate fibers Medial Leminiscus: Composed of the ascending internal arcuate fibers after their crossing.
    [Show full text]
  • Lecture (6) Internal Structures of the Brainstem.Pdf
    Internal structures of the Brainstem Neuroanatomy block-Anatomy-Lecture 6 Editing file Objectives At the end of the lecture, students should be able to: ● Distinguish the internal structure of the components of the brain stem in different levels and the specific criteria of each level. 1. Medulla oblongata (closed, mid and open medulla) 2. Pons (caudal and rostral). 3. Midbrain ( superior and inferior colliculi). Color guide ● Only in boys slides in Green ● Only in girls slides in Purple ● important in Red ● Notes in Grey Medulla oblongata Caudal (Closed) Medulla Traversed by the central canal Motor decussation (decussation of the pyramids) ● Formed by pyramidal fibers, (75-90%) cross to the opposite side ● They descend in the lateral white column of the spinal cord as the lateral corticospinal tract. ● The uncrossed fibers form the ventral corticospinal tract Trigeminal sensory nucleus. ● it is the larger sensory nucleus. ● The Nucleus Extends Through the whole length of the brainstem and its note :All CN V afferent sensory information enters continuation of the substantia gelatinosa of the spinal cord. the brainstem through the nerve itself located in the pons. Thus, to reach the spinal nucleus (which ● It lies in all levels of M.O, medial to the spinal tract of the trigeminal. spans the entire brain stem length) in the Caudal ● It receives pain and temperature from face, forehead. Medulla those fibers have to "descend" in what's known as the Spinal Tract of the Trigeminal ● Its tract present in all levels of M.O. is formed of descending (how its sensory and descend?see the note) fibers that terminate in the trigeminal nucleus.
    [Show full text]
  • Chapter 3: Internal Anatomy of the Central Nervous System
    10353-03_CH03.qxd 8/30/07 1:12 PM Page 82 3 Internal Anatomy of the Central Nervous System LEARNING OBJECTIVES Nuclear structures and fiber tracts related to various functional systems exist side by side at each level of the After studying this chapter, students should be able to: nervous system. Because disease processes in the brain • Identify the shapes of corticospinal fibers at different rarely strike only one anatomic structure or pathway, there neuraxial levels is a tendency for a series of related and unrelated clinical symptoms to emerge after a brain injury. A thorough knowl- • Recognize the ventricular cavity at various neuroaxial edge of the internal brain structures, including their shape, levels size, location, and proximity, makes it easier to understand • Recognize major internal anatomic structures of the their functional significance. In addition, the proximity of spinal cord and describe their functions nuclear structures and fiber tracts explains multiple symp- toms that may develop from a single lesion site. • Recognize important internal anatomic structures of the medulla and explain their functions • Recognize important internal anatomic structures of the ANATOMIC ORIENTATION pons and describe their functions LANDMARKS • Identify important internal anatomic structures of the midbrain and discuss their functions Two distinct anatomic landmarks used for visual orientation to the internal anatomy of the brain are the shapes of the • Recognize important internal anatomic structures of the descending corticospinal fibers and the ventricular cavity forebrain (diencephalon, basal ganglia, and limbic (Fig. 3-1). Both are present throughout the brain, although structures) and describe their functions their shape and size vary as one progresses caudally from the • Follow the continuation of major anatomic structures rostral forebrain (telencephalon) to the caudal brainstem.
    [Show full text]
  • IX. Neurology
    IX. Neurology THE NERVOUS SYSTEM is the most complicated and highly organized of the various systems which make up the human body. It is the 1 mechanism concerned with the correlation and integration of various bodily processes and the reactions and adjustments of the organism to its environment. In addition the cerebral cortex is concerned with conscious life. It may be divided into two parts, central and peripheral. The central nervous system consists of the encephalon or brain, contained within the cranium, and the medulla spinalis or spinal 2 cord, lodged in the vertebral canal; the two portions are continuous with one another at the level of the upper border of the atlas vertebra. The peripheral nervous system consists of a series of nerves by which the central nervous system is connected with the various tissues of the body. For descriptive purposes these nerves may be arranged in two groups, cerebrospinal and sympathetic, the arrangement, however, being an arbitrary one, since the two groups are intimately connected and closely intermingled. Both the cerebrospinal and sympathetic nerves have nuclei of origin (the somatic efferent and sympathetic efferent) as well as nuclei of termination (somatic afferent and sympathetic afferent) in the central nervous system. The cerebrospinal nerves are forty-three in number on either side—twelve cranial, attached to the brain, and thirty-one spinal, to the medulla spinalis. They are associated with the functions of the special and general senses and with the voluntary movements of the body. The sympathetic nerves transmit the impulses which regulate the movements of the viscera, determine the caliber of the bloodvessels, and control the phenomena of secretion.
    [Show full text]
  • Central Nervous System. Sense Organs Study Guide
    CENTRAL NERVOUS SYSTEM. SENSE ORGANS STUDY GUIDE 0 Ministry of Education and Science of Ukraine Sumy State University Medical Institute CENTRAL NERVOUS SYSTEM. SENSE ORGANS STUDY GUIDE Recommended by the Academic Council of Sumy State University Sumy Sumy State University 2017 1 УДК 6.11.8 (072) C40 Authors: V. I. Bumeister, Doctor of Biological Sciences, Professor; O. S. Yarmolenko, Candidate of Medical Sciences, Assistant; O. O. Prykhodko, Candidate of Medical Sciences, Assistant Professor; L. G. Sulim, Senior Lecturer Reviewers: O. O. Sherstyuk – Doctor of Medical Sciences, Professor of Ukrainian Medical Stomatological Academy (Poltava); V. Yu. Harbuzova – Doctor of Biological Sciences, Professor of Sumy State University (Sumy) Recommended by for publication Academic Council of Sumy State University as a study guide (minutes № 11 of 15.06.2017) Central nervous system. Sense organs : study guide / C40 V. I. Bumeister, O. S. Yarmolenko, O. O. Prykhodko, L. G. Sulim. – Sumy : Sumy State University, 2017. – 173 p. ISBN 978-966-657- 694-4 This study gnide is intended for the students of medical higher educational institutions of IV accreditation level, who study human anatomy in the English language. Навчальний посібник рекомендований для студентів вищих медичних навчальних закладів IV рівня акредитації, які вивчають анатомію людини англійською мовою. УДК 6.11.8 (072) © Bumeister V. I., Yarmolenko O. S., Prykhodko O. O, Sulim L. G., 2017 ISBN 978-966-657- 694-4 © Sumy State University, 2017 2 INTRODUCTION Human anatomy is a scientific study of human body structure taking into consideration all its functions and mechanisms of its development. Studying the structure of separate organs and systems in close connection with their functions, anatomy considers a person's organism as a unit which develops basing on the regularities under the influence of internal and external factors during the whole process of evolution.
    [Show full text]
  • Neuroanatomy Syllabus
    NEUROANATOMY AN NEUR COURSE CONTENT A T COMPETENCIES OMY The first year medical student should be able to understand and describe the gross O anatomy of central & peripheral nervous systems and correlate anatomical basis of clinical manifestations. NERVOUS TISSUE Nerve cell types, neuroglia: types, functions, blood brain barrier Level 2: Specific neuronal and neuroglial types with function Level 3: Neurotransmitters Functional components: Enumeration Afferent / Efferent; Somatic / Visceral / Branchial; General / Special Level 2: Equation with spinal and cranial nerves Level 3: Neurobiotaxis DIVISIONS OF THE NERVOUS SYSTEM: MAJOR DIVISIONS Level 2: Detailed division Level 3: Embryological link RECEPTORS AND EFFECTORS: Functional and anatomical classification; Dermatomes, myotomes Level 2: Details of functions, microanatomy, neurotransmitters, Segmental awareness Level 3: Special sense receptors (rods, cones, statoacoustic, taste buds), Axial lines, Neuromuscular junctions, muscle spindles, reflex arc SPINAL CORD Gross features: Extent (child / adult), enlargements, conus medullaris, filum terminale, spinal meninges Level 2: Spinal segments, vertebral correlation, significance of enlargements Level 3: Development, comparison with other parts of CNS, anomalies Cross sections above / below T6: TS draw and label, differences above and below T6, arrangement of grey and white matter at different levels Level 2: Lamination, nuclei of grey matter at upper & lower cervical, mid-thoracic, Lumbar & sacral levels Level 3: Details of lamination, nuclei
    [Show full text]
  • Brainstem II
    Brainstem II Medical Neuroscience Dr. Wiegand Internal Brainstem | Cranial nerve nuclei | Location of selected tracts | Reticular formation Developmental Organization 1 Developmental Organization Sulcus Limitans Developmental Organization FromFrom PritchardPritchard && Alloway:Alloway: Fig.Fig. 4-14-1 2 Cranial Nerve Nuclei Organization | Medial to sulcus limitans z GSE ⇒ SVE ⇒ GVE | Lateral from sulcus limitans z VA ⇒ GSA ⇒ SSA FromFrom PritchardPritchard && Alloway:Alloway: Fig.Fig. 4-44-4 SEN MOT Generalizations | Sensory nuclei lateral to sulcus limitans | Motor nuclei medial to sulcus limitans | Visceral nuclei are on either side of sulcus | Innervation of skeletal muscle (GSE & SVE) most medial | General and special visceral afferent nuclei in same column I, II Cranial Nerves – Telencephalon & Diencephalon | Olfactory – z smell (SVA) | Optic – z vision (SSA) 3 III, IV Cranial Nerves – Mesencephalon | Oculomotor – z extraocular eye muscles (GSE) – oculomotor nucleus z PSNS to eye (GVE) – Edinger-Westphal nucleus | Trochlear – z extraocular muscle (sup. oblique) (GSE) – trochlear nucleus V, VI Cranial Nerves – Metencephalon | Trigeminal – z Masticatory muscles (SVE) – trigeminal motor nucleus z General sensation of the head and face (GSA) – trigeminal complex | Abducens – z extraocular muscle (lat. rectus) (GSE) – abducens nucleus VII Cranial Nerves – Metencephalon | Facial – z Facial expression muscles (SVE) – facial motor nucleus z Glands (submandibular, sublingual & lacrimal) (GVE) – superior salivatory & lacrimal nucleus z Taste (SVA) – rostral solitary nucleus z General sensation of ear (GSA) – trigeminal complex 4 VIII Cranial Nerves – Metencephalon Vestibulocochlear – z Hearing (SSA) – dorsal and ventral cochlear nuclei z Balance (SSA) – vestibular nuclei IX Cranial Nerves – Mylencephalon | Glossopharyngeal z Stylopharyngeus muscle (SVE) – n. ambiguus z PSNS to parotid gland (GVE) – inferior salivatory n. z Taste (SVA) – rostral solitary n.
    [Show full text]
  • Non-Invasive EEG Functional Neuroimaging for Localizing Epileptic Brain Activity
    THESIS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Non-invasive EEG Functional Neuroimaging for Localizing Epileptic Brain Activity by YAZDAN SHIRVANY Department of Signals and Systems CHALMERS UNIVERSITY OF TECHNOLOGY G¨oteborg, Sweden 2013 G¨oteborg 2013 Non-invasive EEG Functional Neuroimaging for Localizing Epileptic Brain Activity YAZDAN SHIRVANY ISBN 978-91-7385-810-6 This thesis has been prepared using LATEX. Copyright c YAZDAN SHIRVANY, 2013. All rights reserved. Doktorsavhandlingar vid Chalmers Tekniska H¨ogskola Ny serie nr 3491 ISSN 0346-718X Department of Signals and Systems Signal Processing and Biomedical Engineering Chalmers University of Technology SE-412 96 G¨oteborg, Sweden Phone: +46 (0)31 772 1716 Fax: +46 (0)31 772 1725 E-mail: [email protected] Front cover: Credit @psdesign1 - Fotolia.com. Printed by Chalmers Reproservice G¨oteborg, Sweden, February 2013 If we knew what it was we were doing, it would not be called research, would it? A. Einstein (1879-1955) Abstract Epilepsy is one of the most common neurologic diseases in the world, and is present in up to 1% of the world’s population. Many patients with epilepsy never receive the treatment which make them seizure free. Surgical therapy has become an important therapeutic alternative for patients with drug resistant epilepsy. Cor- rect and anatomically precise localization of the epileptic focus, preferably with non-invasive methods, is the main goal of the pre-surgical epilepsy diagnosis to decide if resection of brain tissue could be a successful treatment option. The most important diagnosis tool used at epilepsy surgery centers is electroencephalogra- phy (EEG), which is used to find the source of activities inside the brain by mea- suring the potential on the scalp with EEG electrodes at different locations.
    [Show full text]
  • Lab 2. Medulla A
    Lab 2. Medulla A. Lesion Lessons Lesion 3.1. Mike Rowmeter i) Location: ii) Signs/symptoms: iii) Cause: Lesion 3.2. Anne Chovee i) Location: ii) Signs/symptoms: iii) Cause: Medical Neuroscience 3– Spinomedullary junction. Locate and note the following: • the enlarged substantia gelatinosa of the dorsal horn is a caudal extension of the spinal tri- geminal nucleus. • the spinal trigeminal tract is located superficially to the nucleus and is made up ofprimary trigeminal afferent fibers that entered the brain stem in the pons and then descended to this level. •MLF (medial longitudinal fasciculus) is often considered to include these tracts: – reticulospinal – tectospinal Label these structures on – medial vestibulospinal Figure 1. • fasciculus gracilis • fasciculus cuneatus hypothalamic autonomic tract • spinal trigeminal nuc. – also known as “descending sympathetics” • spinal tract of V • dorsal spinocerebellar tr. • descends diffusely in the lateral brain stem • ventral spinocerebellar tr • projects to the intermediolateral nucleus of the • spinothalamic tr. spinal cord • rubrospinal tract • lesion –> Horner’s syndrome (Ptosis, miosis, • lat. corticospinal tr. anhydrosis, and enopthalmos • ant. corticospinal tr. • vestibulospinal tr. Fig 1. Spinomedullary junction. From G. Jelg- ersma, Tabula 106, 1931 3– Loyola University Medullary Level of the Pyramidal (Motor) Decussation Locate and note the following: Question classic • pyramidal decussation – obvious in the ventral midline. Which types of sensory – pyramidal tract - fibers arise in cerebral cortex, descend to the lower medulla, modalities are con- and cross here to the contralateral spinal cord where they form the lateral veyed by the dorsal corticospinal tract that runs in the lateral funiculus. columns? • spinal trigeminal nucleus replaces the dorsal horn in function.
    [Show full text]
  • Neuroanatomy for the Neuroscientist Stanley Jacobson • Elliott M
    Neuroanatomy for the Neuroscientist Stanley Jacobson • Elliott M. Marcus Neuroanatomy for the Neuroscientist Stanley Jacobson Elliott M. Marcus Tufts University Health Science Schools University of Massachusetts Boston, MA School of Medicine USA Worcester, MA USA ISBN 978-0-387-70970-3 e-ISBN 978-0-387-70971-0 DOI: 10.1007/978-0-387-70971-0 Library of Congress Control Number: 2007934277 © 2008 Springer Science + Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science + Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper 9 8 7 6 5 4 3 2 1 springer.com To our families who showed infinite patience: To our wives Avis Jacobson and Nuran Turksoy To our children Arthur Jacobson and Robin Seidman Erin Marcus and David Letson To our grandchildren Ross Jacobson Zachary Letson and Amelia Letson Preface The purpose of this textbook is to enable a neuroscientist to discuss the structure and functions of the brain at a level appropriate for students at many levels of study, including undergraduate, graduate, dental, or medical school level.
    [Show full text]
  • The Functional Organization of Perception and Movement
    16 The Functional Organization of Perception and Movement Sensory Information Processing Is Illustrated in the In this chapter we outline the neuroanatomi- Somatosensory System cal organization of perception and action. We focus Somatosensory Information from the Trunk and Limbs Is on touch because the somatosensory system is par- Conveyed to the Spinal Cord ticularly well understood and because touch clearly The Primary Sensory Neurons of the Trunk and Limbs illustrates the interaction of sensory and motor Are Clustered in the Dorsal Root Ganglia systems—how information from the body surface The Central Axons of Dorsal Root Ganglion Neurons Are ascends through the sensory relays of the nervous Arranged to Produce a Map of the Body Surface system to the cerebral cortex and is transformed into Each Somatic Submodality Is Processed in a Distinct motor commands that descend to the spinal cord to Subsystem from the Periphery to the Brain produce movements. The Thalamus Is an Essential Link Between Sensory We now have a fairly complete understanding Receptors and the Cerebral Cortex for All Modalities of how the physical energy of a tactile stimulus is Except Olfaction transduced by mechanoreceptors in the skin into Sensory Information Processing Culminates in the electrical activity, and how this activity at different Cerebral Cortex relays in the brain correlates with specifc aspects Voluntary Movement Is Mediated by Direct Connections of the experience of touch. Moreover, because the Between the Cortex and Spinal Cord pathways from one relay to the next are well deline- ated, we can see how sensory information is coded An Overall View at each relay.
    [Show full text]
  • Direct in Vivo MRI Discrimination of Brain Stem Nuclei and Pathways
    Published April 30, 2020 as 10.3174/ajnr.A6542 ORIGINAL RESEARCH ADULT BRAIN Direct In Vivo MRI Discrimination of Brain Stem Nuclei and Pathways T.M. Shepherd, B. Ades-Aron, M. Bruno, H.M. Schambra, and M.J. Hoch ABSTRACT BACKGROUND AND PURPOSE: The brain stem is a complex configuration of small nuclei and pathways for motor, sensory, and au- tonomic control that are essential for life, yet internal brain stem anatomy is difficult to characterize in living subjects. We hypothesized that the 3D fast gray matter acquisition T1 inversion recovery sequence, which uses a short inversion time to sup- press signal from white matter, could improve contrast resolution of brain stem pathways and nuclei with 3T MR imaging. MATERIALS AND METHODS: After preliminary optimization for contrast resolution, the fast gray matter acquisition T1 inversion re- covery sequence was performed in 10 healthy subjects (5 women; mean age, 28.8 6 4.8 years) with the following parameters: TR/ TE/TI ¼ 3000/2.55/410 ms, flip angle ¼ 4°, isotropic resolution ¼ 0.8 mm, with 4 averages (acquired separately and averaged outside k-space to reduce motion; total scan time ¼ 58 minutes). One subject returned for an additional 5-average study that was com- bined with a previous session to create a highest quality atlas for anatomic assignments. A 1-mm isotropic resolution, 12-minute ver- sion, proved successful in a patient with a prior infarct. RESULTS: The fast gray matter acquisition T1 inversion recovery sequence generated excellent contrast resolution of small brain stem pathways in all 3 planes for all 10 subjects.
    [Show full text]