Cranial Neuroimaging and Clinical Neuroanatomy: Atlas of MR Imaging and Computed Tomography

451 Pages·2003·36.9 MB·English

by  Wolfgang Weinrich

Thieme

Cranial Neuroimaging
and Clinical Neuroanatomy
Atlas of MR Imaging and Computed Tomography
Hans-Joachim Kretschmann, M.D.
Professor and Former Director, Department of Neuroanatomy
Hannover Medical School
Hannover, Germany
Wolfgang Weinrich, M.D.
Professor and Former Head, Neurological Clinic
Krankenhaus Nordstadt, Klinikum Hannover
Hannover, Germany
Foreword by Ruth G. Ramsey, M.D.
Third edition, revised and expanded
664 illustrations
Drawings by Ingeborg Heike and Rudolf Mutschall, D.D.S
Thieme
Stuttgart • New York
IV
Library of Congress Cataloging-in-Publication Data is available
Important note: Medicine is an ever-changing science un
from the publisher.
dergoing continual development. Research and clinical ex
perience are continually expanding our knowledge, in par
1st English edition 1986 ticular our knowledge of proper treatment and drug ther
apy. Insofar as this book mentions any dosage or applica
(published under Neuroanatomy and Cranial Computed Tomo
tion, readers may rest assured that the authors, editors, and
graphy
2nd (published under Cranial Neuroimaging and Clinical Neu publishers have made every effort to ensure that such refer
ences are in accordance with the state of knowledge at the
roanatomy) English edition 1992
time of production of the book.
1st German edition 1984 Nevertheless, this does not involve, imply, or express any
2nd German edition 1991 guarantee or responsibility on the part of the publishers in
(has been merited as one of the most beautiful German books respect to any dosage instructions and forms of applications
1991) stated in the book. Every user is requested to examine
3rd German edition 2003 carefully the manufacturers' leaflets accompanying each
1st Italian edition 1989 drug and to check, if necessary in consultation with a physi
cian or specialist, whether the dosage schedules mentioned
1st Japanese edition 1986 therein or the contraindications stated by the manufac
2nd Japanese edition 1995 turers differ from the statements made in the present book.
Such examination is particularly important with drugs that
1st Spanish edition 1988 are either rarely used or have been newly released on the
market. Every dosage schedule or every form of application
used is entirely at the user's own risk and responsibility. The
Prof. Hans-Joachim Kretschmann, M.D.
authors and publishers request every user to report to the
Former Director of Department Neuroanatomy
publishers any discrepancies or inaccuracies noticed.
Hannover Medical School
Carl-Neuberg-StraBe 1
30625 Hannover
Germany
Prof. Wolfgang Weinrich, M.D.
Former Head of Neurological Clinic
Krankenhaus Nordstadt, Klinikum Hannover
Haltenhoffstr. 41
30169 Hannover
Germany
Illustrated by:
Ingeborg Heike, Department of Neuroanatomy,
Hannover Medical School, Germany
Rudolf Mutschall D.D.S, Hatten/Sandkrug, Germany
© 2004 Georg Thieme Verlag, Some of the product names, patents, and registered designs re
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V
Foreword to the Third Edition
This is the third edition of the book Cranial Neuroi- tomic structures on the MR images obtained in clini
maging and Clinical Neuroanatomy. There have been cal practice. MR images and annotated line drawings
changes and improvements in all chapters. It is a use are available in the axial, coronal and sagittal planes.
ful addition to any library as it provides accurate ana This greatly aids in the three-dimensional localiza
tomic correlation with easy to read and understand tion of various anatomic structures.
vascular and neurofiber track illustrations, which are As in the previous additions, there are also il
of the highest quality. The over-sized pages and well- lustrations of the ventricles and cisterns and a discus
designed layout allow for easy reading of the text. sion of CSF flow dynamics.
Furthermore, the use of standard terminology aids The clear, color-coded, identification of the vascu
understanding. lar supply to various areas of the brain on individual
The introduction includes an expanded discussion slices is very instructive and especially helpful in
of the variety of neuroimaging tests that are presently today's practice where early stroke detection and lo
available as well as the indications for each of these calization of the areas of involvement are vital prior
tests. This guidance is particularly helpful to those to interventional procedures.
practicing clinicians who are faced with the dilemma The color-highlighted illustrations of the fiber
of which neuroimaging studies to request and in what tracts for the various neurological pathways are ex
order they should be performed. The advantages and cellent. These can be used by the radiologist to under
disadvantages of each are highlighted. stand the clinical setting and by neuroscientist to aid
This new edition contains additional images that in the diagnosis and treatment. Many of the cranial
include the vascular supply to the posterior fossa. The nerve pathways and interconnections are compli
rapid development of MRI and neurofunctional imag cated, and these illustrations greatly aid understand
ing has made this type of anatomic correlation even ing of the anatomic locations and relationships. Those
more valuable and welcome. involved in functional imaging will find this chapter
Dr. Kretschmann is a senior neuroanatomist at the particularly helpful.
Hannover School of Medicine and Dr. Weinrich a neu Every effort has been made to update and enliven
rologist and neuroradiologist; they work with a dedi the text. Consequently studying and learning is more
cated team of young enthusiastic neuroscientists. To fun and enjoyable. The images have been upgraded
gether they have used the thin gross anatomic slices and improved throughout. There is also an up-to-date
of the brain that are then traced and outlined for the list of references for the reader who is interested in
various images included in their text. The line draw more in-depth reading.
ings in three planes—axial, coronal and sagittal- Finally, the book is an excellent reference for day-
identify the slice positions that are used and their re to-day teaching on a wide variety of issues relating to
lationship to the normal anatomic structures. These neuroimaging, including vascular supply and neuro
line drawings, taken from anatomic specimens, pro functional studies. It is a plesure to recommend this
vide a clearer picture of the anatomy than the actual excellent text to students at any level who are inter
MR images and allow ready correlation with the MR ested in neuroimaging of the cranium.
images. Each of these slices is then outlined and
highlighted to identify the various anatomic struc Ruth G. Ramsey, M.D., F.A.C.R.
tures that are then also annotated in great detail. President, Illinois Radiological Society
The present third edition adds to the excellence of Councilor, American College of Radiology
the previous two editions by including actual MR im Medical Director
ages of volunteers that correlate with the enhanced Premier Health Sercvices
and annotated line drawings. The excellent quality of Clinical Professor of Radiology
the images allows for easy identification on the ana University of Illinois Medical School, Chicago
VI
Preface
Our book Neuroanatomy and Cranial Computed Tomography and the number of images has almost doubled. Therefore, the
first appeared in 1984. At that time computed tomography rev amount of cerebral structures described has increased con
olutionized the field of medicine, particularly neurology and siderably. In addition, friends of the former editions en
neurosurgery. The purpose of the illustrations and text of our couraged us to introduce the arterial territories of the infraten-
book was to provide necessary neuroanatomic information torial space. Nevertheless, this book is intended as a tool for
using images of anatomic slices. Our aim was to enable the everyday practice. It aids the physician to correlate the
reader to identify the complex structure of the brain on the patient's symptoms with the neuroimaging findings. This in
monitor for diagnostic purposes to correlate the loss of func formation considerably facilitates diagnosis and can be of
tion with the localization of the cerebral lesion. great importance for the choice of therapy. The target reader
The technique of magnetic resonance imaging permitted ship includes neurologists, neurosurgeons, neuropediatrici-
multiplanar presentations in all desired planes. The second ans, neurophysiologists, anatomists, physicians, traumatolo
edition, published in 1992 under a new title Cranial Neuroi- gists, oncologists, as well as students interested in the neuro-
maging and Clinical Neuroanatomy, presented graphic illustra oriented specialities and especially physicians undergoing
tions of anatomic slices in three standard planes. further training in clinical neurology.
For this third edition the old MR and CT images of the atlas
have been completely replaced with large-sized illustrations,
Acknowledgments
We would like to thank all colleagues engaged in the closely as Graessner, Siemens Hamburg introduced to us newly special
sociated departments at the Hannover Medical School. Our ized technical concepts in the presentation of MR atlas images
grateful thanks especially to Prof. H. Becker, Department of and was of tremendous support in our work. We dedicate our
Neuroradiology, Dr. G. Berding, Department of Nuclear Medi thanks as well to H. Mahramzadeh, Regionales Rechenzentrum
cine, Prof. K. Gartner, Central Laboratory for Animal Experi Niedersachsen, Hannover University for his practical as
mentation, Prof. Claudia Grothe, Department of Neu sistance in the computergraphic processing of printed copies.
roanatomy, Prof. H. Lippert, Prof. R. Pabst, and Dr. U. Thorns (t), Dr. Gabriele Engelcke, Department of Radiology, Kinder-
Department of Functional and Applied Anatomy. krankenhaus auf der Bult, Hannover and Dr. G. Glinzer together
Prof. M. Samii gave us the opportunity to work in the re with Dr. R. Metz, Department of Neurology, Agnes-Karl-
cently opened International Neuroscience Institute (INI) in Krankenhaus, Laatzen/Hannover were kind enough to assist us
Hannover. The MR and CT images appearing in the third edition with recommended omissions and additions to the texts.
would not have been possible without the help of Prof. U. Piep- Translation of new chapters and amendments to the third
gras, Dr. T. Liebig, Dr. C. Dalle Feste (INI), Mrs. B. Gehrmann, Mrs. edition were undertaken by Mrs. Nicola van Dornick. Dr. An
M. Houbolt, and Mrs. A. Hohensee. gela Krönauer kindly checked the complete text for any further
Prof. A. Schwartz and P. Brunotte of the Neurological Clinic, changes required. For additional improvements we dedicate
Nordstadt Krankenhaus, Klinikum Hannover were kind thanks to Mrs. Susanne Kretschmann and Dr. Anja Schmidt. The
enough to give critical proposals and valuable clinical sugges responsibility for the translation rests with the author (K) only.
tions for improvements to the text. Prof. Jean A. Biittner-En- Following completion of the English manuscript we were
never from the Institute of Anatomy, Ludwig-Maximilians- grateful for the improvements recommended by M.J. T. FitzGer-
University, Munich was most helpful in her comments relating ald, M. D., Professor Emeritus of Anatomy, University of Galway,
to the vestibular and oculomotor systems. Ireland (author of the informative and awarded book Clinical
We would also like to express our thanks to the former co Neuroanatomy and Related Neuroscience, Saunders 2002). For
workers of the Department of Neuroanatomy, Hannover Medi further improvements we thank Dr. V. Beckmann, Röttenbach,
cal School, who presented excellent dissertations on three-di Dr. Louise McKenna, Siemens AG Erlangen, Prof. Ruth G. Ram
mensional reconstructions of the functional systems and cere sey, M. D., Medical Director Premier Health Services, Chicago,
bral arteries: Dr. C. Buhmann, Dr. Andrea Gloger, Dr. S. Gloger, 111., Dr. H. Requardt, Siemens AG Erlangen, and Prof. G. Vossius,
Dr. Anja Schmidt, Dr. Britta Vogt, Dr. H. Vogt, and Dr. D. Weirich. Institute of Biomedical Technics, University of Karlsruhe.
The results of these papers have been mentioned in the text. A big thank-you is directed to our respective families for all
The technical aspects of our work were supported by Mrs. Ni their patience and understanding during the compilation of
cola van Dornick, Mrs. Ingeborg Heike, and Mr. K. Rust. Dr. Anja the book, especially to Dr. Britta Kretschmann and Mrs. Frauke
Schmidt and Dr. C. Schrader provided invaluable help in cor Weinrich.
recting the drafts of the manuscripts. Mrs. Claudia Loock, Mrs. Mr. G. Krüger, Production Director of Thieme Publishers
Riem Hawi, and Mrs. Zuleyha Demir dedicated many hours to has been a supervisory figure behind our book since 1984 and is
reading through the completed manuscripts for final correc responsible for the excellent didactic compilation and the
tions. make-up of our work. Last but not least, we would like to ex
Expertise and clinical advice were imparted by Prof. B. Ter- press our thanks to Dr. C. Bergman, Dr. T. Pilgrim, and Dr. 0
wey, Institute for Magnet Resonance Diagnostics, Zentralklini- Schneider at Thieme Publishers for their loyal cooperation in
kum Bremen, Dr. W. Ruempler, Radiological, Oncological and the presentation of the text and illustrations of our book.
Nuclear Practice, Stade, and by Dr. A. Majewski and R.-H.
Prawitz, MRT-Practice, Nordstadt Hannover.
We appreciate the constructive ideas and advice regarding Hannover, Autumn 2003
fMRI given by Prof. J. Frahm, Max Planck Institute, Gottingen. J. Hans-Joachim Kretschmann Wolfgang Weinrich
VII
Contents
1 Introduction 1
1.1 Background and Objectives 1 1.3 Intravital and Postmortem Neuro-
1.2 Three-dimensional Coordinate Systems anatomy 10
for the Localization of Brain Structures . . . . 4 1.4 Terminology 11
1.5 Abbreviations and Notes for the Reader. . .11
2 Neuroimaging and Guideline Structures 14
2.1 Computed Tomography 14 2.5.2 Head and Neck Region 19
2.2 Magnetic Resonance Imaging 15 2.5.3 Neurocranium 19
2.3 Emission Computed Tomography 16 2.5.4 Cisterns and the Ventricular System . . . 19
2.4 Ultrasound Techniques 17 2.5.5 Blood Vessels 20
2.5 Guideline Structures in Imaging 2.5.6 Dural Structures 20
Procedures 18 2.6 Clinical Value of the New Imaging
2.5.1 Facial Skeleton 18 Techniques 21
3 Topography of the Facial Skeleton and its Cavities in Multiplanar
Parallel Slices 210
3.1 Facial Skeleton 210 3.4 Oral Cavity 227
3.2 Nasal Cavity and Paranasal Sinuses 211 3.5 Masticatory Apparatus 228
3.3 Orbit 218 3.6 Lateral Facial Region 228
4 Topography of the Pharynx and Craniocervical Junction in Multiplanar
Parallel Slices 230
4.1 Pharynx and Parapharyngeal Space 230 4.3 Blood Vessels in the Head and Neck 234
4.2 Craniocervical Junction 231
5 Topography of the Neurocranium and its Intracranial Spaces
and Structures in Multiplanar Parallel Slices 236
5.1 Neurocranium 236 5.4 Arteries of the Brain and their Vascular
5.2 Cranial Cavity 238 Territories 253
5.3 Cerebrospinal-Fluid-Containing Spaces .. 239 5.5 Veins of the Brain 283
VIII Contents
5.6 Cranial Nerves 286 5.7.3 Cerebellum 303
5.7 Subdivisions of the Brain 288 5.7.4 Diencephalon and Pituitary Gland 305
5.7.1 Medulla Oblongata and Pons 288 5.7.5 Telencephalon 307
5.7.2 Midbrain 298
6 Neurofunctional Systems 325
6.1 General Sensory Systems 326 6.7 Olfactory System 372
6.1.1 Anterolateral System 326 6.8 Motor Systems 375
6.1.2 Medial Lemniscus System 331 6.8.1 Pyramidal System 375
6.1.3 Trigeminal System 338 6.8.2 Motor Systems of the Basal Ganglia 383
6.1.4 Topography of Sensory Disorders 342 6.8.3 Oculomotor Systems 388
6.2 Gustatory System 345 6.9 Cerebellar Systems 394
6.3 Ascending Reticular System 348 6.10 Language Areas 400
6.4 Vestibular System 348 6.11 Limbic System 404
6.5 Auditory System 354 6.12 Autonomic Nervous System 412
6.6 Visual System 361
7 Neurotransmitters and Neuromodulators 415
7.1 Catecholaminergic Neurons 416 7.6 Glutamatergic and Aspartatergic
7.1.1 Dopaminergic Neurons 416 Neurons 419
7.1.2 Noradrenergic Neurons 417 7.7 Peptidergic Neurons 419
7.1.3 Adrenergic Neurons 417 7.7.1 SP-Containing Neurons 419
7.2 Serotoninergic Neurons 417 7.7.2 VIP-Containing Neurons 420
7.3 Histaminergic Neurons 418 7.7.3 p-Endorphin-Containing Neurons 420
7.4 Cholinergic Neurons 418 7.7.4 Enkephalinergic Neurons 420
7.5 GABAergic Neurons 419
8 Material and Methods 421
9 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
10 Index 435
1
1 Introduction
1.1 Background and Objectives even cured, less aggressively using interventional
neuroradiology as opposed to open surgical interven
Medical and technical advances in neuroradiology tions.
over the last three decades have led to new diagnostic The "ready availability" of the wide range of diag
and therapeutic approaches in medicine. Due to the nostic possibilities of modern neuroimaging for all
highly invasive nature of the classical neuroradiologic physicians may also result in a number of disadvan
procedures (pneumoencephalography, ventriculo tages and even risks for the patients. It must be em
graphy, cerebral and spinal angiography and myelo phasized that not all intracranial diseases can be de
graphy), they were diagnostic methods of last resort. tected or excluded at all times with either MRI or CT.
Specific clinical neurologic indications and precau Unilateral symptoms do not always stem from the
tions were necessary before administration of such cerebral region. The "image pathology" recognized at
procedures. Today, pneumoencephalography, ven first glance may not in fact be responsible for the
triculography, cerebral and spinal angiography and clinical findings. The correlation of image pathology
myelography have been replaced by neuroimaging or and clinical findings requires functional and topical
reserved for special questions. anatomic knowledge. The presentation of this neuro-
Modern neuroimaging (computed tomography functional correlation is one aim of our book.
[CT], magnetic resonance imaging [MRI], emission Image pathology is neither described in the text
computed tomography, and ultrasound scanning) for nor depicted in the illustrations in this book. Relevant
the main part is noninvasive. Therefore neuroimaging references have been made to neuroradiologic text
is frequently performed as an introduction to techni books (17, 66a, 101,198, 344,375,403,404,440,467).
cal diagnostics and in many cases prior to laboratory Every physician and radiologist should not only be
tests. The risk of overlooking or belatedly detecting a aware of the many positive aspects of the various
critical intracranial space-occupying process, impair neuroradiologic procedures but also of the associated
ment of circulation of the cerebrospinal fluid (CSF), or limitations and drawbacks. In this way, incorrect in
compression of the spinal cord is thus considerably vestigations at the wrong anatomic location can be
reduced. This holds true for many of the industrial avoided. The referring physician must acquaint the
nations that are able to provide the appropriate radiologist with all relevant clinical data.
equipment in sufficient numbers and offer a well- The expectations of neuroscience in regard to
balanced medical infrastructure. neuroradiology and its further development remain
MRI and CT of the central nervous system (CNS) exceptionally high. This applies to magnetic reso
are predominantly used as the primary technical di nance spectroscopy, the development of multidetec-
agnostic tools. Modern neuroimaging through the tor and multislice spiral CT, and especially to
availability of immediate and short-term radiologic functional MRI. For this reason, MR orC T images and
follow-up has replaced the long clinical observation the large anatomic atlas illustrations are of equal size
of progress, e.g. for the observation of spontaneous and have been printed side by side in this up-to-date
regression of subdural hematoma or hygroma or the version of our book. Newly introduced to this edition
need for surgical intervention. MRI as therapy con are the T2-weighted MR images corresponding to the
trol monitor for multiple sclerosis has led to the Tl-weighted MR images (Chap. 8). A number of atlas
development of new therapeutic concepts and made illustrations have undergone changes, for example
their evaluation possible. The high degree of sensitiv where more exact information has appeared in the
ity of MRI enables detection of millimeter-sized literature or as a result of our experience.
tumors (e.g. microadenoma of the pituitary gland, in- With neuroimaging of the living human body,
tracanalicular acoustic schwannoma), so that micro slices with a thickness of 1-10 mm are usually
surgical operative removal may in individual cases scanned. These slices consist of small cuboids
take place without any functional loss. (Voxel = Volume x Element). Their height corre
Today, diagnostic neuroradiology has advanced to sponds to the thickness of the slice, and the length of
the extent that it accompanies and determines the their sides corresponds to the image matrix
methods of therapy. In addition, interventional neu (Chap. 2.1). For each voxel the X-ray absorption is de
roradiology has been introduced. Often, vascular im termined in CT, the intensity of the signal in MRI, and
pairments (especially vascular malformations) and the radioactivity in positron emission tomography
stenosing vascular processes are able to be treated, or (PET). Each value determined from a voxel is repre-