Neuroanatomy of cognition, neuroanatomy and cognition.
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Animals↗
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Neuroanatomy and its clinical application.
In years prior, articles concerned with neuroanatomy have stressed just that, the anatomy. It is for this reason that this article was written. The primary intent addresses the clinical aspects of neuroanatomy, and as such, has stressed so-called "anatomic function." An overview of neuroanatomy as well as neural function and deficit is provided. The article is intended for both the student and practitioner in the hopes of taking the labor out of its study and replacing it with a logical approach to the neuroanatomy and its clinical applications.
Humans↗
The functional neuroanatomy of classic delayed response tasks in humans and the limitations of cross-method convergence in prefrontal function.
Three classic delay tasks: spatial delayed response, delayed spatial alternation and delayed object-alternation are prototypical experimental paradigms for mapping the functional neuroanatomy of prefrontal cortex in animals. These tasks have been applied in human lesion studies, yet there have been very few studies investigating their functional neuroanatomy in healthy human subjects. We used functional magnetic resonance imaging to investigate the functional neuroanatomy of these classic paradigms (and a fourth: object delayed response) in a single sample of healthy human participants. Consistent with previous animal, human lesion, and functional neuroimaging studies, activity was observed in prefrontal and posterior parietal cortices across all three delay tasks. Task-specific activations, however, were not entirely consistent with predictions drawn from animal lesion studies. For example, delayed object-alternation activated dorsolateral prefrontal cortex, a region not generally implicated in animal lesion reports. Spatial delayed response, classically associated with the dorsolateral prefrontal cortex, did not activate this region; it rather activated posterior premotor cortices involved in response preparation, as did spatial alternation. All three tasks activated the frontopolar cortex, a region not considered crucial in animal research but associated with manipulation of internally generated information in recent human research. While cross-method convergence may be attained for lower level perceptual or motor tasks, the results of this study caution against the assumption that lesion-specific effects in animals generalize to human prefrontal cortex function.
Adult↗
Neuroanatomy of the male rhabdosphincter.
OBJECTIVES: The external striated urethral sphincter (rhabdosphincter) is a tubular muscle sleeve that extends from the prostato-membranous urethra and perineal membrane to the bladder neck. The male rhabdosphincter neuroanatomy remains unclear, and a better understanding of its innervation may provide insight into potential modifications of radical pelvic surgery to improve urinary continence. METHODS: Fresh cadaveric dissections of 12 male hemipelves were undertaken to investigate the neuroanatomy of the urinary rhabdosphincter. RESULTS: Neuroanatomic courses of the nerve supply to the rhabdosphincter revealed that, in the perineum, the perineal nerve (a terminal branch of the pudendal nerve) provided branches directly to the bulbospongiosus muscle and the urinary rhabdosphincter. In the pelvis, the course of the pelvic nerve was as follows: (1) arising from the inferior hypogastric plexus, it had a weblike course beneath the muscle fascia of the levator ani muscle; (2) traveling posterolateral to the rectum, it gave many branches that perforated into the lateral rectum; and (3) at the level of the prostatic apex, still beneath the levator ani muscle fascia (superior fascia), it sent multiple direct branches to the inferolateral aspect of urinary rhabdosphincter. The pudendal nerve traversed the pelvis in the pudendal canal, and, before leaving the pelvis to enter the perineum, it gave an intrapelvic branch that courses with the pelvic nerve to innervate the rhabdosphincter. CONCLUSIONS: Our understanding of the neuroanatomy of what may be the continence nerves has been improved by fresh cadaveric dissection. The rhabdosphincter receives nerve fibers from the pelvic nerve and dual innervation from an intrapelvic branch and a perineal branch of the pudendal nerve. Better understanding of these anatomic findings may have potential surgical significance with respect to improvement in postoperative urinary continence.
Cadaver↗
3D brain mapping using a deformable neuroanatomy.
This paper presents two different mathematical methods that can be used separately or in conjunction to accommodate shape variabilities between normal human neuroanatomies. Both methods use a digitized textbook to represent the complex structure of a typical normal neuroanatomy. Probabilistic transformations on the textbook coordinate system are defined to accommodate shape differences between the textbook and images of other normal neuroanatomies. The transformations are constrained to be consistent with the physical properties of deformable elastic solids in the first method and those of viscous fluids in the second. Results presented in this paper demonstrate how a single deformable textbook can be used to accommodate normal shape variability.
Algorithms↗
The neuroanatomies of schizophrenia.
Schizophrenia is a brain disease whose pathophysiology has escaped detection despite intensive investigation. The failure to delineate the neuroanatomy of schizophrenia is related in part to both the subtle nature of the neuropathological abnormalities and to the failure to address adequately the pathophysiological heterogeneity of schizophrenia. The symptoms of schizophrenia aggregate into relatively independent symptom complexes, which suggests that there may be a distinct neural substrate for each complex. If this is true, then the neuroanatomy of schizophrenia is better addressed as the separate neuroanatomies of symptom complexes. However, the use of symptom complexes to guide future neuroanatomical investigations raises crucial methodological issues, including the differentiation of primary versus secondary symptoms, trait versus state characteristics, and continuous versus categorical variables. Decisive hypothesis testing requires that these issues be addressed in study design.
Brain↗
Rheumatoid arthritis. Neuroanatomy, compression, and grading of deficits.
STUDY DESIGN: The authors summarize published data regarding cervical spine involvement in rheumatoid arthritis, define the neurologic manifestations, and provide recommendations for management of these complex and difficult problems. OBJECTIVES: The authors attempted to accurately define the neurologic lesions resulting from rheumatoid involvement of the cervical spine despite the complexity of the neuroanatomy of the cervicomedullary region and the diversity of pathology. SUMMARY OF BACKGROUND DATA: Despite the long-standing recognition of cervical spine involvement in rheumatoid arthritis, appreciation of the different neurologic manifestations of this disease has been lacking or misunderstood. METHODS: The authors reviewed the relevant neuroanatomy, neurovascular anatomy, and neuropathologic lesions that interact to create these complex and often confusing clinical situations. RESULTS: Rheumatoid arthritis produces encroachment on the brainstem and cervical spinal cord. The minimum space available at the craniocervical junction for the neural structures is 13 to 14 mm, which is fairly constant. Below C2, the available space is only 12 mm. When the amount of space reduced below this amount, there is, by definition, neural compression. The site of compression and/or repeated microcontusions will determine subsequent neurologic deficits. At the craniovertebral junction, neural compression and traumatic injury typically occur anteriorly at the pyramidal decussation producing cruciate paralysis with considerable weakness in both arms and minimal leg involvement. Cranial settling can result in lower medulla and cranial nerve dysfunction. Subaxial stenosis typically results in a more typical myelopathy. CONCLUSIONS: Accurate diagnostic studies are mandated to determine the location of compression and to fully appreciate the resultant neurologic deficits. To improve more complete comprehension of the neurologic manifestations of rheumatoid arthritis, the relevant neuroanatomy, neurovascular anatomy, and neuropathologic lesions must be understood.
Animals↗
Computer-based neuroanatomy laboratory for medical students.
BACKGROUND: To present the laboratory portion of our first-semester Human Neuroanatomy course at Temple University Medical School more effectively and efficiently and to replace the glass slide/microscope-based laboratory component of the course, we developed a computer-based substitute. METHODS: For this computer-based neuroanatomy laboratory program, we photographed the (a) gross brain sliced and dissected specimens and (b) all the glass slides, from the sacral cord through the head of the caudate nucleus. We digitized the photographed images and, using Multimedia ToolBook (Asymetrix), created a computerized atlas, laboratory guide, and a clinical problem-solving section. To assess the effectiveness of the computerized laboratory, we compared student performances between those classes that previously had the traditional laboratory with two succeeding classes that used the computer-based laboratory. RESULTS: Test score results of the laboratory portion of the course suggested that performance on laboratory material was virtually unchanged by the substitution of the computer program. By a survey taken at the end of the course, the students were very satisfied with the computerized program as a teaching method. CONCLUSIONS: The students and faculty enthusiastically agreed that the computer program was an effective substitute method for the traditional glass-slide laboratory and that it was a beneficial self-educational tool that fostered independent learning. The program encouraged student interaction and group learning and fostered independence. It was a more efficient method for faculty and students without sacrificing performance.
Computer-Assisted Instruction↗
Progress and perspectives in computational neuroanatomy.
The tremendous increase in processing power of personal computers has recently allowed the construction of highly sophisticated models of neuronal function and behavior. Anatomy plays a fundamental role in supporting and shaping nervous system activity, yet to date most details of such a role have escaped the efforts of experimental and theoretical neuroscientists, mainly because of the problem's complexity. When accurate cellular morphologies are included in electrophysiological computer simulations, quantitative and qualitative effects of dendritic structure on firing properties can be extensively characterized. Complete models of dendritic morphology can be implemented to allow the computer generation of virtual neurons that model the anatomical characteristics of their real counterparts to a great degree of approximation. From a restricted and already available experimental database, stochastic and statistical algorithms can create an unlimited number of non-identical virtual neurons within several mammalian morphological classes, storing them in a compact and parsimonious format. When modeled neurons are distributed in three-dimensional and biologically plausible rules governing axonal navigation and connectivity are added to the simulations, entire portions of the nervous system can be "grown" as anatomically realistic neural networks. These computational constructs are useful to determine the influence of local geometry on system neuroanatomy, and to investigate systematically the mutual interactions between anatomical parameters and electrophysiological activity at the network level. A detailed computer model of a "virtual brain" that was truly equivalent to the biological structure could in principle allow scientists to carry out experiments that could not be performed on real nervous systems because of physical constraints. The computational approach to neuroanatomy is just at its beginning, but has a great potential to enhance the intuition of investigators and to aid neuroscience education. Anat Rec (New Anat): 257:195-207, 1999.
Animals↗
Design and utility of a web-based computer-assisted instructional tool for neuroanatomy self-study and review for physical and occupational therapy graduate students.
The cadaver continues to be the primary tool to teach human gross anatomy. However, cadavers are not available to students outside of the teaching laboratory. A solution is to make course content available through computer-assisted instruction (CAI). While CAI is commonly used as an ancillary teaching tool for anatomy, use of screen space, annotations that obscure the image, and restricted interactivity have limited the utility of such teaching tools. To address these limitations, we designed a Web-based CAI tool that optimizes use of screen space, uses annotations that do not decrease the clarity of the images, and incorporates interactivity across different operating systems and browsers. To assess the design and utility of our CAI tool, we conducted a prospective evaluation of 43 graduate students enrolled in neuroanatomy taught by the Divisions of Physical and Occupational Therapy at the University of Utah, College of Health. A questionnaire addressed navigation, clarity of the images, benefit of the CAI tool, and rating of the CAI tool compared to traditional learning tools. Results showed that 88% of the respondents strongly agreed that the CAI tool was easy to navigate and overall beneficial. Eighty-four percent strongly agreed that the CAI tool was educational in structure identification and had clear images. Furthermore, 95% of the respondents thought that the CAI tool was much to somewhat better than traditional learning tools. We conclude that the design of a CAI tool, with minimal limitations, provides a useful ancillary tool for human neuroanatomy instruction.
Computer-Assisted Instruction↗
Design characteristics that affect speed of information access and clarity of presentation in an electronic neuroanatomy atlas.
Functional Neuroanatomy, an interactive electronic neuroanatomical atlas, was designed for first year medical students. Medical students have much to learn in a limited time; therefore a major goal in the atlas design was that it facilitate rapid, accurate information retrieval. To assess this feature, we designed a testing scenario in which students who had never taken a neuroanatomy course were asked to complete two equivalent tests, one using the electronic atlas and one using a comparable hard copy atlas, in a limited period of time. The tests were too long to be completed in the time allotted, so test scores were measures of how quickly correct information could be retrieved from each source. Statistical analysis of the data showed that the tests were of equal difficulty and that accurate information retrieval was significantly faster using the electronic atlas when compared with the hard copy atlas (P < 0.0001). Post-test focus groups (n = 4) allowed us to infer that the following design features contributed to rapid information access: the number of structures in the database was limited to those that are relevant to a practicing physician; all of the program modules were presented in both text and image form on the index screen, which doubled as a site map; pages were layered electronically such that information was hidden until requested, structures available on each page were listed alphabetically and could be accessed by clicking on their name; and an illustrated glossary was provided and equipped with a search engine.
Humans↗
Computer-enhanced learning in neuroanatomy.
The recent development of powerful microcomputers and the introduction of object-oriented programming languages has now made available to educationists software that can be easily used to design and develop computer-based learning material. We have developed courseware and tutorware in the field of neuroanatomy which are pedagogically structured and yet provide multiple paths of learning for the individual student. Neuroanatomy is a difficult subject to learn because of the structural intricacy and functional correlations that it entails. The courseware enables students to approach the subject at different levels of difficulty and progress at their own pace towards a comprehensive understanding of structure and function aided by text integrated with graphics, sound and animation. A significant advantage to authors of similar courseware is the option to update the contents easily when necessary in the future.
Computer-Assisted Instruction↗
[The neuroanatomy of Juan Valverde de Amusco and medicine at the time of the Spanish renaissance].
Juan Valverde de Amusco (c. 1525-c. 1564) is considered to have been the most important Spanish anatomist of the XVI century. A follower of Vesalius, he increased and divulged knowledge of anatomy during the Renaissance and his book The history of the composition of the human body was printed in Rome in 1556. The objective of this paper is to study the neuroanatomy in this book and present unpublished biographical data and describe the main contributions of this Castilian doctor to the neurosciences, in the context of Spanish medicine during the Renaissance period. He was born in the town of Hamusco (today Amusco) in the province of Palencia, which belonged to the Crown of Castile. Juan Valverde emigrated to Italy to improve his scientific knowledge. He carried out anatomical studies using the then revolutionary method of direct observation, as opposed to the Galenic criteria of authority inherited from the Medieval period. He trained in Padua under Realdo Colombo and lived in Rome where he practiced medicine until his death, becoming deservedly famous. He did not return to Spain since in the Spanish universities of the time there was a mentality which was reactionary to modern anatomy. His works, published in Italy but in the Spanish language, give an idea of the power of the Crown of Castile in the Europe of that period. The book is profusely illustrated with the first illustrations ever published in the history of printing, drawn by Nicolas Beatrizet. The book was sold widely and was translated and reedited on many occasions, until well into the XVIII century. For the first time Valverde made precise references to the minor circulation. He was the first anatomist to describe the muscles for movement of the eye correctly and the intracranial course of the carotid arteries. In his work he made the first drawing of the stapes, described by the Valencian Luis Collado. Vesalius and Valverde contributed decisively to the beginnings of modern neuroanatomy. Thanks to them, the brain is no longer an organ unknown to science.
Anatomy, Artistic↗
Neuroanatomy for the dentist in the twenty-first century.
Both the anatomy and physiology parts of national boards have questions on neuroscience. Currently, there are course guidelines established for dental neuroanatomy but not for dental neuroscience. As a result, there is great variability in what and how neurosciences are taught to dental students. At first glance, it is difficult to determine where neurosciences fit in the dental curriculum. One area where there is a close tie between basic science and clinical care is the realm of pain control. Since the Institute of Medicine study recommended that basic and clinical sciences curricula provide clinically relevant education, a neuroscience curriculum can integrate basic understanding of how the nervous system works in the care and management of dental pain. This paper describes the integrated approach to teaching neuroanatomy as a component of the head and neck gross anatomy course at the University of Louisville. This integrated strategy provides dental students with the basic concepts of neuroscience, pain pathways, autonomic nervous system, and detailed information on the cranial nerves.
Autonomic Nervous System↗
Comparative neuroanatomy: place, principles, practice and programme.
In this paper an outline is presented of the foundations of comparative neuroanatomy. The significance of topology (i.e. the geometry of distortion) for an accurate analysis of the kinds of morphological transformations to which central nervous systems are subjected is emphasized. The major tasks of comparative neuroanatomy are: (1) to sample the variation existing in the central nervous systems on the basis of an analysis of a multitude of carefully selected species; (2) to place the patterns of variation found, wherever possible, in an phylogenetic context; (3) to relate the morphological data and relations determined, to their putative biological (functional, behavioural) significance, and (4) to reflect on the question of which specific factors and processes might have caused the changes through which the brains of organisms have passed, and to develop explanatory scenarios.
Anatomy, Comparative↗
The functional neuroanatomy of episodic memory: the role of the frontal lobes, the hippocampal formation, and other areas.
Because it allows direct mapping of synaptic activity during behavior in the normal subject, functional neuroimaging with the activation paradigm, especially positron emission tomography, has recently provided insight into our understanding of the functional neuroanatomy of episodic memory over and above established knowledge from lesional neuropsychology. The most striking application relates to the ability to distinguish the structures implicated in the encoding and the retrieval of episodic information, as these processes are extremely difficult to differentiate with behavioral tasks, either in healthy subjects or in brain-damaged patients. Regarding encoding and retrieval, the results from most studies converge on the involvement of the prefrontal cortex in these processes, with a hemispheric encoding/retrieval asymmetry (HERA) such that the left side is preferentially involved in encoding, and the right in retrieval. However, there are still some questions, for instance, about bilateral activation during retrieval and a possible specialization within the prefrontal cortex. More expected from human and monkey lesional data, the hippocampal formation appears to play a role in both the encoding and the retrieval of episodic information, but the exact conditions which determine hippocampal activation and its fine-grained functional neuroanatomy have yet to be fully elucidated. Other structures are activated during episodic memory tasks, with asymmetric activation that fits the HERA model, such as preferentially left-sided activation of the association temporal and posterior cingulate areas in encoding tasks and preferentially right-sided activation of the association parietal cortex, cerebellum, and posterior cingulate in retrieval tasks. However, this hemispheric asymmetry appears to depend to some extent on the material used. These new data enhance our capacity to comprehend episodic memory deficits in neuropsychology, as well as the neural mechanisms underlying the age-related changes in episodic memory performances.
Brain Mapping↗
Neuroanatomy of the pelvis: implications for colonic and rectal resection.
PURPOSE: Urinary dysfunction remains a common complication of radical pelvic surgery, particularly after abdominoperineal resection. In treating rectal carcinoma, the extent of primary resection and lymphadenectomy are major determinants in the degree of postoperative urologic morbidity. METHODS: Twelve male and eight female hemipelves from fresh cadavers were dissected with reference to the neuroanatomy of the lower genitourinary tract. These cadavers were dissected within twelve hours of thaw from frozen state. The cadavers were hemisected at the level of the sacral promontory for better exposure of neural trunks and vascular structures leading into the pelvis. These structures were followed down sequentially into the true pelvis, using magnified dissection under operating microscope or loupe dissection or both. RESULTS: Coordinated lower urinary tract function relies on both autonomic and somatic nerve activity. Emanating from the inferior hypogastric plexus, the pelvic nerve supplies sympathetic and parasympathetic innervation to the pelvic viscera. The course of the pelvic nerve is as follows: 1) from the inferior hypogastric plexus, it has multiple branches forming a web-like complex within the endopelvic fascial sleeve, some of which innervate the bladder detrusor; 2) a main branch traveling inferolateral to the rectum remains deep to the fascia of the levator ani muscle and courses to the external urinary sphincter; 3) at the level of the prostatic apex (or bladder neck in females), this pelvic nerve branch sends direct branches to the urinary sphincter. The pudendal nerve traverses the pelvis in the pudendal canal, and before leaving the pelvis to enter the perineum, it gives an intrapelvic branch that courses alongside the ischium to enter the external urinary sphincter. In the ischiorectal fossa, terminal branches of the pudendal nerve (i. e., perineal nerve) can be seen inserting into the urinary sphincter. CONCLUSIONS: Urinary retention and urinary incontinence represent two distinct urologic complications after abdominoperineal resection. Injury to detrusor branches of the pelvic nerve can cause detrusor denervation and urinary retention. In addition, injury to intrapelvic branches of the pelvic and pudendal nerves to the urinary sphincter can result in intrinsic sphincter deficiency and urinary incontinence. A better understanding of the neuroanatomy of the lower genitourinary tract can give a physiologic basis for clinical findings of postoperative voiding dysfunction and may help the surgeon refine surgical technique by more precisely determining resection limits to minimize urologic complications.
Aged↗
Neuroanatomy of penile erection: its relevance to iatrogenic impotence.
The neuroanatomy of erection in men is not well defined. Recently, we isolated successfully the cavernous nerves for acute and chronic neurostimulation to induce penile erection in dogs and monkeys. We then investigated the anatomy of these nerves in humans by cadaveric dissection and serial histologic sectioning. Our experience in tracing the spinal nuclei responsible for vesical and urethral function by transportation of horseradish peroxidase enabled us to explore the location and organization of the spinal center for erection. Thus, systemic knowledge of the neuroanatomy of erection was accumulated. The spinal nuclei for control of erection are located in the intermediolateral gray matter at the S1 to S3 and T12 to L3 levels in dogs, and the S2 to S4 and T10 to L2 levels in humans. From these sacral nuclei axons issue ventrally and join the axons of the nuclei for the bladder and rectum to form the sacral visceral efferent fibers. These fibers emerge from the anterior root of S2 to S4, and join the sympathetic fibers to form the pelvic plexus, which then branches out to innervate the bladder, rectum and penis. The fibers innervating the penis (cavernous nerves) travel along the posterolateral aspect of the seminal vesicle and prostate, and then accompany the membranous urethra through the genitourinary diaphragm. These fibers are located on the lateral aspect of the membranous urethra and ascend gradually to the 1 and 11 o'clock positions in the proximal bulbous urethra. Some of the fibers penetrate the tunica albuginea of the corpus spongiosum, while others spread to the trifurcation of the terminal internal pudendal artery and innervate the dorsal, deep and urethral arteries. Shortly before the 2 corpora cavernosa merge the cavernous nerves penetrate the tunica albuginea along with the deep artery and cavernous vein. The terminal branches of these nerves innervate the helicine arteries and the erectile tissue within the corpora cavernosa. Because of the intimate relationship of the cavernous nerves to the rectum, prostate and urethra, they can be damaged easily during urological and pelvic procedures. This systemic knowledge of the human cavernous nerves from the spinal center to the erectile tissue should permit a better understanding of erection and impotence. Furthermore, with the aid of intraoperative neurostimulation, the cavernous nerves may be identified and preserved, thereby preventing iatrogenic impotence.
Animals↗