04---滑车神经Trochlear Nerve.pptVIP

CRANIAL NERVE ANATOMY颅神经结构 The Trochlear Nerve The fourth cranial nerve provides motor innervation to only a single muscle, the superior oblique muscle （上斜肌）. Real origin of trochlear nerve Cerebral peduncle（大脑脚） Nucleus（神经核） Trochlear nucleus滑车神经核 The trochlear nucleus is situated at the level of the inferior colliculus（滑车神经核位于下丘水平）, just ventral to the aqueduct（中脑导水管腹侧）, posterior to the MLF（内侧纵束）and just inferior to the oculomotor nerve complex. The localization of the nucleus very close to the MLF explains why lesions that involve the trochlear nucleus most often cause both a fourth nerve palsy and an internuclear ophthalmoplegia (INO)（核间性眼肌麻痹）. Trochlear nucleus Axons leaving the nucleus course dorsally around the aqueduct and the left and right fascicular segments cross each other（左右束交叉） at the level of the superior medullary velum（上髓帆） before exiting the midbrain at its posterior surface（中脑背侧出脑）, just caudal to the inferior colliculus. These are two unique features of the fourth cranial nerve: (1) it is the only cranial nerve crossing the midline, hence a superior oblique muscle is always innervated by the contralateral trochlear nucleus（上斜肌由对侧滑车神经核支配） and (2) it is the only cranial nerve exiting the brainstem at its dorsal surface. Apparent origin of trochlear nerve Inferior colliculus Cistern of great cerebral vein Cisternal segment The trick is to look for the superior medullary velum, a small flat band at the back of the superior part of the fourth ventricle. At that level, the nerves exit the brainstem in a nearly horizontal mediolateral direction （水平沿中间外侧方向） until they reach the free edge of the tentorium（天幕游离缘）. Cisternal segment They then course anteriorly around the brainstem and pass through the gap between the superior cerebral artery and superior cerebellar artery, lateral to the oculomotor nerve. Because the nerves have to turn around the complete brainstem, they are the crainal nerves with the longest intracranial segment. Intracavern