PONS

(Bridge,L)
 Pons
 The middle part of the
brainstem.
 Situated in the posterior
cranial fosa on the clivus
(formed by union of basi-
sphenoid and basi-
occiput).
 Connected to cerebellum
by two middle cerebellar
peduncles.
PONS in MRI
Expanding lesions of clivus can invade the pons
 parts

Dorsal part is tegmentum

 Relation to the IV ventricle
 Forms the upper half
of the floor of the IV
ventricle.
 (the backs of pons
and medulla form the
floor of the IV
ventricle)
 Cisterna pontis
 Situated on the
ventral aspect of
pons.
 Contains basilar
artery.
 External features
 Convex ventral surface
(facing the clivus) –
basilar part of pons(basis
pontis)
 This has a basilar groove
(sulcus basilaris) for the
artery of same name.
 Dorsal part (back) is
called the TEGMENTUM
forms the floor of the IV
ventricle.
 Basilar surface and trigeminal
nerve
 The V nerve is
attached to basilar
pons by two roots
and demarcates the
pons from middle
cerebellar peduncle.
 A vertical line drawn
just lateral to sensory
root is the junction of
the two.
BORDERS AND RELATED STRUCTURES
 Basilar artery and pons
 Formed at the lower
border of pons.
 Terminates at the upper
border of pons
 by dividing into two
posterior cerebral
arteries.
 Superior cerebellar
arteries curve along the
upper border and
cerebral peduncles enter
here.
 AICA curves around the
lower border.
 Arterial supply
 Basilarartery gives
number of pontine
branches.
 Also by AICA and
SCA (superior
cerebellar artery)
Cranial nerve nuclei in the pons
 V,VI,VII,VIIInerves are attached to pons.
 (remember!! except the first two cranial
nerves (olfactory and optic) the rest are
attached to brain stem in this fashion:
 III and IV- midbrain
 V to VIII- pons
 IX to XII- medulla
 Cerebello pontine angle
 This clinically
important angle has
the following
structures:
 VII and VIII
nerves,flocculus of
cerebellum, lateral
apertures of IV
ventricle with choroid
plexus.
Cerebello pontine angle
CP ANGLE
 Acoustic neuroma
and CP angle
A thickening of Schwann cells of VIII nerve
can lead to CP angle syndrome.

 Features of this syndrome include:

 1.Progressive deafness and vertigo (VIII nerve
damage)
 2.ipsilateral ataxia and staggering gait
(cerebellar peduncle injury)
 CP angle syndrome
 3.ipsilateral lower motor neuron type of
facial palsy.
 4.ipsilateral loss of pain and temperatures
sensation and loss of corneal reflex due to
involvement of spinal tract and nucleus of
V nerve.
The correct medical term for acoustic
neuroma is vestibular schwannoma,
as it rarely arises from the the acoustic division
of VIII nerve!!

P
 Internal structure
 Grey matter and white matter
 The structure of basis pontis is similar
throughout the pons.
 Tegmentum on the other hand, differs in
structure in the upper and lower halves.
 Grey matter and white matter
 Pontine nuclei.
 Nuclei of V,VI,VII and VIII cranial nerves.
 Pontine respiratory center.
 White matter contains ascending and
descending tracts and transverse ponto
cerebellar fibers.
 Structure of basis pontis
(white matter)
 Longitudinal fibers (corticopontine,corticonuclear
and corticospinal fibers).
 Corticopontine fibers relay in ipsilateral pontine
nuclei.
 Corticonuclear fibers terminate mainly in
contralateral motor nuclei of cranial nerves.
 Corticospinal fibers descend to form pyramids of
medulla.
 Transverse fibers
 Arise in the pontine nuclei and pass to the
opposite cerebellar hemisphere and form
ponto cerebellar fibers.
 The pontine nuclei form an important part
of the cortco-ponto-cerebellar pathway,
connecting the cerebral cortex of one side
to the cerebellar hemisphere of the
opposite side.
 IV

Internal structure of pons

 Tegmentum (dorsal part)
 Sincethe structure differs in the upper and
lower parts of pons, lets examine T.S of
pons at these two levels.
 T.S. through lower (caudal) pons
 Grey matter- nuclei of VI,VII,VIII and
spinal nucleus of V nerves.
 Abducent nucleus is looped by facial
nerve fibers which forms an elevation
called “facial colliculus”. This phenomenon
of migration of nerve fibers is called
“neurobiotaxis”.
V
 Remember!
Facial colliculus is not formed by facial nerve nucleus
but by abducent nucleus!!

VI

Neurobiotaxis
 Other nuclei in tegmentum
 Superior and inferior
salivatory nuclei.
 4 vestibular and 2 cochlear
nuclei.
 Spinal tract and its nucleus
of V on their way to
midbrain above.
 White matter at this level
contains trapezoid body
(fibers from cochlear
nuclei), medial lemniscus
(becomes transverse),
MLF and tectospinal tracts.
Medial lemniscus
In medulla
 T.S. Through upper pons
 Main features are:
 Sensory and motor nuclei of V
 Lateral lemniscus along with other
lemnisci
T.S THROUGH UPPER PONS
 Main structural differences in tegmentum at two levels

Lower pons Upper pons

Nuclei of VI,VII,VIII Motor and principal
nerves, spinal sensory nucleus of
Grey matter
nucleus of V. V.

2 lemnisci; medial 4 lemnisci;

and spinal. medial,lateral,spinal
White matter and trigeminal
lemnisci.
Trapezoid body is Trapezoid body
present. absent.
Trapezoid body and the lateral lemniscus
are concerned with

The auditory pathway

Clinical aspects of pons
 Millard- Gubler syndrome
 Results from a vascular lesion in lower
pons where pyramidal tracts, abducent
and facial nerves are situated.
 Features:
 Contra lateral hemiplegia (involvement of
corticospinal tracts)
 Ipsilateral facial palsy
 Ipsilateral medial squint (involvement of
abducent)

Alternating abducent hemiplegia?

 The area of close relationship between
the VI nerve, pyramids and basilar artery
Millard-Gubler syndrome
 Pontine hemorrhage
 Involvement of basilar artery branches or
AICA (bilateral and extensive) results in:
 Pin-point pupil (sympathetic fibers)
 Hyperpyrexia
 Deep coma (reticular formation)
 Bilateral paralysis of limbs and face
Astrocytoma of pons
The most common tumour of
the brainstem.
Usually occurs in childhood.