Cranial Nerve Roots Research Articles

Rhombomere transplantation repatterns the segmental organization of cranial nerves and reveals cell-autonomous expression of a homeodomain protein.

The developing vertebrate hindbrain consists of segmental units known as rhombomeres. Hindbrain neuroectoderm expresses 3' Hox 1 and 2 cluster genes in characteristic patterns whose anterior limit of expression coincides with rhombomere boundaries. One particular Hox gene, referred to as Ghox 2.9, is initially expressed throughout the hindbrain up to the anterior border of rhombomere 4 (r4). Later, Ghox 2.9 is strongly upregulated in r4 and Ghox 2.9 protein is found in all neuroectodermal cells of r4 and in the hyoid crest cell population derived from this rhombomere. Using a polyclonal antibody, Ghox 2.9 was immunolocalized after transplanting r4 within the hindbrain. Wherever r4 was transplanted, Ghox 2.9 expression was cell-autonomous, both in the neuroectoderm of the graft and in the hyoid crest cell population originating from the graft. In all vertebrates, rhombomeres and cranial nerves (nerves V, VII+VIII, IX, X) exhibit a stereotypic relationship: nerve V arises at the level of r2, nerve VII+VIII at r4 and nerves IX-X extend caudal to r6. To examine how rhombomere transplantation affects this pattern, operated embryos were stained with monoclonal antibodies E/C8 (for visualization of the PNS and of even-numbered rhombomeres) and HNK-1 (to detect crest cells and odd-numbered rhombomeres). Upon transplantation, rhombomeres did not change E/C8 or HNK-1 expression or their ability to produce crest cells. For example, transplanted r4 generated a lateral stream of crest cells irrespective of the site into which it was grafted. Moreover, later in development, ectopic r4 formed an additional cranial nerve root. In contrast, transplantation of r3 (lacks crest cells) into the region of r7 led to inhibition of nerve root formation in the host. These findings emphasize that in contrast to spinal nerve segmentation, which entirely depends on the pattern of somites, cranial nerve patterning is brought about by factors intrinsic to rhombomeres and to the attached neural crest cell populations. The patterns of the neuroectoderm and of the PNS are specified early in hindbrain development and cannot be influenced by tissue transplantation. The observed cell-autonomous expression of Ghox 2.9 (and possibly also of other Hox genes) provides further evidence for the view that Hox gene expression underlies, at least in part, the segmental specification within the hindbrain neuroectoderm.

Defect reconstruction and cerebrospinal fluid management in neurotologic skull base tumors with intracranial extension.

Intracranial extension (ICE) is the spread of tumor into the subarachnoid space through dura or along cranial nerve roots. The single-stage removal of the skull base tumor with its ICE has been confounded by cerebrospinal fluid management and defect reconstruction. The purpose of this report is to review a current protocol for managing the cranial base tumor and its ICE as a unit. The ventricular shunting paper of 1987 is retracted. All tumors were managed at a single stage. Defect reconstruction was size dependent. Ninety-eight neurotologic skull base tumors with ICE were managed from 1971 to 1991. The new protocol was initiated in 1987. Results specific to this group are highlighted. For glomus tumors, cerebrospinal fluid leak rates have been dramatically reduced overall from 14.5% to 4%. The leak rates for nonglomus tumors, overall, have improved slightly. Complications are discussed. The development of this surgical approach protocol improves the functional outcome in patients of surgeons who aspire to disease "cure" rather than "control."

Immunohistochemical distribution and biological activity of pituitary adenylate cyclase-activating polypeptide (PACAP) in the central nervous system of the frog Rana ridibunda.

The primary structure of frog pituitary adenylate cyclase-activating polypeptide (PACAP) has recently been determined and the results show that the sequence of PACAP has been highly conserved during evolution. In particular, the structure of the 1-27 fragment of PACAP is identical in frog and mammals. Using an antiserum raised against PACAP27, we have investigated the distribution of PACAP-containing neurons in the central nervous system of the frog Rana ridibunda by the immunofluorescence technique. The main populations of immunoreactive perikarya were located in the medial and ventral diencephalon, i.e., the preoptic nucleus, the ventral and dorsal infundibular nuclei, the nucleus posterocentralis thalami, and the ventral and ventrolateral areas of the thalamus. In the telencephalon, sparse cell bodies were found in the nucleus accumbens septi, the amygdala, the pallial commissure, and the bed nucleus of the pallial commissure. In the hindbrain, the torus semicircularis, the nucleus profundus and the nucleus anteroventralis tegmenti of the mesencephalon also contained populations of PACAP-immunoreactive perikarya. Beaded nerve fibers were observed throughout the brain. Occasionally they formed bundles, e.g., from the ventral infundibulum to the external vascular layer of the median eminence, from the central thalamus to the optic tectum, and rostrocaudally, from the nucleus accumbens septi to the nucleus entopeduncularis. Other areas, such as the interpeduncular nucleus, the nucleus isthmi and the roots of cranial nerves V and VIII in the medulla oblongata, were also densely innervated. The adenylate cyclase-stimulating activity of PACAP was tested by using a static incubation technique for hypothalamic slices.(ABSTRACT TRUNCATED AT 250 WORDS)

Anomalous hypoxic acidification of medullary ventral surface

In castrated male goats, two flexible catheters, one open ended for reference and the other ending in a 1-mm-diam glass bulb pH electrode, were advanced ventrally through a left posterior fossa craniotomy into the subarachnoid space between the 9th and 10th cranial nerve roots, passing medially into cerebrospinal fluid (CSF) over the medullary ventral surface (MVS). They were anchored to dura and fascia, tunneled under the scalp, and terminated in connectors on the left horn. After several days for recovery, while the animals were awake, the effects of CO2 and hypoxia on pH of the film of CSF between the pia and arachnoid (pHMVS) were recorded along with end-tidal PCO2 and PO2 (mass spectrometer), ventilation (pneumotachometer) through a permanent tracheostomy, and, when possible, ear arterial O2 saturation (SaO2). High PCO2 acidified MVS as expected: delta pH MVS/delta log PCO2. = -0.64 +/- 0.14, producing a ventilatory response slope delta VI/delta pHMVS = 372 l/min. Hypoxia resulted in acid shifts even when PCO2 was allowed to fall. The development of hypoxic acidosis was related to the location of pH electrodes determined at necropsy. In isocapnic hypoxia, pH over putative chemoreceptor surfaces fell in proportion to desaturation: delta pHMVS = 0.0033(SaO2)-0.34, r = 0.80, Sy.x = 0.025. With uncontrolled arterial PCO2, similar acidosis occurred when SaO2 fell below 85-90%: delta pHMVS = 0.0039(SaO2)-0.34, r = 0.88, Sy.x = 0.032. With constant hypoxia, pH fell (tau = 3.7 +/- 2.2 min) to a plateau after 10-20 min and showed rapid recovery (tau = 2.0 +/- 1.3 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Chemosensitive ventrolateral medulla in the cat: the fine structure and GABA-induced cardiovascular effects

These studies were designed to provide information on both GABA influences on the neuronal structures within the rostral ventrolateral medulla (RVLM) involved in the cardiovascular control, and fine structure of the GABA-sensitive RVLM in cats. By electron microscopy, the S-type asymmetric junctions (believed to mediate excitation) as well as F-type symmetric junctions (thought to provide inhibition) were identified within the RVLM area examined. The axonal terminals thick with spherical electron-transparent synaptic vesicles, measuring about 50 nm in diameter and forming S-type synapses, were distributed within the entire area. Large numbers of axonal terminals forming the F-type synapses and filled with flattened synaptic vesicles with a longitudinal axis of around 60–80 nm were found at the site located 5–6 mm caudal to the trapezoid bodies. Both spherical electron-transparent and flattened synaptic vesicles could be found together with electron-dense vesicles averaging 80–160 nm in diameter. No axonal terminals containing only the latter type of vesicles were found within the area studied. Some axo-axo-dendritic F-S-type synapses were identified within the RVLM. Unilateral injection of GABA into the RVLM site located 2–5 mm caudal to the trapezoid bodies induced a dose-related fall in the systemic arterial pressure and inhibition of the renal nerve sympathetic activity, the most marked responses being found at the site 4–5 mm caudal to the trapezoid bodies. It also resulted in decrease of heart rate and myocardial contractility when injected into a distinct site, located 0–1.5 mm rostral to the outflow of the 12th cranial nerve roots. There was some laterality in GABA effects on heart rate and myocardial contractility following its injections into the RVLM on the left and right side. Injections of bicuculline into the GABA-sensitive RVLM site resulted in an increase in cardio-haemodynamic responses together with the enhancement of renal nerve sympathetic activity in a dose-related fashion. These results suggest that, in cats, GABA-sensitive sympathoexcitatory neuronal structures in the RVLM alter peripheral sympathetic vasomotor and cardiac nerve background activities through GABA action on the bicuculline-sensitive GABA a-receptors.

Trigeminal neuralgia caused by compression from arteries transfixing the nerve

The authors present three patients with trigeminal neuralgia due to compression by an artery that transfixed the sensory root of the fifth cranial nerve. These cases represented 0.8% of 384 patients with trigeminal neuralgia treated by microvascular decompression at the authors' clinic during the past 12 years. In the remaining 381 cases, the compressing vessels were successfully removed from the trigeminal nerve without much difficulty, for an initial cure rate of 94.3%. In the three cases reported, however, the compressing artery penetrating the nerve could not easily be maneuvered away from the nerve. In the first two cases, partial rhizotomy perpendicular to the axis of the nerve at the site of arterial transfixion made it possible to separate the artery from the nerve. However, these two patients developed postoperative facial sensory impairment. In the third case, rhizotomy was performed longitudinal to the axis of the nerve at the site of arterial transfixion, making it possible to reposition the artery peripherally beyond the root entry zone of the nerve without causing any postoperative sensory deficits of the face. No recurrent pain has developed in more than 2 1/2 years since surgery in any of these three cases. When performing microvascular decompression surgery on patients in whom the compressing artery penetrates the nerve, the technique used in our third patient is the procedure of choice.

Are the post-inspiratory neurons in the decerebrate rat cranial motoneurons or interneurons?

We examined the membrane potentials of 63 respiratory neurons in the ventrolateral medulla of decerebrate rats, whose trajectories had the characteristics of the post-inspiratory neurons, i.e. exhibiting hyperpolarization during inspiration, rapid depolarization at end-inspiration and progressive repolarization with a decrementing pattern during the intervals between phrenic bursts. Synaptic responses of 6 post-inspiratory neurons which were tested by stimulation of cervical vagus or superior laryngeal nerves were excitatory. Eleven of these 63 post-inspiratory neurons were labeled by intracellular injection of horseradish peroxidase (HRP). Ten of these 11 labeled neurons were motoneurons since their axons exited the medulla after joining the roots of cranial nerves. However, only one of these motoneurons was antidromically activated by stimulation of the ipsilateral cervical vagus nerve. We assumed that most of the post-inspiratory medullary neurons of the present study were motoneurons, but not interneurons, although antidromic invasion was not possible after stimulation of the cervical vagus and superior laryngeal nerves. Two post-inspiratory neurons of this sample had bulbospinal axons, which were revealed by antidromical activation of spinal cord and HRP labeling, respectively. The axon of the labeled bulbospinal neuron had axonal collaterals which were distributed within the region of the nucleus ambiguus of the ipsilateral medulla. The functional significance of this type of post-inspiratory neuron is discussed.

A rare cause of nasal obstruction: A solitary neurofibroma

This case represents a peripheral nerve sheath tumor as a cause of nasal obstruction. Nerve sheath tumors are relatively uncommon; however, most otolaryngologists will encounter them. These tumors develop from cranial and spinal nerve roots and from peripheral nerves. In total, approximately 25% to 44% of nerve sheath tumors occur in the head and neck region. Although the most important are cranial nerve tumors--the majority being acoustic neuromas arising from the vestibular nerve--they may also develop in the nasal cavity.

Alternate expression of the HNK-1 epitope in rhombomeres of the chick embryo

Rhombomeres are regarded as the manifestation of innate segmentation within the vertebrate CNS. To investigate developmental changes occurring in the CNS and PNS, a series of chick embryos were immunostained with several monoclonal antibodies. The HNK-1-immunoreactivity (IR) appeared in rhombomeres (r) 3 and r5 around stage 15, when r2 and r4 were not stained. This alternate pattern is similar to the Krox-20 gene expression in the mouse embryo. At levels of r2 and r4, HNK-1 + neural crest cell masses were attached to the CNS forming cranial sensory ganglia. In these rhombomeres, an accumulation of neuroepithelial cells near the cranial nerve root and early development of neuroblasts in the basal plate were observed. The above observations seem to suggest that the alternate HNK-1-IR in rhombomeres might be related to the expression of cell adhesion molecules, and therefore also to the adhesion of the cranial ganglion precursors to the CNS, which takes place every other rhombomere in the preotic region. Thus, the alternate pattern of the HNK-1-IR seems to be related to the morphogenesis of preotic branchial nerves.

The cranial nerve vascular compression syndrome: II. A review of pathophysiology

The various hypotheses regarding the pathophysiologies of trigeminal neuralgia and hemifacial spasm are reviewed, and the results of recent physiological studies on the pathogenesis of hemifacial spasm are discussed. Evidence is presented that strongly supports the hypothesis that the symptoms and signs of hemifacial spasm are caused by hyperactivity in the facial motonucleus. Some of the contradictions regarding the prevalence of vascular conflicts in the cerebellopontine angle and the symptoms of vascular compression are discussed, and a hypothesis is presented that assumes that a suitable substrate must be present, in addition to vascular compression of the respective cranial nerve root, for the symptoms and signs of a cranial nerve vascular compression disorder to develop. Finally, it is discussed how this hypothesis can explain some of the differences between the disorders that can be cured by microvascular decompression of respective cranial nerves.

Familial hemifacial spasm associated with arterial compression of the facial nerve

This report of an 88-year-old woman with familial hemifacial spasm includes the first published postmortem description of hemifacial spasm with cross-compression of the seventh cranial nerve root exit zone by a redundant loop of the anterior inferior cerebellar artery and associated vascular plexus. Histological examination of the seventh and eighth cranial nerve complex suggested nerve degeneration because increased numbers of corpora amylacea were present just distal to the compression concavity. There was no evidence of demyelination or gliosis of the nerve. This case suggests that vascular compression of the nerve root exit zone is an important condition in the etiology of most of these cases. This is the third reported case of familial hemifacial spasm; to date, all such patients have had left facial involvement. The family pedigree in this case suggests a pattern of autosomal-dominant inheritance with partial penetrance. The genetic basis for familial hemifacial spasm may involve anatomical variants or anomalies of the posterior circulation, since both posterior inferior cerebellar arteries were congenitally absent in this case.

Bilateral Fenestrations of the Vertebrobasilar Artery with Trigeminal Neuralgia

Fenestration of cerebral vessels is congenital and usually of no clinical significance. A 58-year-old female presented with left trigeminal neuralgia associated with double fenestrations of the vertebrobasilar artery. Vertebral angiography showed bilateral fenestrations in the intracranial segment. The left fenestrated artery originated at the distal portion of the vertebral artery and terminated at the middle portion of the basilar artery, compressing the left Vth cranial nerve root. The neuralgia improved after microvascular decompression. Fenestration of cerebral vessels is usually single. Five of eight reported cases with double fenestrations had bilateral extracranial fenestrations at the atlantoaxial portion of the vertebral artery. Bilateral fenestrations of the vertebrobasilar artery with trigeminal neuralgia have not been previously reported.

Primary spinal leptomeningeal astrocytoma

This autopsy case report describes a clinically aggressive, histologically well-differentiated, diffuse, primary leptomeningeal astrocytoma. This rare tumour produced a meningitic clinical picture associated with hydrocephalus, focal spinal cord necrosis, and signs of spinal and cranial nerve root irritation. Despite the microscopic features, death occurred approximately 7 weeks after the first meningeal symptoms.

Pre-inspiratory burst in the caudal medulla of rabbits

The activity of 48 respiratory units in the paraolivary region from the middle to the rostral end of the hypoglossal cranial nerve root, and the effect of electrical stimulation and l-glutamate applied to the region on phrenic nerve activity was investigated in 14 rabbits. Electrical stimulation (50 Hz, 0.2 ms current pulses at intensities 5–20 μA) and l-glutamate (30–100 ng) shortened the expiratory time and increased the respiratory rhythm with no change in tidal phrenic nerve activity. Rhythmic activity preceding the phrenic nerve activity (pre-inspiratory burst) was recorded in the paraolivary region. The temporal relationship between the pre-inspiratory (pre-I) burst and the phrenic activity remained constant even when the respiratory frequency was altered by passive lung inflation. These results suggest that structures in the paraolivary region may influence the respiratory rhythm in rabbits and that pre-I burst neurons may play a role in triggering periodic phrenic activity.

Adrenergic innervation of the vasa nervorum in the cranial nerves and spinal roots in the subarachnoid space

Fluorescence microscopy revealed that the innervation of the vasa nervorum of both cranial and spinal nerve roots in the subarachnoid space in the monkey is adrenergic in nature. The endoneurium of the cranial nerve roots contained free adrenergic nerve fibers which were not related to the vessel wall.

The sequence of myelination in the brainstem of the rat monitored by myelin basic protein immunohistochemistry

The temporal order which is observed by nervous pathways in their myelination was investigated in the brainstem of neonatal to 16-day-old albino rats. The immunohistochemical detection of myelin basic protein in newly forming myelin sheaths provided a highly sensitive and specific criterion to judge the time of onset and the progress of myelination in its initial stages. Immunohistochemistry was performed on paraffin-embedded tissue according to the unlabeled peroxidase-antiperoxidase method. A small number of immunoreactive fibers was already present in neonate rats in the ventral funiculus of the cervical spinal cord and in the medial longitudinal fascicle of the medulla oblongata. By the 4th postnatal day myelination had commenced in many sensory tracts and in the trigeminal root, in the tectospinal tract, in the inferior cerebellar peduncle and in the roots of most cranial motor nerves. The auditory pathway up to the inferior colliculus, the gracile, spinocerebellar and rubrospinal tracts and the superior cerebellar peduncle had acquired some myelin on the 7th day. Phylogenetic late fiber systems also appeared to myelinate comparatively late: the transverse pontine fibers and the medial cerebellar peduncle started on the 10th day, and in the corticospinal tract a conspicuously synchronized myelination appeared on the 13th day. All pathways of the brainstem possessed myelinated fibers on the 16th day and some tracts had approached their relative maturity.

Arterial compression of the fifth cranial nerve causing trigeminal neuralgia: angiographic findings.

A common cause of trigeminal neuralgia (TN) is compression of the root of the fifth cranial nerve by a tortuous basilar artery or one of its branches. Microvascular decompression surgery has proved valuable in relieving the symptoms of these patients with nerve compression. We performed vertebral angiography on 22 patients with TN. The angiographic appearances were compared with the findings obtained from an anatomic study in which the positions of 20 trigeminal nerves in the skull were determined radiographically in 12 cadavers. By using this information, we were able to predict the presence of arterial-nerve compression in 20 of the 22 patients, and these positions were later confirmed at surgery. We describe the angiographic findings in patients with TN as well as the findings in a control group of 159 individuals with no history of TN. From these preliminary results, angiography appears to be valuable in the preoperative evaluation of patients with TN.

A spatial analysis of the blood-brain barrier damage in experimental allergic encephalomyelitis.

Experimental allergic encephalomyelitis was induced in young male Lewis rats. Following the development of neurological signs, the local distribution of perivascular inflammatory cellular infiltrates and the local blood-to-tissue transfer constants (K1) of alpha-aminoisobutyric acid (AIB) were determined, and these results were compared. Perivascular infiltrative lesions were generally found near areas of the CNS that normally lack an effective blood-brain barrier (BBB) such as the choroid plexus and the entry zones of the cranial and spinal nerve roots. This distribution pattern indicates that the entry of the causative agent into CNS tissue may be by way of the permeable microvessels of these structures. In tissue around inflamed veins, the mean transfer constant was slightly but significantly increased (2.8 +/- 1.5 microliter g-1 min-1) compared with uninvolved regions (0.9 +/- 0.2 microliter g-1 min-1) and similar areas in control animals (0.9 +/- 0.3 microliter g-1 min-1). Analysis of the autoradiographic method of determining transfer constants suggested that the AIB influx rate in the lesion areas may actually be manyfold larger than measured, that BBB permeability may be greatly increased at such sites, and that the areas of lymphocytic infiltration and increased K values may be virtually identical.

Deterioration of auditory evoked potentials during cerebellopontine angle manipulations. An interpretation based on an experimental model in dogs.

Evoked action potentials from the internal auditory meatus portion of the cochlear nerve (IAM-EAP's) and brain-stem auditory evoked potentials (BAEP's) from the vertex were simultaneously recorded during cerebellopontine angle (CPA) manipulations (retractions of the cerebellar hemisphere and the cochlear nerve) in dogs. The BAEP changes noted in these dogs were the same as those seen in patients. The IAM-EAP's showed graded deterioration related to BAEP changes. The results are as follows: Prolongation of the I-V interpeak latency of BAEP's, the most common finding during CPA manipulations, is the reflection of prolongation of the I-II interpeak latency, which is caused by conduction impairment or block of the nerve impulses between the extracranial portion of the cochlear nerve and the brain stem. The operative manipulations representing stretch or compression injury to the cochlear nerve in the CPA leads to an acute traumatic cranial nerve root lesion--a retrocochlear lesion. The obliteration of all BAEP components including wave I cannot be caused by conduction block. This is caused by occlusion of the internal auditory artery. Wave I of the BAEP's and the P1-N1 complex of the IAM-EAP's are important indicators of cochlear blood flow during surgical intervention. As possible causes of internal auditory artery obstruction, mechanical distortion of the relationship between the anterior inferior cerebellar artery (AICA) and the internal auditory artery at the junctional portion, mechanical vasospasm of the AICA-internal auditory artery complex, and ensuing no-reflow phenomena are discussed. Evoked action potentials are expected to be a useful intraoperative real-time monitor during CPA surgery that can detect rapid changes derived from cochlear artery insufficency. The real-time aspects can overcome some of the disadvantages of BAEP monitoring.

Respiratory bursts at the midline of the rostral medulla of the lamprey.

The contribution of a rostral crossed pathway to the coordination of fictive breathing was tested in isolated brains of adult lampreys, Ichthyomyzon unicuspis. Periodic bursts of small spikes were recorded at the midline at the rostral level of the V motor nuclei. These occurred prior to bursts by respiratory motoneurons in the IX-X cranial nerve roots. The bursts at the midline could be generated in the rostral half of the medulla, since they continued after isolation of the isthmic-trigeminal region by transections. Stimulation at the rostral midline excited respiratory motoneurons monosynaptically and could entrain or reset the respiratory rhythm. Sections of the midline sparing the rostral site still permitted bilateral synchronization of respiratory bursts. Alternatively, sections of the rostral midline still allowed coordination of respiratory bursts through crossed caudal pathways, although abnormal timing patterns were observed. It is concluded that the motor pattern for respiration is partly generated and coordinated in the rostral half of the medulla of the lamprey and is transmitted to respiratory motoneurons through descending pathways.