Perspectives on neuroanatomy

Neuroanatomy is a complex subject. The wealth of anatomical detail discovered and described over the past century is staggering. With the constant introduction of powerful new neuroanatomical techniques, more details are arriving at an increasing rate, and there seems to be no end in sight.

Fortunately, it is possible to acquire a rather simple (or simplified at least) anatomical framework for understanding the organization of the human brain, which is the foundation for understanding neurological functions and dysfunctions in clinical practice. Indeed, the neuroanatomical detail required for competent practice forms a very limited subset of the total information available. It is important not to lose sight of this reality as your knowledge grows and your understanding of the "Normal Body" matures. You will be challenged to build upon this simple neuroanatomical framework a more precise and accurate body of knowledge that will help you recognize various neurological impairments, injuries and diseases that afflict the nervous system. But first things first.

Very soon you will encounter—perhaps for the first time—the human brain. As we explore the basic parts of the mammalian brain and many particular features of the human brain, don't let the moment of excitement and wonder pass you by as you hold, closely inspect and take apart what is widely declared to be the pinnacle of vertebrate evolution! So let's get ready and organized to make the most of our learning experiences in the laboratory.

There are a few basic rules that you should follow in the laboratory when you examine human brains:

• Always come to the laboratory ready to discover, with a clear 'game plan' in mind for your learning activities
  (the Readiness Assessment process will keep you on track in this regard).


• Always wear gloves when handling human tissue in the laboratory.


• Laboratory coats and laboratory clothes are not required or necessary, but you may dress in laboratory attire if you wish; there is also a supply of disposable lab aprons for your use.


• Keep the brains in the dissecting pans provided for them and immerse them in water or cover them with moist paper towels when you are not examining them. It is very important that the brains do not dry out!


• As you hold brain specimens, always keep the specimens above a container (no dropped brains, please!).


• Should any tissue break off from the specimens, leave it in the dissecting pan so that it can be disposed of properly after the laboratory session.


• You should closely examine and inspect the specimens, but do not damage them! You should not dissect the brain as you would the rest of the cadaver unless explicitly guided to do so by a faculty member.

Experience encourages us to reinterate: please treat these specimens gently! Intact human brains are difficult to obtain, and with proper care, these specimens will be used for several years by various groups of learners in the broader brain science community here at Duke.

Lastly, you should recognize the incredible generosity of the individuals who donated their bodies (and brains) to biomedical research and the education of learners, such as yourselves. As you handle the brains in the lab, consider the courageous ambition of the donors and apply yourself to your learning accordingly. This will be one means of honoring the hopes and dreams of these anonymous (to us at least) individuals who exercised their final wish to advance human knowledge through their gift to you of discovery and learning.

How to use this Laboratory Guide

Following this brief Introduction, you will find five chapters that address the foundations of clinical neuroanatomy that you will experience in five lab sessions. These chapters address the superficial features of the human brain (Lab 1), the blood supply of the brain and spinal cord (Lab 2), the internal features of the forebrain (Lab 3), the superficial features of the brainstem and spinal cord, including the cranial nerves (Lab 4), and, finally, the internal features of the brainstem and spinal cord (Lab 5). In addition, there are Appendices that highlight the major somatic sensory and somatic motor pathways and provide an orientation to problem-solving in clinical neuroanatomy. Application of this Laboratory Guide to your studies of human neuroanatomy will provide the framework needed to understand neurological function and dysfunction, and to diagnose patients who are living with neurological injury, disorders and disease.

So how should you approach your studies with this Laboratory Guide in hand? Here are some tips:

1. Read the text and study the figures in advance. This seems obvious, especially in a team-based learning curriculum. However, we all know how much is asked of you and the temptation to find tasks to eschew is tangible. But please don't eschew the simple task of reading this Guide! We believe that the text provides a concise exposition of human neuroanatomy and that the illustrations and photographs are clear and accurate. It is well worth your valuable time to follow this basic plan.


2. Discuss and describe the structures identified in bold font. The neuroanatomical structures identified in bold are those that you should be able to describe and discuss upon completion of the corresponding laboratory session. The Readiness Assessments before each lab will be based on the corresponding chapter in this Guide, with most of the assessment items relating back to these bolded terms.


3. Do the Challenges. Throughout each chapter, you will find a set of activities in green boxes that we label "Challenges". These are written to provide you with active learning exercises that are designed to demonstrate or reinforce the neuroanatomy described in the corresponding section of the chapter. Some Challenges direct you to interact with brain specimens that are available in the laboratory; others may be done using Sylvius4 software in or outside of the laboratory setting (see below). If you follow the first tip, your time in the lab can then be well focused by doing the Challenges. As questions and new insights arise, let the active learning described in these green boxes be the launching pad for further application and discovery. To facilitate this process, have your printed copies of this Guide with you in the lab, and launch the PDF version on the computer workstations at your laboratory table.


4. Use Sylvius4 to extend the laboratory experience. Each of you is provided with a copy of neuroanatomical software, called Sylvius4—An Interactive Atlas and Visual Glossary of Human Neuroanatomy. This software provides the image library for many of the photographs and micrographs that are reproduced in this Guide. All of the neuroanatomy that is described in this Guide is featured in one way or another in Sylvius4. So the two resources should go hand-in-hand. Each chapter in the Guide contains Sylvius Self Study Exercises in blue boxes. These exercises extend the basic learning experience in the relevant section of the chapter, and provide step-by-step instructions for using the software. For help and tips using Sylvius4, see Appendix 4 of this website.

Given the pace and duration of the course, Brain & Behavior will come and go before you know it! We trust that these learning resources will serve you well now, and whenever a working knowledge of functional neuroanatomy is needed as you progress in your studies, scholarship and practice.