- Univ Clermont 1, UFR Médecine, EA 7282, Image-Guided Clinical Neuroscience and Connectomics, Clermont-Ferrand, F-63001, France
- Service de Neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63003, France
- Service d’Ophtalmologie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63003, France
- Service de Nutrition, CHU Clermont-Ferrand, Clermont-Ferrand, F-63003, France
- Service de Neurochirurgie, CHU de Nice, Nice, F-06200, France
- Service de Pédiatrie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63003, France
- Unité de Neuroradiologie, CHU Clermont-Ferrand, Clermont-Ferrand, F-63003, France
- Department of Neurosurgery, University of California, Los Angeles, USA
Department of Neurosurgery, University of California, Los Angeles, USA
DOI:10.4103/2152-7806.110667Copyright: © 2013 Lemaire J This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Lemaire J, Nezzar H, Sakka L, Boirie Y, Fontaine D, Aurélien Coste, Coll G, Sontheimer A, Sarret C, Gabrillargues J, Salles AD. Maps of the adult human hypothalamus. Surg Neurol Int 17-Apr-2013;4:
How to cite this URL: Lemaire J, Nezzar H, Sakka L, Boirie Y, Fontaine D, Aurélien Coste, Coll G, Sontheimer A, Sarret C, Gabrillargues J, Salles AD. Maps of the adult human hypothalamus. Surg Neurol Int 17-Apr-2013;4:. Available from: http://sni.wpengine.com/surgicalint_articles/maps-of-the-adult-human-hypothalamus/
The human hypothalamus is a small deeply located region placed at the crossroad of neurovegetative, neuroendocrine, limbic, and optic systems. Although deep brain stimulation techniques have proven that it could be feasible to modulate these systems, targeting the hypothalamus and in particular specific nuclei and white bundles, is still challenging. Our goal was to make a synthesis of relevant topographical data of the human hypothalamus, under the form of magnetic resonance imaging maps useful for mastering its elaborated structure as well as its neighborhood. As from 1.5 Tesla, Inversion-Recovery sequence allows locating the hypothalamus and most of its components. Spotting hypothalamic compartments is possible according to specific landmarks: the anterior commissure, the mammillary bodies, the preoptic recess, the infundibular recess, the crest between the preoptic and the infundibular recesses, the optical tract, the fornix, and the mammillo-thalamic bundle. The identification of hypothalamus and most of its components could be useful to allow the quantification of local pathological processes and to target specific circuitry to alleviate severe symptoms, using physical or biological agents.
Keywords: Brain mapping, hypothalamus, inversion-recovery sequence, magnetic resonance imaging, stereotaxy
The hypothalamus is a small and heterogeneous region of the prosencephalon. It is situated in a strategic position at the crossroad of four systems, neurovegetative, neuroendocrine, limbic, and optic. Its numerous functional facets, from behavior to chronobiology, make the hypothalamus likely one of the most challenging region of the human brain. From a clinical perspective, several reports have proven that hypothalamus neuromodulation is possible;[
The hypothalamus is a double diencephalic structure located within the right and left walls and the floor of the third ventricle. The pituitary stalk is developed from the infundibular recess to the hypophysis or pituitary gland. The hypothalamus is placed obliquely in front and below the thalamus, limited posteriorly by the subthalamus and the anterior upper brain stem [
3D reconstruction of the adult human hypothalamus displayed on three orthogonal (a. Frontal view; b. Left lateral view; c. Inferior view) T1-weighted MRI slices crossing the mammillary bodies (light blue): hypothalamus (green plus light blue), anterior white commissure (purple), thalamus (brown), pallidum (purple), third ventricle (yellow; the brain aqueduct and the ventricular foramen are also reconstructed), and optical system (dark blue)
Internal organization of hypothalamus
The adult's hypothalamus has a volume of approximately 0.7 cm3 in each side, as measured on MRI.[
The visualization of all hypothalamic nuclei and white matter tracts is not feasible with current clinical imaging; however, several pertinent landmarks are identifiable with 1.5 Tesla using appropriate sequences.[
MRI coronal slices (white matter attenuated inversion recovery sequence; joined slices, matri × 0.56 × 0.56 mm, 2-mm thickness) from posterior (a) to anterior (g): third ventricle (1), mammillary body (2), fornix (3), thalamus (4), mammillo-thalamic bundle or Vicq d’Azyr fascicle (5), nucleus entopedoncularis or nucleus of ansa lenticularis (6), zona incerta (7), optical tract (8), pallidum (9), hypothalamus (10), anterior white commissure (11), optic chiasma (12), internal capsule posterior limb (13), internal capsule anterior limb (14)
The complex organization of hypothalamic nuclei makes it difficult to visualize details of location and shape of the nuclear heaps. However, it can be made simpler using semi-realistic drawing[
(a) Schematic drawing of hypothalamic nuclei, lateral view from the midline; left, nuclei directly located under the wall of the third ventricle; right, more deeply located nuclei up to the lateral region. (b) 3D overview of hypothalamic nuclei, constructed from a 3D high-field MRI data set; left, frontal view; intermediate, lateral view; right, medial view; the ventral tegmental area (VTA) is located within the retro hypothalamic region. Anterior commissure, Ac; dorsal or posterior nucleus, D; dorsomedial nucleus, Dm; fornix, Fx; fornix nuclei F; infundibular (arcuate) nucleus, If; lateral nucleus, L; mammillary body, Mb; mammillo - thalamic bundle, Mtb; optic chiasma, Cx; paraventricular nucleus, Pv; preoptic nuclei, Pr; suprachiasmatic (ovoid) nucleus, Sc; ventricular foramen, Vf; supraoptic (tangential) nucleus, So; tuberomamillaris (mamilloinfundibularis) nucleus, Tm; ventromedial (tuber principal) nucleus, Vm
Most hypothalamic nuclei are well described, however, there are still ambiguous definitions revealing the incomplete understanding of each nucleus in humans.[
The anatomic relationships are numerous and can be regrouped according to three main structures of each hemisphere, the subcallosal area of the limbic lobe[
Overview of structures neighboring the hypothalamus (Hyp), 3D reconstruction from a high - field MRI data set merged with schematic drawing; left, frontal view; right, superior view: amygdala, Am; ansa lenticularis nucleus, Nal; basal forebrain bundle, Bfb (and *); diagonal band of Broca, Bd; epithalamus, Ep; fornix, Fx; globus pallidum intern, GPi; mammillo-thalamic bundle, Mtb; red nucleus, RN; septum, Se; stria medullaris, Sm; stria terminalis, St; sublenticular radiations, SLr; substantia innominata (of Reichert), Sir; translenticular radiations, TLr; supraoptic commissure, Soc; thalamus, Tha
MRI spotting of the hypothalamus
The location of human hypothalamus and hypothalamic nuclei have been studied;[
MRI landmarks and line used to spot hypothalamic compartments and nuclei (projection on 3D reconstruction from a high-field MRI data set; lateral view. (a) The hypothalamus is lined posteriorly by the vertical line (Post) placed behind the mammillary body and perpendicular to an anterior commissure posterior commissure (ACPC) segment. The anterior line (Ant) rises from the preoptic recess (Por), perpendicular to ACPC. Two intermediate lines, anterior (IntAnt) and posterior (IntPost), respectively, goes from the dorsal region of the optic chiasma (Cx) to the anterior point of the intermediate third of the ACPC line and from the crest (c) placed between the optical recess and the infundibular recess (Ir), to the posterior point of the intermediate third of the ACPC line. The anterior horizontal line (LineP; doted black line) goes parallel to ACPC (toward the posterior point at the origin of Post). The intermediate horizontal line (LineP2) is parallel to ACPC and origins at the midpoint of the segment of IntAnt between the point where IntAnt crosses LineP and the point where IntAnt crosses ACPC. The ventral line (Vent) goes from C to the intersection of LineP2 and IntPost. (b) The fornix limits the medial border of the lateral nucleus (l), which is visible in the background; the mammillo-thalamic bundle (Mtb) is displayed. (c) The area limited by the LineP2, LineP and IntAnt and IntPost projects on the lateral nucleus
MRI landmarks and lines used to spot hypothalamic compartments and nuclei (projection on 3D reconstruction from a high-field MRI data set. From A to F: left, frontal view; intermediate, sagittal slice, right, coronal slice; gray dotted lines show section plans. (a) Preoptic nuclei (Pr) and supraoptic plus suprachiasmatic nuclei (Soc). (b) Dorsomedial nucleus (Dm) lined laterally by the fornix. (c) Ventromedial nucleus (Vm) lined laterally by the tuberomamillaris nucleus (Tm). (d) Tuberomamillaris nucleus (Tm); placed below the fornix extending laterally to the optical tract (Ot). (e) Lateral nucleus (l), lined medially by the fornix; the inferior region overlaps with the tuberomamillaris nucleus. (f) Dorsal nucleus (d), placed behind the fornix (not visible here) and lined posteriorly by the mammillo-thalamic bundle (Mtb)
The anatomo-functional architecture of the hypothalamus is well-established;[
Visual system and hypothalamus
The retino-hypothalamus tract (RHT) is the main connection between the eye and the hypothalamus, a direct afferent pathway from the retina, going through the optic chiasma. In mammalians, axons of photosensitive retinal ganglion cells, expressing melanopsin, project to the suprachiasmatic nucleus.[
Limbic system and hypothalamus
Two groups of hypothalamic nuclei are directly involved in the limbic circuitry, the preoptic and the mammillary. Broadly the preoptic connects the frontal lobe, the thalamo-tegmental region, the septum, the lenticular nucleus, the substantia innominata of Reichert, and the anterior perforate; mainly through the basal forebrain bundle, the ansa lenticularis, and the radiate system; the medial nucleus of the preoptic nucleus being in continuity with the nucleus of the stria terminalis.[
From a white matter tract point of view, the stria medullaris of the thalamus connects the epithalamus or habenula, with the preoptic and septal regions, and also possibly with the nucleus of Meynert.[
Appetite control and hypothalamus
The hypothalamus is a major integrator of hormonal and nutrient-induced signals of hunger and satiety with the aim of regulating energy stores and food intakes. The central role of the hypothalamus in the control of feeding has emerged in the past century from lesioning studies. Indeed, various lesions of the ventromedial hypothalamus were shown to cause hyperphagia and obesity[
Mechanisms of appetite control became a public health focus because of its numerous clinical implications of obesity, currently reaching world epidemic levels.[
The neurobehavioral aspects of obesity are complex and poorly understood, food sensing and craving are currently major areas of research. The neurologic component of food regulation is centered on the hypothalamus.[
Involved on human neurological function such as memory, neurovegetative, neuroendocrine, behavior, and chronobiological rhythms, the human hypothalamus emerges as the next challenging human structure to understand and modulate in the next decades. The advances of functional and anatomical images, including positron emission tomography, high tesla MRI and the modern computational ability to integrate these images to enhance our understanding of functional localization in the hypothalamus, likely will open up a new therapeutic frontier based on physical and biological agents to treat ailments yet not reached by our modern medicine.
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