title: Perpetuation of errors in illustrations of cranial nerve anatomy.
abstract: For more than 230 years, anatomical illustrations have faithfully reproduced the German medical student Thomas Soemmerring's cranial nerve (CN) arrangement. Virtually all contemporary atlases show the abducens, facial, and vestibulocochlear nerves (CNs VI-VIII) all emerging from the pontomedullary groove, as originally depicted by Soemmerring in 1778. Direct observation at microsurgery of the cerebellopontine angle reveals that CN VII emerges caudal to the CN VIII root from the lower lateral pons rather than the pontomedullary groove. Additionally, the CN VI root lies in the pontomedullary groove caudal to both CN VII and VIII in the vast majority of cases. In this high-resolution 3D MRI study, the exit location of CN VI was caudal to the CN VII/VIII complex in 93% of the cases. Clearly, Soemmerring's rostrocaudal numbering system of CN VI-VII-VIII (abducens-facial-vestibulocochlear CNs) should instead be VIII-VII-VI (vestibulocochlear-facial-abducens CNs). While the inaccuracy of the CN numbering system is of note, what is remarkable is that generations of authors have almost universally chosen to perpetuate this ancient error. No doubt some did this through faithful copying of their predecessors. Others, it could be speculated, chose to depict the CN relationships incorrectly rather than run contrary to long-established dogma. This study is not advocating that a universally recognized numbering scheme be revised, as this would certainly create confusion. The authors do advocate that future depictions of the anatomical arrangements of the brainstem roots of CNs VI, VII, and VIII ought to reflect actual anatomy, rather than be contorted to conform with the classical CN numbering system.
authors: Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and.
authors: C
authors: C
authors: Eduardo Corrales
authors: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
authors: Albert
authors: A
authors: Mudry
authors: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
authors: Robert K
authors: RK
authors: Jackler
mesh_terms: D003391:Cranial Nerves / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D049669:History, 16th Century; D049670:History, 17th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D006801:Humans; D019300:Medical Errors; D008488:Medical Illustration / Q000266:history
keywords: CN = cranial nerve; FIESTA = fast imaging employing steady-state acquisition; abducens nerve; anatomy; cochlear nerve; cranial nerve; facial nerve; perpetuation; vestibulocochlear nerve