PAC 505L Foundations of Clinical Medicine

Laboratory Dissection Guide

This dissection guide is available as a PDF on Canvas and as a hard copy at each dissection table. This
guide is intended to serve as an outline of the dissection goals and expectations for each laboratory
session.

DISCLAIMER
While this dissection guide is comprehensive, it should not be misconstrued as being all encompassing.
Your faculty reserve the right to test you on content that may not be explicitly presented in this guide.

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 Laboratory Dissection Outline

Lab 1 Extrinsic and Intrinsic Musculature of the Back

Lab 2 Laminectomy and Spinal Cord
Lab 3 Craniotomy and Cranial Nerves

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 LAB #1 –EXTRINSIC & INTRINSIC MUSCULATURE OF THE BACK
(Grant’s Dissector [17th Ed.] pp. 1-6; 7-20)

TODAY’S GOALS:
1. Familiarize oneself with the donors, the lab environment, and safety procedures/protocols.
2. Learn to hold a scalpel and apply scissor technique.
3. Reflect the skin and superficial fascia of the back.
4. Identify the superficial and intermediate extrinsic back muscles in situ.
5. Review the attachments, actions, innervations, and blood supply of the trapezius, latissimus dorsi, levator
scapulae, rhomboid minor and rhomboid major.
6. Identify the spinal accessory nerve (CN XI), superficial branch of the transverse cervical artery, and dorsal
scapular artery and nerve.
7. Identify the superficial, intermediate, and deep layers of the intrinsic back muscles (excluding the suboccipital
muscles) and describe their primary attachments, actions, and innervation.

DISSECTION NOTES:
 Ensure that the cadaver is in the prone (face down) position. Make
the skin incisions (on both sides) shown in Figure 1, starting with a
midline incision that extends from the external occipital
protuberance (EOP) on the skull down to the sacrum. Then, make a
series of horizontal incisions extending laterally from the midline
incision (review these bony landmarks on a skeleton if unfamiliar):
– From the EOP to the mastoid process of the skull (2);
– From near the superior angle of the scapula to the acromion
(tip of the shoulder; 3);
– From the inferior angle of the scapula toward the mid-
axillary line (4);
– From the sacrum extending along the arc of the iliac crest
(hip bone; 5)
 Make sure that your initial cuts do not go too deep. You can always
make them deeper on a second pass through.
 Clean and remove the skin and fat. It’s easiest to start this process
by peeling up the skin from a ‘corner’ and using forceps or a “finger Figure 1.
hole” (see Figure 2) to begin to reflect the skin. Try to find the plane
of section between the loose connective tissue (fat) and the deep fascia covering the muscles (Figure 3). If you
are reflecting red muscle fibers, you’re too deep. Take your time today and please ask for help if you need it!

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Figure 2. Figure 3.
Superficial Extrinsic Back Muscles (p. 14-17)
There are five pairs of superficial extrinsic back muscles. These muscles are extrinsic shoulder muscles that serve to
attach the upper limb to the axial skeleton and act on the upper extremity.

As you find each of the following muscles, take the time to review their attachments, actions, and neurovascular
supply. Non-dissecting group members, take control here; quiz your group mates as they are dissecting! This
information is best appreciated as you find the muscles and their structures on the donors.

1. Trapezius:
 Attachments: External occipital protuberance;
superior nuchal line; spinous processes of C7-T12
vertebrae; nuchal ligament; lateral 1/3 of the
clavicle; acromion; spine of the scapula
 Actions: Rotate, elevate, adduct, and depress
(READ) the scapula; tilt the head
 Supply: Spinal accessory n. (CN XI) and superficial
branch of transverse cervical a.
 Dissection instructions: On both sides, detach this
muscle from its attachment to the spinous
processes, nuchal ligament, external occipital
protuberance, scapular spine and acromion using
scissors, beginning inferiorly and proceeding
towards the head (see the dotted lines on the left
side of Figure 4). Cut as close to the spinous
processes as you can, but leave the muscle
attached to the clavicle. You have properly
reflected the muscle when you can take the lowest
point of the muscle and flip it up alongside the
head (bringing the lowest point of the muscle up
Figure 4.
towards the ear). Once reflected, explore the
underside of this muscle to identify the spinal
accessory n. (CN XI) and superficial branch of the
transverse cervical a. that supply it. The nerve and artery are coursing together on the deep surface of the
muscle. Practice using the scissor technique (Page 2 in the Dissector) to separate these neurovascular
structures! Take care not to cut them!

2. Latissimus dorsi:
 Attachments: Spinous processes of T7-T12; posterior sacrum; thoracolumbar fascia; iliac crest; inferior 3-4 ribs;
floor of the bicipital groove of the humerus
 Actions: Extend, adduct, and medially rotate the arm (John Travolta!)
 Supply: Thoracodorsal (middle subscapular) nerve and thoracodorsal a.
 Dissection instructions: Insert your fingers under the superior border of the muscle and loosen the plane of
loose CT that lies between the underside of the latissimus dorsi and the underlying deep back muscles (i.e.,
erector spinae). Using scissors, cut the medial portion of latissimus dorsi from its attachments to the
thoracolumbar fascia and spinous processes (see the dotted lines on the right side of Figure 4). Doing so will
allow you to reflect the muscle laterally (i.e., grab the medial portion you just cut and flip it over to the side
laterally). Do not disturb its attachments to ribs 8-12 or the inferior scapula (if it’s attached there). The

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 thoracodorsal (middle subscapular) nerve and thoracodorsal a. will be studied during a later dissection, so
don’t try to locate these now.

Deep to the trapezius, identify the remaining 3 muscles in

the superficial group (Figure 5). The dissection instructions
for these three muscles will be presented as a group after
listing their characteristics.

3. Levator scapulae:
 Attachments: Transverse processes of C1-C4; superior
angle of the scapula
 Actions: Elevate the scapulae
 Supply: Dorsal scapular n. and dorsal scapular a.

4. Rhomboid minor:
 Attachments: Spinous processes of C7-T1; medial
(vertebral) border of the scapula at the level of the Figure 5.
scapular spine
Notice that rhomboid minor is above
 Actions: Adduct (retract) the scapulae
rhomboid major; this is an anatomical ‘trend’!
 Supply: Dorsal scapular n. and dorsal scapular a.

5. Rhomboid major:
 Attachments: Spinous processes of T2-T5; medial (vertebral) border of the scapula below the level of the
scapular spine
 Actions: Adduct (retract) the scapulae
 Supply: Dorsal scapular n. and dorsal scapular a.

Dissection instructions: Identify the levator scapulae in situ; do not remove either of its attachments. On both sides,
detach the rhomboids from their midline attachments using scissors and reflect them laterally. Oftentimes, these two
muscles are fused, appearing as a single muscle. Use the attachment points of the rhomboid muscles as your guide to
distinguish between the two muscles. Once reflected, examine and explore the deep surface of these muscles near their
attachment to the vertebral border of the scapula to find the dorsal scapular artery and nerve (see Figure 6).
Oftentimes you can see their faint outline running along the vertebral border of the scapula just deep to the fascia.

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Figure 6.
Intermediate Extrinsic Back Muscles (p. 17-18)

These muscles are thought to minimally participate in respiration

(accessory muscles of respiration) or serve a proprioceptive function
(more likely). They’re not that important comparatively, but you’ll likely
see them as you’re dissecting. They tend to be a little shiny or iridescent
and are very thin. They’re shown in Figure 7.
1. Serratus posterior superior (may get reflected with the
rhomboids)
2. Serratus posterior inferior (this one often gets reflected with
latissimus dorsi – you can look for it on the underside of the
muscle if you don’t immediately see it).

Intrinsic Back Muscles (p. 18-19)

Whereas the extrinsic group of back muscles acts on the upper

extremity, the intrinsic group of back muscles (also called the
paraspinous muscles) act on the vertebral column and are considered Figure 7.
‘deep’ back muscles! These ‘anti-gravity’ muscles are important in
maintaining posture in the standing position and controlling the movements of the spinal column. There are three
groups of intrinsic back muscles and all are innervated segmentally by dorsal primary rami (DPR).

1. Superficial group of intrinsic back muscles: This group

contains two muscles that we’re interested in seeing today.
These are splenius capitis (the portion of the muscle
associated with the head) and splenius cervicis (the portion
of the muscle associated with the neck; this is really a single
muscle; it’s just divided by region/attachment). These
muscles have fibers that course obliquely from the spine out
towards the head (see Figure 8). The muscles bilaterally
extend the head and neck, as well as laterally flex the neck
and rotate the head towards the same side when unilaterally
contracted. (Can you perform these actions?).
 Dissection instructions: Remove their attachments from
the spinous processes and reflect them superolaterally
(up towards the ear). Leave their superior attachments
undisturbed.
Figure 8.
2. Intermediate group of intrinsic back muscles: The middle
group of intrinsic back muscles is composed of three individual muscles that are arranged in vertical columns
(Figure 9) that run parallel to the spinal cord; collectively, we refer to them as erector spinae. The innermost
muscle closest to the spinous processes is a skinny muscle called spinalis. Moving laterally, you’ll encounter the
incredibly thick longissimus. The most lateral of the three muscles is called iliocostalis because it spans
obliquely from the ilium to the ribs, or costals. This group acts to extend the vertebral column (and head) when
contracting bilaterally, or to bend the vertebral column laterally when just one side contracts (i.e., ipsilateral
flexion).
 Dissection instructions: Separate the muscles from each other with your fingers. Try to make it obvious that
they are three separate muscles.
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 3. Deep group of intrinsic back muscles: This group consists of the
transversospinalis group and the suboccipital muscles. The
transversospinalis group of muscles lies in the transversospinal
groove, or the ‘paraspinal gutter’ in between the spinous processes
and the transverse processes of the vertebrae. It contains several
muscles, but we’re only interested in one: semispinalis (Figure 9).
This deep muscle is located inferior and medial to splenius capitis
(and inferior to longissimus) and has fibers that course in a straight
fashion, from inferior to superior, like a semi-truck! It has a capitis
and cervicis portion, too; the muscles you will see in lab are likely
semispinalis capitis. Semispinalis helps splenius (and erector spinae)
to extend the neck and upper spine when contracting bilaterally and
rotates the head towards the opposite side unilaterally (i.e., if the
muscle on the right contracts, the head goes left).
 Dissection instructions: Please only observe this muscle; there is
no need to reflect it during today’s lab. You do not need to
dissect the muscles of the suboccipital group, either, but you are
responsible for knowing their characteristics, innervation, and Figure 9.
functions; as well as their relation to the suboccipital triangle and
its contents.

REVIEW QUESTIONS: Try to answer these questions before you leave for the day!
 How are the extrinsic back muscles organized and what are their general functions?
 What are accessory muscles of respiration? When would you expect these muscles to contract?
 If I wanted to test the integrity of a patient’s CN XI, what movement might I ask them to perform? (Think about
the action(s) of this muscle).
 A 38-year-old woman with a long history of shoulder pain is admitted to a hospital for surgery. During the
surgery, her dorsal scapular artery is ligated. The ligation could produce ischemia in which of the muscles we
discussed today?

PEER TEACHING GUIDE: Please use the following outline/questions to guide your peer teaching session.
 Provide a description of the incisions made to create several skin flaps on the back. Any dissecting tips or advice
to share with your group mates? How do you locate the best plane for removing the skin and superficial fascia?
 Demonstrate where the superficial extrinsic back muscles are in situ after removing the skin flaps. How many
superficial extrinsic back muscles are there? Do these muscles move the back? Or do they produce movements
elsewhere?
 How were you able to reflect the trapezius and latissimus dorsi muscles? Could you see the rhomboids and
levator scapulae before you reflected these structures?
 What are the principal actions of the superficial extrinsic back muscles? Where do they attach?
 What is the neurovascular supply for the superficial extrinsic back muscles? Where do you find these structures?
 What are the intermediate extrinsic back muscles? Where are they located? What do they do?
 Demonstrate the location of the intrinsic back muscles in situ. What are some of the key functions of our
intrinsic back musculature? How does this compare to the functions of the extrinsic back musculature?
 Review the innervation of the deep back muscles. What does it mean for something to be innervated
“segmentally”? (It’s okay if we haven’t discussed this; try to think about it critically).

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 LAB #2 – LAMINECTOMY AND SPINAL CORD
(Grant’s Dissector [17th Ed.] pp. 23-27)

TODAY’S GOALS:
1. Review the bony landmarks discussed in lecture, paying particular attention to the osteology relevant to a
laminectomy. [Study these bony landmarks using models or real bones.]
2. Review the ligaments of the vertebral column (i.e., ligamentum flava, interspinous ligament, and supraspinous
ligament), their locations, and their functions. [Can you recognize them on a model? On a donor?]
3. Open the vertebral canal and dissect the meningeal coverings to expose the spinal cord.
4. Locate the three meningeal layers, their spaces, and the structures of the spinal cord.

DISSECTION NOTES:
 A laminectomy is a removal of the laminae of the vertebrae. Today’s work will allow us to peer into the vertebral
canal, explore the meningeal layers, and discover the spinal cord nestled snuggly within.
 We will be using a rubber mallet and chisel to remove the laminae. Ensure your eye protection is secure and
understand that cut/broken bone is incredibly sharp. Do not attempt to remove bony fragments with your
fingers.

Laminectomy, Spinal Cord, and Meningeal Coverings (p. 24-27)

 Before we begin this process, take a few minutes to review the osteology of the spine relevant to a laminectomy
(i.e., the spinous processes, transverse processes, and vertebral arch; Figure 1). Look at isolated vertebrae from
the cervical, thoracic, and lumbar regions. Ensure that you can identify the level based on its characteristic
features.

Figure 1.

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 To cut the laminae, we must remove any musculature lying
between the spinous processes and the transverse processes
(i.e., the paraspinal gutter or the transversospinal groove);
this includes the deep semispinalis muscle and the overlying
erector spinae group.

Dissection instructions:
 Locate the inferior angle of the scapula. Using your finger,
draw an imaginary line inward to locate the T7 spinous
process (you may need to retract the scapula to find the
right level). Make a scalpel cut across the T7 spinous
process.
 Locate the top of the iliac crest. Using your finger, draw an
imaginary line inward to locate the L4 spinous process. Make
a scalpel cut across the L4 spinous process.
 Locate the transverse processes of the T7 and L4 vertebrae
(come about two fingers lateral to the spinous processes on Figure 2.
each side and feel for the bony protrusion). Use the scalpel to make a vertical cut from T7’s transverse
processes down to the transverse processes of L4. You should have defined a large rectangular area with your
scalpel cuts.
 Use the edge of a chisel to “scoop” away musculature lying in the transversospinal groove between those
vertebral levels (see Figure 2). You should be able to pull most muscle aside laterally (by gently stretching and
tugging); some you may need to cut and remove. Place any removed tissue into your tissue bin.
 When the muscle has been cleared, use a chisel and a rubber mallet to make a series of cuts through the
laminae bilaterally. Your chisel should be held at ~45° angle (this is important). Use the hammer to pound the
chisel into the laminae. When you have gone through the depth of the lamina, you will feel a ‘give’. Remove the
chisel once you reach this depth and progress to another lamina until all laminae have been breached between
T7 and L4. Finally, make transverse cuts with the chisel at the T7 and L4 levels.
 With care, you should be able to remove the dorsal portion of the vertebral arch between these levels as a
single piece. DO NOT USE YOUR FINGERS TO REMOVE THE CUT BONE – IT IS INCREDIBLY SHARP.

Identification Instructions:
 On the undersurface (the vertebral canal side) of the “roof” of the bony segment you removed, observe the
yellow ligamentum flavum connecting adjacent laminae. Between the adjacent spinous processes, you should
be able to see the interspinous ligaments. The supraspinous ligament may be challenging to see, but it extends
between the tips of the spinous processes (see Figures 3 and 4).

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Figure 3. Figure 4.
 With the roof of the vertebral canal removed, observe the spinal cord with its meninges in situ. Think about the
contents of the vertebral canal. What should you expect to find? Review Figure 5 once you’ve discussed among
yourselves!

Figure 5.

Figure 6.

 Now you’re ready to identify the contents of the vertebral canal (Figures 5-7)! These should include the:
– Epidural space: This is the area directly surrounding the dura mater. What do you expect to see here?
– Dura mater: The “tough mother.” This is the outermost and densest of the three layers. Where does it
typically end in adults?
– Subdural space: This is a ‘potential’ space directly between the dura mater and the arachnoid mater.
What does it mean if there is fluid in this space?
– Arachnoid mater: This is the middle “spider” mother. It’s incredibly delicate and avascular. In living
individuals, it’s loosely adhered to the inner surface of the dura. Look for its ‘spider-web-like’ trabeculae
or projections connecting it to the pia mater!
– Subarachnoid space: This is the space just below the arachnoid mater. What is contained within this
space?
– Pia mater: The innermost, “gentle” mother. It’s intimately associated with the spinal cord; when you’re
touching the spinal cord, you’re touching the pia mater.
– Denticulate ligaments: These are little “teeth-like” extensions of pia mater along the lateral margins of
the spinal cord. What do they do? Look for them to pass between the dorsal and ventral rootlets.
– Ventral and dorsal rootlets: These are the immediate lateral extensions of the dorsal and ventral horns!
They consist of bundles of axons that will come together to form larger dorsal and ventral roots. What
fiber types are carried by dorsal roots? Ventral roots?
– Dorsal root ganglion (DRG): This contains the cell bodies for afferent (sensory) neurons in a given
dermatomal level. Look for this as a large swelling in an intervertebral (IV) foramen.
– Conus medullaris: This is the ‘conical’ tapered end of the spinal cord that ends at the L1-L2 vertebral
level in adults. Where does it end in neonates? Where does it end in embryos?

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 – Cauda equina: The “horse’s tail” is a collection of ventral and dorsal root from the lumbar, sacral, and
coccygeal regions of the spinal cord that emerge close to the conus medullaris. Why does this collection
of roots exist as a large grouping?
– Filum terminale: This is another extension of the pia mater. The intradural portion [filum terminale
internum] extends to the S2 vertebral level, and the extradural portion [filum terminale externum]
attaches to the coccyx. Are these two separate structures? What is its/their function?

Figure 7.

REVIEW QUESTIONS: Try to answer these questions before you leave for the day!
 What structures make up the vertebral arch?
 Why does the spinal cord end at different vertebral levels throughout development?
 What are the three meningeal spaces? Which are ‘real’ and which are only ‘potential’ spaces? What’s the
difference?
 What’s the clinical significance of the vertebral venous plexus?
 How is blood supplied to the spinal cord?
 What is a lumbar puncture? Why is it performed? How is it possible that the needle does not damage the
lumbar, sacral, and coccygeal nerve roots floating within the dural sac?
 Would a lesion of a ventral root result in a motor or sensory deficit? What about a ventral ramus?
 Which vertebral ligaments do you expect to be damaged with extreme hyperextension? Why?

PEER TEACHING GUIDE: Please use the following outline/questions to guide your peer teaching session.
 Give your table mates a vertebra and ask them to identify the level (i.e., cervical, thoracic, or lumbar) and any
pertinent bony features.
 Describe the steps you took to perform the laminectomy. Where did you make your cuts? What did you pull
aside or scrape away?
 Describe and demonstrate the contents of the vertebral canal, including the meningeal coverings, the meningeal
spaces, any ligaments you can see, and the key features of the spinal cord.
 Quiz your tablemates on the location of the cell bodies for afferent (sensory) and efferent (motor) neurons.

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 LAB #3 – Craniotomy and Cranial Nerves
(Grant’s Dissector [17th Ed.] pp. 289-291; 299-313)

TODAY’S GOALS:
1. Identify and reflect the layers of the scalp to reveal the calvaria.
2. Safely remove the calvaria using the autopsy saw, chisel/rubber mallet, and T tool.
3. Identify the cranial meninges and review their functions and extensions.
4. Remove the cerebrum, cerebellum, brainstem, and upper regions of the spinal cord from the skull and vertebral
column.
5. Identify the lobes, significant fissures, and sulci of the cerebrum, as well as the cerebellum.
6. Locate the twelve pairs of cranial nerves on the gross brain and where they exit/enter via the cranial fossae.
7. Review the names, numbers, functions, and general routes of the cranial nerves.
8. Identify the cranial fossae, their significant foramina, and the cranial nerves that course through each.

DISSECTION NOTES:
 Today’s focus is all about the brain, the spinal meninges, and the cranial nerves!
 The degree of preservation of the brain varies from donor to donor. Traditional embalming is done through the
femoral vessels in the anterior thigh. This route is excellent for embalming most of the body but has variable
results with the brain. Be mentally prepared for your donor’s brain to be anywhere on the spectrum from well-
preserved to a gelatinous substance.
 At all times throughout the lab today, ensure that your eye protection is firmly
intact. When the autopsy saw is on, NO ONE should be in the direct line of the
spinning blade, including the person wielding the saw. Prioritize your safety above
all else.

Scalp and Calvaria Removal (p. 289-291, p. 299-300)

 To visualize the brain, its coverings, and the cranial nerves, we will need to begin
with a craniotomy. The removal of the skull cap will require use of both the autopsy
(Stryker) saw and a rubber mallet/chisel set. As the autopsy saw is intended to cut
bone, we must first remove the scalp to expose the calvaria (i.e., skull cap).
 The human scalp consists of five layers and can be remembered with the acronym
“SCALP” (see Figure 1). From superficial to deep, these include S = skin; C = (dense)
connective tissue; A = aponeurosis (i.e., a broad, flat tendon); L = loose connective
Figure 1.
tissue; P = periosteum.

Dissection Instructions:
 Using a sharp scalpel, perform the cuts shown in Figure 2. This includes C (nasion or bridge of the nose) to A
(vertex, or the most superior aspect of the calvaria) and A to G (external occipital
protuberance); as well as A (vertex) to D (a spot one finger width anterior to the ear)
bilaterally. Push deeply with the scalpel until you reach the bone with each cut.
 Starting at the vertex (A), begin to reflect each of the four flaps inferiorly using
forceps/a hemostat and a scalpel. Reflect each section deeply (down to the bone),
pulling as far inferiorly as the level at which a hat would rest on one’s head (see Figure
2). The flaps may be cut off and discarded in the tissue bin. You do not need to leave
them as they’re shown in Figure 3.

Figure 2.
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 Continue using your instruments (including the broad end of a
chisel) to scrape the layers of the scalp (including the muscle)
from the calvaria. To achieve an optimal cut, the path of the saw
blade (see the black dotted lines in Figure 3) must be devoid of
tissue. When you can clearly trace a finger all the way around
the circumference of the skull and from ear to ear over the top
of the skull, you’re ready for the autopsy saw.
 Before proceeding, ensure that your eye protection is firmly in
place. The autopsy saw is an electric saw and must be used with
extreme caution. Designate one or more individuals from your
group to perform the saw cuts. Note that our goal here is not
for you to completely cut through the bone, but rather to cut Figure 3.
into the bone enough to “weaken” its integrity. We will finish
removing the skull cap by hand with the hammer and chisel. [Before you begin, note that the saw will get
progressively hotter (physically) the longer it’s used. If it becomes too hot to comfortably hold, give the saw a
few moments to cool down.]
 Using one hand to hold the saw around the handle and another to grasp the base (see
Figure 4), begin to make the cuts along the circumference of the skull according to
Figure 3. As you cut, BE CAREFUL to cut through only the outer lamina of the calvaria
- not completely through the bone. Sawing through the innermost layer of bone may
result in damage to the underlying dura mater surrounding the brain or the cerebrum
itself, so we want to avoid that if possible. If you feel the saw “push” through the
bone (and you’re no longer hitting bony resistance), you’ve gone too deep. Pull the
saw back a little to continue your cuts. You may need to flip the body from supine to
prone and back to facilitate the cuts appropriately. Ask for help as needed.
 After completing the circumferential cut, break the inner portion of the remaining
bone along your cut line by repeatedly inserting a chisel into the saw cut and hitting
the base of the chisel with a rubber mallet. If you’ve sawed deeply enough, it should
not take much force. Once the skull has been completely cut through, you be able to Figure 4.
slightly wiggle the skull cap away from the lower part of the skull. The skull cap won’t
pull off (please don’t try!), but it should wiggle a bit.
 When you have movement, locate the “T tool” (see Figure 5). This tool will be used to create a small amount of
movement and increase the space between the cut pieces of bone and the circumference of the skull. Insert the
sharp end of the tool (the lowest point of the T) into the saw cut at the point in the middle of the forehead and
twist. You will hear a distinct tearing sound – it may include cracking or sound like a foot being pulled out of
deep, deep mud. Be prepared as this may be unnerving! The sound represents the separating the outer layer of
the dura mater from the overlying bone. Repeat this T tool insertion and twisting around the circumference of
the skull.
 Return to the vertex and locate the two pieces that extend towards the forehead.
Using the T tool or a chisel, carefully insert the instrument between one of the two
quarters of skull and the dura mater near the vertex. Continue to elevate the anterior
skull half, using the chisel/tool to separate skull from dura, and reflect/pull the skull
cap carefully towards the forehead. DO NOT PULL – violent tearing may result in
damage to the dura and brain. Repeat this process with each of the four skull flaps.
When you’re ready to reflect the posterior portions, reflect them from the vertex
towards the posterior aspect of the skull. Remember that cut bone is sharp!

Figure 5.

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  When you’re finished, you should have four removed sections of
skull cap and a clear view of the dura mater surrounding the
brain! Take a moment to notice the grooves in the inner surface
of the skull cap – these are caused by the middle meningeal
artery. Damage to this artery may result in an epidural
hematoma! You may also see a few granular pits (granular
foveolae / arachnoid granulations) in the calvaria (see Figure 6).
These pits are due to the hypertrophy (increase in size) of small
structures called arachnoid villi that caused the bone to resorb
locally. The arachnoid villi return cerebral spinal fluid (CSF) to the
dural venous sinuses for ‘recycling.’

Cranial Meninges (p. 300-302)

 The cranial meninges consist of the same structures observed Figure 6.
surrounding the spinal cord, with one exception. The cranial dura
mater consists of two layers: a rough, dull external, periosteal layer (that adheres to the inner surface of the
skull) and a smooth, slick inner, meningeal layer (that faces other meninges and the brain itself). Think of these
‘layers’ as two sides of the same coin: the periosteal layer is like the head side on a penny while the meningeal
layer is like the tail side of a penny. They are entirely indistinguishable apart from where they separate to form
the falx cerebri and falx cerebelli and enclose the dural
venous sinuses. Observe the branches of the middle
meningeal artery that extend across the dura bilaterally.

Dissection Instructions:
 Once you’ve finished appreciating the middle meningeal
artery, begin to cut the dura mater around its
circumference using scissors according to the yellow
dotted lines shown in Figure 7. Begin your cuts anteriorly
and work posteriorly, stopping about an inch from the
midline bilaterally at the occipital pole.
 Carefully, use blunt dissection to gently retract the anterior
pole of the dura mater. Insert scissors between the
cerebral hemispheres to cut the falx cerebri where it Figure 7.
attaches to the crista galli of the ethmoid bone (see Figure
8). The falx cerebri is an extension of the meningeal layer of
dura mater, which descends between the cerebral
hemispheres along the midline to physically separate the right
and left cerebral hemispheres.
 Grasp the anterior pole of the dura and gently pull it
posteriorly, gradually working the falx cerebri free from
between the cerebral hemispheres as you progress. As you
move, note the small bridging veins that pass from superior
cerebral veins (which are inferior to the arachnoid mater and
therefore within the subarachnoid space!) on the brain’s
superior surface to drain superiorly into the superior sagittal
sinus along its lateral sides. You will need to cut some of these
Figure 8.

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 veins to completely retract the falx cerebri. Damage to these veins can result in a subdural hematoma!
 Once the dura mater is reflected posteriorly, identify the arachnoid mater covering the surface of the brain.
Look for the characteristic webbing!
 Using scissors, make a tiny incision through the arachnoid mater over the lateral surface of the brain. Observe
the pia mater lying below on the surface of the brain. Note that it follows the contours of the brain, passing into
all sulci and fissures; it cannot be removed from the brain’s surface, just as the spinal pia could not be removed
from the surface of the spinal cord!

Brain Removal (p. 303-304)

 It’s time to remove the brain! I recommend everyone crowd around the individual who will be doing the
cutting, as you’ll only get one view of it like this!
 Gently elevate the frontal lobes of the brain.
Then, use a probe to lift the olfactory bulbs
from the cribiform plate on both sides of the
crista galli. You may need to carefully trim the
small nerve fibers projecting from the bulb
inferiorly through the cribiform plate. As you
continue to elevate the anterior aspect of the
cerebral hemispheres, you are going to see
several structures pull taut. Many of these are
cranial nerves! Study Figure 8 as you go.
 Using a very sharp scalpel, carefully cut the
following structures bilaterally (in the middle
of their length) as you move posteriorly: optic
nerve, internal carotid artery, and
oculomotor nerve. Cut the stalk of the
pituitary gland in the midline where it rests in
the sella turcica.
 On the right side, gently lift the temporal lobe
(lateral brain) and identify the tentorium
cerebelli, a horizontal extension of meningeal
dura that separates the cerebrum (above)
from cerebellum (below; refer back to Figure Figure 8.
8). Use a scalpel to cut the anterolateral
aspects of the tentorium cerebellum as anteriorly as possible. Continue cutting as you move posteriorly,
following the curvature of the tentorium toward the occipital pole. Repeat this process on the left side.
 With the tentorium cerebelli cut, you should now have a clear view of the trochlear nerve, trigeminal nerve,
and abducens nerve. Cut these bilaterally in the middle of their length, so that we may be able to observe them
in the cranial fossae, too.
 Continue elevating the cerebrum and brainstem slightly to see the remainder of the cranial nerves: facial and
vestibulocochlear nerves near the internal acoustic meatus; glossopharyngeal, vagus, and accessory nerves
near the jugular foramen; and the hypoglossal nerves near the foramen magnum.
 Look into the foramen magnum and you’ll see the spinal cord, a few nerves, and the vertebral arteries where
they enter the skull. Extend a scalpel as far down as you can into the foramen magnum and then make a clean
cut through both the spinal cord and vertebral arteries in one pass. If done successfully, you should now be able
to lift the brain, cerebellum, brainstem, and upper region of the spinal cord out of the skull.

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  There is plenty to study here, including all the dural infoldings and dural venous sinuses, but they are not the
focus of the remainder of our lab. If you wish to identify them, please refer to the Dissector after you’ve
completed the remainder of the lab.

Gross Brain, Cranial Nerves, and Cranial Fossae (p. 306-313)

 The last task that remains for this lab is to identify the lobes,
fissures, and sulci of the brain; as well as identify the cranial
nerves on the gross brain and on the cranial fossae!
 On the outer surface of the cerebrum, identify the:
o Frontal lobe
o Parietal lobe
o Temporal lobe
o Occipital lobe
o Central sulcus separating frontal lobe from parietal lobe
Figure 9.
o Precentral gyrus, which is the ‘hill’ anterior to the central
sulcus; this is the primary motor cortex.
o Postcentral gyrus, which is the ‘hill’ posterior to the
central sulcus; this is the primary sensory cortex.
o Longitudinal fissure splitting the two cerebral
hemispheres
o Lateral sulcus separating the temporal lobe from
parietal lobe
o Transverse fissure, which separates the inferior aspect
of the cerebrum from the cerebellum
 On the inner surface of the cerebrum and brainstem (refer back
to Figure 8), identify:
o CNs I-XII [take time to identify them, note their number,
name and base functions]
o Regions of the brainstem, including the midbrain, pons, Figure 10.
and medulla oblongata
o Upper region of the spinal cord
 From a superior view, look down into the cranial vault (see Figure 10). Identify the Anterior, middle, and
posterior cranial fossae. Look again for the parts of the CNs that you can identify from this view.
o In the anterior cranial fossa, locate the cribiform plate (route for CN I filaments) and crista galli of the
ethmoid bone; as well as the roof of the orbital cavities on either side of the ethmoid bone.
o In the middle cranial fossa, locate the:
 Superior orbital fissure: Route for CNs III, IV, V1, and VI
 Optic canal: Route for CN II
 Foramen rotundum: Route for V2
 Foramen ovale: Route for V3
 Trigeminal ganglion (and the three divisions of CN V)
o In the posterior cranial fossa, locate the:
 Internal acoustic meatus: Route for CNs VII and VIII
 Jugular foramen: Route for CNs IX, X, and XI
 Foramen magnum: Route for part of CN XI, the vertebral arteries, and the spinal cord
 Hypoglossal canal: Route for CN XII

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REVIEW QUESTIONS: Try to answer these questions before you leave for the day!
 What layers comprise the scalp? Where are most of the blood vessels located?
 Damage to which vessel(s) may result in an epidural hematoma? Subdural hematoma?
 How do the cranial meninges differ from the spinal meninges? What structures are considered extensions of
cranial meninges?
 Which of the cranial nerves have a purely sensory function? Purely motor function? Mixed function?
 What are the names of each of the cranial nerves?
 Which cranial fossa contains the foramen ovale and the optic canal? Which contains the hypoglossal canal? The
cribiform plate?
 A tumor within the internal acoustic meatus has the potential to compress/damage which cranial nerve(s)?
 Which cranial nerves have a parasympathetic function?
 What are the names of V1, V2, and V3?
 Why are the precentral and postcentral gyri of particular importance? What roles do they play?

PEER TEACHING GUIDE: Please use the following outline/questions to guide your peer teaching session.
 Review the process used to reflect the layers of the scalp and quiz your table mates on the names of the five
layers.
 Demonstrate the three layers of cranial meninges and quiz your table mates on the spaces impacted by epidural
and subdural hematomas. Point out the falx cerebri and the tentorium cerebelli, as well as a dural venous sinus.
 Demonstrate the lobes of the brain, as well as its pertinent sulci and gyri; the cerebellum; the regions of the
brainstem, and the territories of the cranial fossae.
 Demonstrate the cranial nerves in situ as they leave/enter the floor of the cranial fossae. Quiz your table mates
on the names, numbers, and functions of each nerve.
 Demonstrate the location of the cranial nerves on the inferior surface of the cerebrum and brainstem.

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