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OK. So hello everyone and welcome back to the New Anatomy Collaborative. I'm Mara, the chair of the Collaborative this year. And I'm delighted to present our talk for today, which is section two se session three of the series and now hand over to Dara who will present our speaker and our talk for today. Um Hi, everybody. Thank you for joining us this evening and I'm glad to and I'm glad to introduce Miss Sosa Kawari as who's gonna be leading our talk on the cerebellum. This is our seventh talk of the series er as Evident and as said by Paul, previously, our series is gonna be our medal this year. This where we can attract audiences from all around the world. And Miss, so, Miss, so Kawari, who's also who's a sur neurosurgical registrar at Queen Square um has agreed to kind of give this talk. So I'm just gonna hand over the stage to her to do that. Thanks again, Miss Kawari. Thank you everyone for having me. OK, let's do this. I'm gonna try and share a screen now. Hopefully you can see me now, see my screen. Yup. Yup. Amazing. OK. So let's go. Um We're gonna talk about the cerebellum today. Uh Again, as they've mentioned, I'm Sosia, I'm one of the registrars, one of the North London trainees. Um And yeah, so in terms of the Anz Rejector, what we've um been asked to cover is the anatomy. So we'll talk about briefly the anatomy of the cerebellum. Then we'll talk about how that anatomy relates to the function of the cerebellum, um, the vascular supply. So we'll talk about arterial and venous supply. We'll talk about some clinical situations because that's probably when it gets a bit more interesting and then how you can identify things on imaging, so brief touch on the anatomy. So I'm sure we all know this. But um the cerebellum also known as the little brain, although it's called little brain is actually has as many neurons as the whole cerebrum. And so, even though it is a lot smaller, it actually is densely packed, it's in the posterior cranial fossa. And that is important because it's a small area. It's a really, really small area. So when things go wrong, um it can cause a lot of problems very quickly, particularly because of what's in front of it, which is the brainstem, it's separated um from the main cerebrum by the tentorium. And that's a usual but very good pathway um for certain surgeries and things like that because you can track along it very, very easily. The cerebellum itself. It's divided into lobes So you have to imagine it almost rolled out. So if you imagine to unroll the cerebellum, which is kind of around in shape. If you unroll it, you have the anterior lobe at the top that's divided by the primary fissure, you have the posterior lobe and then right at the bottom at the bottom as you've unrolled, it is the flopping nodular though. Um And the main thing is posterial lobe is more motor coordination, but it has a bit more to do with um the hemispheres as well, which we'll talk about later. And the floccular nodular has more to do with the balance and the eye movement. So now looking at the cerebellum in the other way, so that's looking at it from the top, you've got two hemispheres and that's then divided by the vermis. So the vermis is that midline structure and then within each hemisphere that's divided into the intermediate zone. So that's the first part is the vermis and then more laterally to that, it's called the lateral zone. And the reason we differentiate that out is more because of the function of it. So, cerebellum of course, isn't just floating there doing its own thing. It's of course connected. So the connections is by the cerebellar peduncles. Now, there are three of those and they are important because they all do slightly different things. So you have the superior, middle and inferior, superior, one gives you output to the midbrain, middle gives you input from the pals and the lower one gives you input from the spinal cord and the rest of the brainstem. So that's the main division of the peduncles. And you can see that a lot more when you do both dissections of the cerebellum. Now, when we look at the anatomy of the cerebellum into a bit more detail, this is when it gets a bit more complicated. So they're further divided. So apart from the vermis and the hemispheres and whatever else, they're further divided into lobules, this is when it gets a bit tricky with the names. Um And there is a way of remembering it, which is at the bottom. Um But the main thing is that the divisions are in the vermis, but they carry on laterally to the horizontal areas too. So what that means is you've got the same divisions, slightly different names just to confuse us more. Um But it follows all the way out. So it's kind of having that same division all the way. So for example, if you look at the therms, so that's the top picture first division again, imagine it all rolled out because that's usually a lot easier to imagine. I've got the lingula then going further up, you've got the central lobule followed by the colon, et cetera, et cetera. You've got the primary fissure, which is one of the grooves that you can see and you have the horizontal fissure which again, is one of the main ones you can see. And of course, you've got some other ones as well, but the same lobules that you have in the therms, which again, that was a midline structure as you follow them out laterally, they have different names for the same area. So for example, if you look at pyramid, so even though it's called the pyramid in the vermis, when you follow it laterally, it's called the biventral lobule. So unfortunately, it doesn't have the same name, but it's similar divisions. Good. Now, let's get a little bit about the, the function and why that's important in the cerebellum. So the main easy way this is from um one of the radiologists who does very good tweets and about uh anatomy and radiology on Twitter. But um the main easy way of remembering it is if you look at the cerebellum, the most medial part of it is usually sensory and motor is followed after that. And then the later hemispheres, you're thinking more about cognitive function. So even though we think of the cerebellum as mainly, you know, the signs for Danish, um the cytokines, ataxia, whatever else, there is also cognitive function in the cerebellum. So it's important to remember that and when that becomes really important is actually as, as we've developed and um as evolution has gone by our cerebrum has gotten bigger and actually our lateral aspects of the cerebellum has gotten bigger as well. And that was the cognitive part. So the other important functional area of the cerebellum is the nuclei, you've got main three ones um that are important to know about fastigial interposed and dentate. Now again, we keep that same thinking. These are all very, very small nuclei. The dentate is the largest one. It's called dentate because it's called s serrated edge. So fid to start with this is the most medial part. Now, this is very important for the vestibular input. So much more important for balance, that's more sensory input. Interposed is actually two nuclei emboli form and globose. And that's more again. Now, if we go back to that same theory that medial to lateral is sensory motor than cognition, then interposed is more motor. So that's the coordination of the opposing muscle groups and then the dentate, that's the largest one. And that's usually the one that's easier to see on imaging. That's the one that has more to do with the cognition and the planning of motor function. Again, these are very, very deep cerebellar nuclei and you can often see them in certain types of strokes and things um when they become um affected no vascular supply. So we all remember the circle of Willis, I'm sure we can all draw it out. But if we go back to the circle of Willis, you've got the main circle then further down as you come down when you've got the basilar, which is made up of your two vertebral arteries. This is when we start seeing all the vessels that go to the cerebellum and at least one easy.