Department of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Neonatology, ZNA Middelheim, Antwerp, Belgium; Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium.
Department of Pediatric Neuroradiology, Università Degli Studi di Milano, Milan, Italy.
Handb Clin Neurol. 2020;171:245-289. doi: 10.1016/B978-0-444-64239-4.00014-X.
Transient anatomical entities play a role in the maturation of brain regions and early functional fetal networks. At the postmenstrual age of 7 weeks, major subdivisions of the brain are visible. At the end of the embryonic period, the cortical plate covers the neopallium. The choroid plexus develops in concert with it, and the dorsal thalamus covers about half the diencephalic third ventricle surface. In addition to the fourth ventricle neuroepithelium the rhombic lips are an active neuroepithelial production site. Early reciprocal connections between the thalamus and cortex are present. The corticospinal tract has reached the pyramidal decussation, and the arteries forming the mature circle of Willis are seen. Moreover, the superior sagittal sinus has formed, and at the rostral neuropore the massa commissuralis is growing. At the viable preterm age of around 24 weeks PMA, white matter tracts are in full development. Asymmetric progenitor division permits production of neurons, subventricular zone precursors, and glial cells. Myelin is present in the ventral spinal quadrant, cuneate fascicle, and spinal motor fibers. The neopallial mantle has been separated into transient layers (stratified transitional fields) between the neuroepithelium and the cortical plate. The subplate plays an important role in organizing the structuring of the cortical plate. Commissural tracts have shaped the corpus callosum, early primary gyri are present, and opercularization has started caudally, forming the lateral fissure. Thalamic and striatal nuclei have formed, although GABAergic neurons continue to migrate into the thalamus from the corpus gangliothalamicum. Near-term PMA cerebral sublobulation is active. Between 24 and 32 weeks, primary sulci develop. Myelin is present in the superior cerebellar peduncle, rubrospinal tract, and inferior olive. Germinal matrix disappears from the telencephalon, except for the GABAergic frontal cortical subventricular neuroepithelium.
短暂存在的解剖结构在脑区的成熟和早期功能性胎儿网络中发挥作用。在妊娠 7 周时,大脑的主要分区可见。在胚胎期末,皮质板覆盖新皮质。脉络丛与皮质板一起发育,背侧丘脑覆盖了大约一半的间脑第三脑室表面。除第四脑室神经上皮外,菱形唇也是一个活跃的神经上皮发生部位。早期丘脑与皮质之间存在相互连接。皮质脊髓束已到达锥体交叉,成熟的 Willis 环动脉可见。此外,上矢状窦已经形成,在颅前孔处,连合体正在生长。在大约 24 周 PMA 的可存活早产儿时,白质束完全发育。不对称祖细胞分裂允许神经元、室下区前体细胞和神经胶质细胞的产生。腹侧脊髓象限、楔束和脊髓运动纤维中存在髓鞘。新皮质板已从神经上皮和皮质板之间分离出短暂的层(分层过渡区)。基板在皮质板的结构组织中起着重要作用。连合纤维束塑造了胼胝体,早期初级脑回已经存在,外侧裂在尾部开始出现,形成外侧裂。丘脑和纹状体核已经形成,尽管 GABA 能神经元继续从神经节向丘脑迁移。近足月 PMA 大脑小叶的分区是活跃的。在 24 周至 32 周之间,初级脑沟发育。上小脑脚、红核脊髓束和下橄榄中存在髓鞘。除了 GABA 能额叶皮质室下神经上皮外,神经上皮从端脑消失。