Көз қозғалысын бақылайтын VI ми тілігінің анатомиясы және патологиясы

Cranial nerve VI, for eye movements

The abducens nerve or abducent nerve, also known as the sixth cranial nerve, cranial nerve VI, or simply CN VI, is a cranial nerve in humans and various other animals that controls the movement of the lateral rectus muscle, one of the extraocular muscles responsible for outward gaze. It is a somatic efferent nerve.

The abducens nucleus is located in the pons, on the floor of the fourth ventricle, at the level of the facial colliculus. Axons from the facial nerve loop around the abducens nucleus, creating a slight bulge (the facial colliculus) that is visible on the dorsal surface of the floor of the fourth ventricle. The abducens nucleus is close to the midline, like the other motor nuclei that control eye movements (the oculomotor and trochlear nuclei). Motor axons leaving the abducens nucleus run ventrally and caudally through the pons. They pass lateral to the corticospinal tract (which runs longitudinally through the pons at this level) before exiting the brainstem at the pontomedullary junction.

The abducens nerve emerges from the brainstem at the junction of the pons and the medulla, superior to the medullary pyramid, and medial to the facial nerve. It runs upwards and forwards from this position to reach the eye. The nerve enters the subarachnoid space (more precisely, the pontine cistern At the apex of the petrous part of the temporal bone, it makes a sharp turn forward to enter the cavernous sinus. In the cavernous sinus, it runs anterior ward alongside (inferolateral to) the internal carotid artery. It enters the orbit through (medial end of) the superior orbital fissure, passing through the common tendinous ring to reach and innervate the lateral rectus muscle of the eye. The resultant palsy is identified through loss of lateral gaze after application of the orthosis. Rare causes of isolated sixth nerve damage include Wernicke–Korsakoff syndrome and Tolosa–Hunt syndrome. Wernicke–Korsakoff syndrome is caused by thiamine deficiency, classically due to alcoholism. The characteristic ocular abnormalities are nystagmus and lateral rectus weakness. Tolosa Hunt syndrome is an idiopathic granulomatous disease that causes painful oculomotor (especially sixth nerve) palsies. Indirect damage to the sixth nerve can be caused by any process (brain tumor, hydrocephalus, pseudotumor cerebri, hemorrhage, edema) that exerts downward pressure on the brainstem, causing the nerve to stretch along the clivus. This type of traction injury can affect either side first. A right sided brain tumor can produce either a right sided or a left sided sixth nerve palsy as an initial sign. Thus a right sided sixth nerve palsy does not necessarily imply a right sided cause. Sixth nerve palsies are infamous as "false localizing signs." Neurological signs are described as "false localizing" if they reflect dysfunction distant or remote from the expected anatomical location of pathology. Isolated sixth nerve palsies in children are assumed to be due to brain tumors until proven otherwise.

Damage to the abducens nucleus does not produce an isolated sixth nerve palsy, but rather a horizontal gaze palsy that affects both eyes simultaneously. The abducens nucleus contains two types of cells: motor neurons that control the lateral rectus muscle on the same side, and interneurons that cross the midline and connect to the contralateral oculomotor nucleus (which controls the medial rectus muscle of the opposite eye). In normal vision, lateral movement of one eye (lateral rectus muscle) is precisely coupled to medial movement of the other eye (medial rectus muscle), so that both eyes remain fixed on the same object. The control of conjugate gaze is mediated in the brainstem by the medial longitudinal fasciculus (MLF), a nerve tract that connects the three extraocular motor nuclei (abducens, trochlear and oculomotor) into a single functional unit. Lesions of the abducens nucleus and the MLF produce observable sixth nerve problems, most notably internuclear ophthalmoplegia (INO).

The sixth nerve is one of the final common pathways for numerous cortical systems that control eye movement in general. Cortical control of eye movement (saccades, smooth pursuit, accommodation) involves conjugate gaze, not unilateral eye movement.

15–40% of people with tuberculosis have some resulting cranial nerve deficit. The sixth nerve is the most commonly affected cranial nerve in immunocompetent people with tuberculosis.

The Latin name for the sixth cranial nerve is "nervus abducens". The Terminologia Anatomica officially recognizes two different English translations: "abducent nerve" and "abducens nerve". "Abducens" is more common in recent literature, while "abducent" predominates in the older literature. The United States National Library of Medicine uses "abducens nerve" in its Medical Subject Heading (MeSH) vocabulary to index the vast MEDLINE and PubMed biomedical databases. The 39th edition of Gray's Anatomy (2005) also prefers "abducens nerve."

The abducens nerve controls the movement of a single muscle, the lateral rectus muscle of the eye. In most other mammals it also innervates the musculus retractor bulbi, which can retract the eye for protection. Homologous abducens nerves are found in all vertebrates except lampreys and hagfishes.