The tentorial notch (also known as the tentorial incisure or incisura tentorii) refers to the anterior opening between the free edge of the cerebellar tentorium and the clivus for the passage of the

brainstem The brainstem (or brain stem) is the posterior stalk-like part of the brain that connects the cerebrum with the spinal cord. In the human brain the brainstem is composed of the midbrain, the pons, and the medulla oblongata. The midbrain is cont ...

. The

midbrain The midbrain or mesencephalon is the forward-most portion of the brainstem and is associated with vision, hearing, motor control, sleep and wakefulness, arousal (alertness), and temperature regulation. The name comes from the Greek ''mesos'', " ...

continues with the

thalamus The thalamus (from Greek θάλαμος, "chamber") is a large mass of gray matter located in the dorsal part of the diencephalon (a division of the forebrain). Nerve fibers project out of the thalamus to the cerebral cortex in all directions, ...

of the

diencephalon The diencephalon (or interbrain) is a division of the forebrain (embryonic ''prosencephalon''). It is situated between the telencephalon and the midbrain (embryonic ''mesencephalon''). The diencephalon has also been known as the 'tweenbrain in ol ...

through the tentorial notch.

Structure

The tentorial notch is located between the tentorial edges and communicates the supratentorial and infratentorial spaces. This area can be divided into three spaces: ''anterior'', ''middle'' (lateral to), and ''posterior'' to the brainstem. The middle incisural space is close to the

and the upper pons at the level of the pontomesencephalic sulcus. Medial temporal lobe structures such as the

uncus The uncus is an anterior extremity of the parahippocampal gyrus. It is separated from the apex of the temporal lobe by a slight fissure called the incisura temporalis (also called rhinal sulcus). Although superficially continuous with the hipp ...

, the parahippocampal gyrus and the hippocampal formation, are also intimately related to the incisura. The principal vascular structures coursing along the middle incisural space are the

posterior cerebral artery The posterior cerebral artery (PCA) is one of a pair of cerebral arteries that supply oxygenated blood to the occipital lobe, part of the back of the human brain. The two arteries originate from the distal end of the basilar artery, where it bifur ...

and the

superior cerebellar artery The superior cerebellar artery (SCA) is an artery of the head. It arises near the end of the basilar artery. It is a branch of the basilar artery. It supplies parts of the cerebellum, the midbrain, and other nearby structures. It is the cause of ...

which pass around the brainstem, parallel to the free tentorial edge. The incisura has also a close relationship with the first 6 cranial nerves.Rothon Jr AL. Tentorial incisura. Neurosurgery 2000;47(Suppl. 3):131–53.

Clinical significance

intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury (mmHg) and at rest, is normally 7–15 Millimeter of mercury, mmHg ...

superior to the cerebellar tentorium is increased, it may force part of the

temporal lobe The temporal lobe is one of the four Lobes of the brain, major lobes of the cerebral cortex in the brain of mammals. The temporal lobe is located beneath the lateral fissure on both cerebral hemispheres of the mammalian brain. The temporal lobe ...

through this notch. This is referred to as a tentorial

brain herniation Brain herniation is a potentially deadly side effect of very high pressure within the skull that occurs when a part of the brain is squeezed across structures within the skull. The brain can shift across such structures as the falx cerebri, the te ...

. The consequences are unconsciousness, widening of the pupil of the affected side, and

hemiparesis Hemiparesis, or unilateral paresis, is weakness of one entire side of the body (''wikt:hemi-#Prefix, hemi-'' means "half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused ...

on the opposite side.

References

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