Neural tube programming and craniofacial cleft formation. I. The neuromeric organization of the head and neck.

This review presents a brief synopsis of neuromeric theory. Neuromeres are developmental units of the nervous system with specific anatomic content. Outlying each neuromere are tissues of ectoderm, mesoderm and endoderm that bear an anatomic relationship to the neuromere in three basic ways. This relationship is physical in that motor and sensory connections exist between a given neuromeric level and its target tissues. The relationship is also developmental because the target cells exit during gastrulation precisely at that same level. Finally the relationship is chemical because the genetic definition of a neuromere is shared with those tissues with which it interacts. The model developed by Puelles and Rubenstein is used to describe the neuroanatomy of the neuromeres. Although important details of the model are currently being refined it has immediate clinical relevance for practicing clinicians because it permits us to understand many pathologic states as relationships between the brain and the surrounding tissues. Relationships between the processes of neurulation and gastrulation have been presented to demonstrate the manner in which neuromeric anatomy is established in the embryo. We are now in a position to describe in detail the static anatomic structures that result from this system. The neuromeric 'map' of craniofacial bones, dermis, dura, muscles, and fascia will be the subject of the next part of this series.