New insights into the upward vestibulo-oculomotor pathways in the human brainstem.

The brainstem vestibulo-oculomotor pathways are not yet fully known. Three different excitatory tracts could be involved in the transmission of upward vestibular eye movement (VEM) signals and upward eye position (EP) signals to the oculomotor nucleus (III): the medial longitudinal fasciculus (MLF), the brachium conjunctivum (BC), and the crossing ventral tegmental tract (CVTT). The involvement of the MLF pathway originating in the medial vestibular nucleus (MVN) in this transmission is experimentally and clinically well established whereas a role of the BC appears to be questionable. Furthermore, there is now accumulating evidence that the CVTT pathway emerging from the superior vestibular nucleus (SVN) also plays an important role in the mediation of excitatory upward EP and VEM signals to the III. This duplication of pathways (MVN-MLF and SVN-CVTT) could be explained by a supplementary and relatively specific function performed by the SVN-CVTT pathway to counteract the gravity pull in the upward eye movement system. Various arguments in support of this hypothesis are reviewed.