The cerebellar vermis (from Latin vermis, "worm") is located in the medial, cortico-nuclear zone of the cerebellum, which is in the posterior fossa of the cranium. The primary fissure in the vermis curves ventrolaterally to the superior surface of the cerebellum, dividing it into anterior and posterior lobes. Functionally, the vermis is associated with bodily posture and locomotion. The vermis is included within the spinocerebellum and receives somatic sensory input from the head and proximal body parts via ascending spinal pathways.
The cerebellum develops in a rostro-caudal manner, with rostral regions in the midline giving rise to the vermis, and caudal regions developing into the cerebellar hemispheres. By 4 months of prenatal development, the vermis becomes fully foliated, while development of the hemispheres lags by 30–60 days. Postnatally, proliferation and organization of the cellular components of the cerebellum continues, with completion of the foliation pattern by 7 months of life and final migration, proliferation, and arborization of cerebellar neurons by 20 months.
Inspection of the posterior fossa is a common feature of prenatal ultrasound and is used primarily to determine whether excess fluid or malformations of the cerebellum exist. Anomalies of the cerebellar vermis are diagnosed in this manner and include phenotypes consistent with Dandy–Walker malformation, rhombencephalosynapsis, displaying no vermis with fusion of the cerebellar hemispheres, pontocerebellar hypoplasia, or stunted growth of the cerebellum, and neoplasms. In neonates, hypoxic injury to the cerebellum is fairly common, resulting in neuronal loss and gliosis. Symptoms of these disorders range from mild loss of fine motor control to severe intellectual disability and death. Karyotyping has shown that most pathologies associated with the vermis are inherited through an autosomal recessive pattern, with most known mutations occurring on the X chromosome.
The vermis is intimately associated with all regions of the cerebellar cortex, which can be divided into three functional parts, each having distinct connections with the brain and spinal cord. These regions are the vestibulocerebellum, which is responsible primarily for the control of eye movements; the spinocerebellum, involved in fine tune body and limb movement; and the cerebrocerebellum, which is associated with planning, initiation and timing of movements.
Structure
upright=1.15|thumb|Anterior surface of cerebellum. The vermis is highlighted in red.
The vermis is the unpaired, median portion of the cerebellum that connects the two hemispheres. Both the vermis and the hemispheres are composed of lobules formed by groups of folia. There are nine lobules of the vermis: lingula, central lobule, culmen, clivus, folium of the vermis, tuber, pyramid, uvula and nodule. Purkinje cells in the intermediate zone of the spinocerebellum project to the interposed nuclei, which control the distal musculature components of the descending motor pathways needed for limb movement. Both of these nuclei include projections to the motor cortex in the cerebrum. It is thought that fastigial nuclei axons are excitatory and project beyond the cerebellum, likely using glutamate and aspartate as neurotransmitters.
Joubert syndrome
Joubert syndrome (JS) is one of the most commonly diagnosed syndromes associated with the molar tooth sign (MTS), or hypoplasia/dysplasia of the cerebellar vermis accompanied by brainstem abnormalities. JS is defined clinically by features of hypotonia in infancy with later development of ataxia, developmental delays, mental retardation, abnormal breathing patterns, abnormal eye movements specific to oculomotor apraxia, or the presence of the MTS on the cranial MRI. JS is an autosomal recessive condition with an estimated prevalence of 1: 100,000.
Dandy Walker malformation
Dandy Walker malformation is a relatively common congenital brain malformation with a prevalence of 1:30,000 live births. Dandy Walker malformation is characterized by enlarged posterior fossa and in which the cerebellar vermis is completely absent, or present in a rudimentary form, sometimes rotated accompanied by an elevation of the fourth ventricle. It is also commonly associated with dysplasias of brainstem nuclei. DWM has been reported to be in association with a wide array of chromosomal anomalies, including trisomy 18, trisomy 9, and trisomy 13. Surveys suggest that prenatal exposure to teratogens such as rubella or alcohol are correlated with development of Dandy Walker malformation.
Rhombencephalosynapsis
Rhombencephalosynapsis is an anomaly characterized by the absence or severe dysgenesis of the cerebellar vermis with fusion of the cerebellar hemispheres, peduncles, and dentate nuclei. Diagnostic features include fusion of the midbrain colliculi, hydrocephalus, absence of the corpus callosum other midline structural brain malformations.
Autism spectrum disorders
Hypoplasia and other structural alterations of the vermis have been identified in many patients with autism spectrum disorder (ASD). While the exact nature and extent of the impacts ASD has on the vermis remain in question, it has also been shown that other injuries and malformations of the vermis sometimes produce symptoms closely analogous to ASD. Furthermore, several genetic syndromes known to cause autism (such as fragile X syndrome) have also been shown to cause damage to the vermis.
Damage
Lesions to the vermis commonly give rise to clinical depression, inappropriate emotional displays (e.g. unwarranted giggling) in addition to movement disorders.
Comparative anatomy
Early neurophysiologists suggest that retinal and inertial signals were selected for about 450 million years ago by primitive brainstem-cerebellar circuitry because of their relationship with the environment. Microscopically, it is evident that Purkinje cell precursors arose from granule cells, first forming in irregular patterns, then progressively becoming organized in a layered fashion. Evolutionarily, the Purkinje cells then developed extensive dendritic trees that increasingly became confined to a single plane, through which the axons of granule cells threaded, eventually forming a neuronal grid of right angles. This suggests that the function of the cerebellum evolved as a mode of computing and representing an image relating to the position of the body in space. The cerebellar vermis evolved in conjunction with the hemispheres; this is seen in lampreys and higher vertebrates.
In fish
In vertebrates, the cerebellar vermis develops between two bilaterally symmetrical formations located dorsal to the upper end of the medulla oblongata, or rhombencephalon. This is the region of termination for the fibers of the vestibular nerve and lateral line nerves; thus, these are the oldest afferent paths to the cerebellum and cerebellar vermis.