VENTRICULAR SYSTEM

AND CSF

DR. OCHIENG’ J
 Development overview
Neural tube

Brain

Rostral Neural canal

Caudal

Spinal
cord
 Lamina terminalis

Interventricular
foramen
Sagittal section of brain:
Ventricles
Cerebral
hemisphere

Lateral
ventricle Cerebral
aqueduct

Ventricle
III

Midbrain

Interventricular Pons
foramen of
Monro

Fourth ventricle Medulla

Lamina terminalis

Diencephalon
• The cerebral ventricular system consists of a
series of interconnecting spaces and channels
within the brain.
• They are derived from the central lumen of the
embryonic neural tube and the cerebral vesicles
to which it gives rise .
• Within each cerebral hemisphere lies a large C-
shaped lateral ventricle . they communicates
through the interventricular foramen with the
third ventricle, which is a midline, slit-like cavity
lying between the right and left halves of the
thalamus.
• Caudally, the third ventricle is continuous with
the cerebral aqueduct, a narrow tube that
passes the length of the midbrain, and which is
continuous in turn with the fourth ventricle, a
wide tent-shaped cavity lying between the
brain stem and cerebellum.

• Caudally, the fourth ventricle is continuous with

the vestigial central canal of the spinal cord.
• The ventricular system contains cerebrospinal
fluid (CSF), which is mostly secreted by the
choroid plexuses located within the lateral,
third and fourth ventricles.

• CSF flows from the lateral to the third ventricle,

through the cerebral aqueduct and into the
fourth ventricle.

• It leaves the fourth ventricle through three

apertures to reach the subarachnoid space
surrounding the brain.
 Ventricles
within brain

Paired lateral
ventricles

Cerebral
aqueduct

Third ventricle Fourth

ventricle

Central canal of
spinal cord
Ventricular system
Site of massa intermedia

Trigone or atrium
Subarachnoid cisterns:
Sagittal section

Superior
cistern

Chiasmatic cistern Cerebellum

Pons
Interpeduncular cistern

Pontine cistern

Medulla
Cerebello-medullary
cistern
Spinal cord
Sagittal section of
brain Corpus callosum

Septum Cerebral Fornix

pellucidum hemisphere

Tectum of
midbrain

Subarachnoid
space

Dura mater

Diencephalon
Optic chiasm
Cerebellum
Pituitary
Pons
Tegmentum of
midbrain
Medulla

Spinal cord
Fourth ventricle:
• The fourth ventricle lies between the brain
stem and the cerebellum.
• Rostrally it is continuous with the cerebral
aqueduct, and caudally with the central canal
of the spinal cord.
• In sagittal section, the fourth ventricle has a
characteristic triangular profile, and the apex of
its tented roof protrudes into the inferior aspect
of the cerebellum.
Fourth ventricle:
 Boundaries:

• The floor of the fourth ventricle is a shallow

diamond-shaped, or rhomboidal, depression
(rhomboid fossa) on the dorsal surfaces of the
pons and the rostral half of the medulla .

• It contains important cranial nerve nuclei. The

precise location of some nuclei is discernable
from surface features.
Floor:
• The striae medullaris, runs transversely across
the ventricular floor and passes into the median
sulcus.
• The superior part of the ventricular floor is
triangular in shape and is limited laterally by
the superior cerebellar peduncles.

• The inferior part of the ventricular floor is also

triangular in shape. It is bounded caudally by
the gracile and cuneate tubercles, and, more
rostrally, by the diverging inferior cerebellar
peduncles.
Floor:

• A longitudinal median sulcus divides the floor of

the fourth ventricle. Each half is itself divided,
by an often indistinct sulcus limitans, into a
medial region known as the medial eminence
and a lateral region known as the vestibular
area.

• The vestibular nuclei lie beneath the vestibular

area.
Floor:
• In the superior part of the ventricular floor, the
medial eminence is represented by the facial
colliculus, a small elevation produced by an
underlying loop of efferent fibres from the
facial nucleus, which covers the abducens
nucleus.

• Between the facial colliculus and the vestibular

area the sulcus limitans widens into a small
depression, the superior fovea.
Floor:
• In the inferior area of the floor of the fourth
ventricle, the medial eminence is represented
by the hypoglossal triangle (trigone), which lies
over the hypoglossal nucleus.

• Laterally, the sulcus limitans widens to produce

an indistinct inferior fovea.

• Caudal to the inferior fovea, between the

hypoglossal triangle and the vestibular area, is
the vagal triangle (trigone), which covers the
dorsal vagal nucleus.
Roof:
• The roof of the fourth ventricle is formed by
the superior and inferior medullary veli.
Superiorly, a thin sheet of tissue, the superior
medullary velum, stretches across the ventricle
between the converging superior cerebellar
peduncles

• The inferior medullary velum is mostly

composed of a thin sheet, devoid of neural
tissue, formed by ventricular ependyma and
the pia mater
Dorsal view of floor
of fourth ventricle

Superior medullary
velum
Pons

Inferior medullary
velum removed
Medulla

Spinal cord Obex (site of 4th ventricle

leading to central canal
 Roof:
• A large median aperture (foramen of Magendie)
is present in the roof of the ventricle as a
perforation in the posterior medullary velum,
just inferior to the nodule of the cerebellum.

• CSF flows from the ventricle through the

foramen into the cerebellomedullary cistern .
Subarachnoid cisterns:
Sagittal section

Superior
cistern

Chiasmatic cistern Cerebellum

Pons
Interpeduncular cistern

Pontine cistern

Medulla
Cerebello-medullary
cistern
Spinal cord
CHOROID PLEXUS

• In the roof of the fourth ventricles, the

vascular pia mater lies in close apposition
to the ependymal lining of the ventricle,
without any intervening brain tissue. It
forms the tela choroidea, which gives rise
to the highly vascularized choroid plexuses
from which CSF is secreted into the
ventricle.
 Medulla in coronal
Choroidal
section: Choroid plexus vessels Pia-ependymal roof of
fourth ventricle
Choroid
plexus
Fourth ventricle

Medulla Lateral recess to

lateral foramen
Choroid plexus

Non-fenestrated
capillary in CNS
(Blood-brain barrier)
 CSF
Production has been accounted for
Movement of the CSF is by pulsating blood
vessels, respiration and changes of
posture
CSF is secreted continuously at a rate of
about 0.5ml per minute i.e. 720 ml per day
Total CSF in the brain 120 ml
CSF pressure can be measured by
attaching a vertical tube to the lumbar
puncture needle – 10 cm water
 Role of CSF
Cushions and insulates delicate nervous tissue •
Gives Buoyancy to the brain (“floats” in CSF). •
Exchange of gases (O2 and CO2), nutrients and •
wastes. •
Applied aspects
Hydrocephalus

• Excessive amount of CSF

• Due to:
– Overproduction of CSF
– Blockage of CSF flow
– Decreased absorption from arachnoid
granulations into dural sinuses
Hydrocephalus is caused by impaired cerebrospinal •
fluid (CSF) production, flow or reabsorption.
The most common cause of hydrocephalus is a flow •
obstruction, hindering the free passage of
cerebrospinal fluid through the ventricular system
and subarachnoid space (e.g. stenosis of the
cerebral aqueduct, obstruction of the
interventricular foraminae - foramen of Monro).
This can be secondary to tumors, hemorrhages,
infections or congenital malfomations. It can also be
caused by overproduction of cerebrospinal fluid
(relative obstruction).
Hydrocephalus
in infant:
Enlarged head
Dandy-Walker syndrome:
Failure of formation of
foramina of Luschka and
Magendie

Giant 4th
ventricle

Cerebellar
remnants
compressed
 MRI of Dandy-Walker Syndrome

Sagittal plane Horizontal plane

Compressed
cerebellum

Giant 4th
ventricle