MENINGES, VENTRICLES, CEREBROSPINAL FLUID AND BOOLD SUPPLY OF THE BRAIN

Dr. Israa M. Sulaiman Dr. Mohammed Faez Department of Anatomy IMS/MSU

OBJECTIVES
Illustrate and describe the Meningess three membranes. Describe the structure of the meninges, its blood supply and nerve supply. Illustrate and describe the venous blood sinuses

The Meninges
The Meninges are the membrane covering the brain and spinal cord. The Meninges consist of three membranes: 1. The dura mater, 2. The arachnoid mater, 3. The pia mater.

The Meninges

The Meninges
1. Dura mater - strong, "Tough mother" a. Falx cerebri b. Falx cerebelli c. Tentorium cerebelli d. Diaphragma sella 2. Arachnoid spidery, holds blood vessels

3. Pia mater "delicate mother"

The Meninges

1) Falx cerebri

2) Tentorium cerebelli 4) Diaphragma sellae 3) Falx cerebelli

Sagittal section showing the duramater

1) Falx cerebri 2) Tentorium cerebelli

Superior view showing the duramater

DURA MATER
Thick dense inelastic membrane and the outermost layer of the meninges Bilaminar: Endosteal layer (outer)

Meningeal layer (inner)

These are closely united except along certain lines, where they separate to form venous sinuses.

DURA MATER
Endosteal layer ; o o Periosteum - inner surface of the skull bones Not continuous with dura mater of spinal cord

Meningeal layer ; o Dura mater proper o Covering the brain o Continuous with dura mater of spinal cord o Folded inwards as 4 septa between part of the brain

o The function of these septa is to restrict the rotatory displacement of the brain.

duramater Superior cerebral veins beneath arachnoid

Superior sagittal sinus

(Dural venous sinus)

Dura mater
Endosteal layer

Meningeal layer They are closely united except along certain lines; they are separated to form venous sinuses
Subdural space

Coronal section of the upper part of the head

DURA MATER
Dura mater septa:
1. 2. 3. 4. Falx cerebri Falx cerebelli Tentorium cerebelli Diaphragma sella

1) Falx cerebri

2) Tentorium cerebelli 4) Diaphragma sellae 3) Falx cerebelli

Sagittal section showing the duramater

The Falx Cerebri

It is a sickle-shaped fold of dura mater that lies in the midline between the two cerebral hemispheres. Its narrow end in front is attached to the internal frontal crest and the crista galli. Its broad posterior part blends in the midline with the upper surface of the tentorium cerebelli. The superior sagittal sinus runs in its upper fixed margin, the inferior sagittal sinus runs in its lower concave free margin, and the straight sinus runs along its attachment to the tentorium cerebelli.

Superior sagittal sinus

Falx cerebri

Frontal crest

Tentorium cerebelli

Crista galli

Inferior sagittal sinus

Straight sinus

The Tentorium Cerebelli

The tentorium cerebelli is a crescent-shaped fold of dura mater that roofs over the posterior cranial fossa. It covers the upper surface of the cerebellum and supports the occipital lobes of the cerebral hemispheres.

Tentorium cerebelli

Falx cerebri

The Falx Cerebelli

The falx cerebelli is a small, sickle-shaped fold of dura mater that is attached to the internal occipital crest and projects forward between the two cerebellar hemispheres. Its posterior fixed margin contains the occipital sinus.

The Diaphragma Sellae

The diaphragma sellae is a small circular fold of dura mater that forms the roof for the sella turcica. A small opening in its center allows passage of the stalk of the pituitary gland

Dural Nerve Supply

Branches of the trigeminal, vagus, and first three cervical nerves and branches from the sympathetic system pass to the dura. The dura is sensitive to stretching, which produces the sensation of headache.

Dural Blood Supply

Dural Arterial Supply The dura maters arteries supply from the internal carotid, maxillary, ascending pharyngeal, occipital, and vertebral arteries. From a clinical standpoint, the most important is the middle meningeal artery, which is commonly damaged in head injuries. Dural Venous Drainage The meningeal veins lie in the endosteal layer of dura. The middle meningeal vein follows the branches of the middle meningeal artery and drains into the pterygoid venous plexus or the sphenoparietal sinus. The veins lie lateral to the arteries.

Arachnoid Mater
Delicate, impermeable & avascular membrane covering the brain Lying between Pia mater (internally) & dura Mater(externally) Separated from dura mater by a potential space, the subdural space (filled by a film of fluid) Separated from pia mater by the subarachnoid space (filled with CSF)

The outer and inner surfaces covered with flattened mesothelial cells

Superior cerebral veins beneath arachnoid

Arachnoid mater

Arachnoid mater
Arachnoid projects into venous sinuses - sites for CSF diffuses into bloodstream

Arachnoid granulations Arachnoid mater Subarachnoid space Arachnoid villi Subdural space

SUBDURAL SPACE : Superior cerebral veins, traverse the subdural space to reach the superior sagittal sinus and its lacunae
Superior cerebral veins beneath arachnoid

*
Dura

Arachnoid

Subdural haematoma

Subarachnoid Space (SP) :

Relatively narrow over the surface of cerebral hemisphere, but sometimes becomes much wider in areas at the base of the brain, the widest space is called subarachnoid cisterns The cisterna cerebellomedularis lies between inferior surface of the cerebellum and roof of 4th ventricle The cisterna interpeduncularis lies between 2 cerebral hemispheres. All the cisternae are in free communication with one another & with the remainder of subarachnoid space

Superior cistern

Chiasmatic cistern
Interpeduncular cistern

Pontine cistern

Cerebellomedullary cistern

Median sagittal section to show the subarachnoid cisterns & circulation of CSF

Pia mater Arachnoid

Dura

*
Subarachnoid haemorrage

Pia Mater
Pia Mater is a vascular membrane covered by mesothelial cells. Closely invests the brain, covering the gyri, descending into the deepest sulci & closely applied to the cortical surface.

Pia mater

Pia mater

Pia Mater
It extends out over the cranial nerves & fuses with their epineurium The cerebral arteries entering the substance of the brain, carry a sheath of pia mater with them

The pia mater forms the TELA CHOROIDAE .

The tela choroidae fuse with ependyma to form the choroid plexus Choroid plexus forms CSF

Choroid plexus of lateral ventricle Ependyma Pia mater of tela choroidae Choroid plexus of 3rd ventricle

Coronal section of the interventricular foramen showing the choroid plexus of 3rd & lateral ventricles

Read About
The Venous Blood Sinuses

VENTRICLES

OBJECTIVES
Illustrate and describe the ventricles. Describe the structure of the ventricles. Illustrate and describe the cerebrospinal fluid (CSF) formation, absorption and circulation.

VENTRICLES(Ventricular System)
A ventricle is an internal cavity of the brain. Within the brain, which is filled with cerebrospinal fluid(CSF). The ventricular system is composed of two lateral ventricles and two midline ventricles( third and fourth ventricles).

VENTRICLES(Ventricular System)
The chambers are connected to allow the flow of cerebrospinal fluid via two interventricular foramen (referred to as the foramen of Monro) and the cerebral aqueduct (referred to as the aqueduct of Sylvius).

Lateral ventricle
Interventricular foramen (Monro) Cerebral aqueduct Third ventricle Fourth ventricle Central canal of medulla oblongata & spinal cord

Lateral view to show the ventricular system of the CNS

VENTRICLES(Ventricular System)
CONSISTS OF :

1) Lateral ventricle
2) Third ventricle

3) Fourth ventricle
4) Central canal of the medulla oblongata & spinal cord

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Lateral Ventricles
The lateral ventricles are two curved shaped cavities located within the cerebrum. The lateral ventricles are separated by the septum pellucidum and do not communicate directly

Lateral ventricle
Parietal lobe

Frontal lobe

Occipital lobe

Temporal lobe

Lateral ventricle
C-shaped cavity & may be divided into :

1. Body 2. Anterior horn

Third ventricle

3. Posterior horn

4. Inferior horn Fourth ventricle

Lateral view of the ventricular cavities of the brain

Posterior horn Anterior horn

Inferior horn

Lateral view to show the ventricular system of the CNS

Third ventricle
The third ventricle is a narrow cavity or a slitlike cleft between the 2 thalamus Communicates ; Anteriorly with lateral ventricles through interventricular foramina (of monro) Posteriorly with fourth ventricle through cerebral aqueduct (of sylvius)

Posterior view to show the ventricular system of the CNS

Third ventricle
Parietal lobe

Frontal lobe

Occipital lobe

Temporal lobe

Third ventricle

ROOF Body of fornix Lateral wall

Thalamus

Third ventricle

FLOOR
Hypothalamus Coronal section of the brain (posterior view)

Fourth ventricle
The fourth ventricle Is a rhomboid or diamond shaped cavity. It is a wide and flattened space located just anterior to the cerebellum and posterior to the upper, or superior, half of the medulla oblongata and the pons.

Fourth ventricle

Cerebral aqueduct ANTERIOR

Fourth ventricle
POSTERIOR Cerebellum

Pons Medulla oblongata (superior half)

Sagittal section of the 4th ventricle

Central canal (spinal cord)

Fourth ventricle
Parietal lobe

Frontal lobe

Occipital lobe

Temporal lobe

Roof or posterior wall of fourth ventricle :

Superior part of the roof ;
Superior medullary velum Cerebral aqueduct ANTERIOR Pons Medulla oblongata (superior half) POSTERIOR

Inferior part of the roof ;

Inferior medullary velum

Fig. : Sagittal section of the 4th ventricle

Floor or rhomboid fossa of fourth ventricle :

Medial sulcus

Formed by ;
1. Posterior surface of the pons

(divides the floor into symmetrical halves)

Medial eminence Sulcus limitans Facial colliculus Stria medullaris (strands of nerve fibers)

2. Cranial of the medulla oblongata

Posterior view of the 4th ventricle

Vagal triangle

Hypoglossal triangle

CENTRAL CANAL Opens superiorly into the fourth ventricle

Fourth ventricle Extends ;

Inferior of medulla oblongata

Central canal
Entire length of spinal cord (Lined with ependyma but no choroid plexus in the central canal)

CENTRAL CANAL
Parietal lobe

Frontal lobe

Occipital lobe

Temporal lobe

Conus medullarisTerminal ventricle

CEREBROSPINAL FLUID

CHOROID PLEXUS
It is formed by invaginating of vascular pia mater into the ventricular cavity It becomes highly convoluted & produce a spongy-like appearance It enters the 3rd and 4th ventricles through their roofs, and the lateral ventricles through the choroid fissure produces cerebrospinal fluid (CSF)
Lateral ventricle

Third ventricle Fourth ventricle

Cavity Of Lateral Ventricle

BODY OF FORNIX

Pia Mater

Choroid Plexus of The Lateral Ventricle

CORPUS CALLOSUM

CN Pia Mater of Tela Choroidae Choroid Plexus of The Third Ventricle

Ependyma Cavity Of Third Ventricle

THALAMUS

Blood supply derives from choroidal branches of the internal carotid & basilar arteries

Coronal section of the cavities of the lateral and 3rd ventricles

Arachnoid mater Pia mater Ependyma Cavity of fourth ventricle

CEREBELLUM

Choroid plexus of the fourth ventricle

T shaped, vertical part is double

Horizontal part extends into lateral recesses of each ventricle (foramina of Luskha)
Blood supply ; posterior inferior cerebellar arteries

What is cerebrospinal fluid (CSF) ?

Clear, colorless fluid Produced by the choroid plexus Found in the : Ventricles of the brain Subarachnoid space (between Arachnoid + Pia mater) around the brain & spinal cord

The pressure of the CSF is kept remarkably constant. Based on the Monro-Kellie doctrine :

Volume of BLOOD, CSF & BRAIN at any time must be relatively constant

Physical characteristics and composition of the CSF Appearance Clear and colourless Volume 130 ml Rate of production 0.5 ml/min Pressure 60-150 mm of water Composition protein 15-45 mg/100 ml glucose 50-85 mg/ 100 ml chloride 720-750 mg/100 ml No. of cells 0-3 lymphocytes/cu mm

Function of the CSF :

1. Cushions & protects the CNS from trauma

2. Provides mechanical buoyancy & support for the brain

3. Serves as a reservoir & assists in the regulation of the contents of the skull

4. Nourishes the CNS

5. Removes metabolites from the CNS 6. Serves as a pathway for pineal secretions to reach the pituitary gland

Sites of formation :
1. Choroid plexus of the ventricle cavities, mostly is formed in the LATERAL VENTRICLES 2. Some originate from the ependymal cells lining the ventricles 3. Some from the brain substances through perivascular spaces

Movement of CSF inside the ventricle is controlled by the:

1. Pulsation of the artery in the choroid plexus
2. By the aid of the cilia & microvilli of the ependymal cells

Superiorly = lateral aspect of each cerebral hemisphere

Choroid plexus of the lateral ventricle

3 Choroid plexus of the 3rd ventricle 3.1 Inferiorly = subarachnoid space around the brain & spinal cord 3.2 Choroid plexus of the 4th ventricle

cerebrospinal fluid (CSF)

The CSF is formed in the lateral ventricles escapes by the foramen of monro into the third ventricle From the third ventricle by the aqueduct into the fourth ventricle. Then from the fourth ventricle the fluid is poured into the subarachnoid spaces through the medial foramen of majendie and the two lateral foramina of luschka. There is no evidence that functional communications between the cerebral ventricles and the subarachnoid spaces exist in any region except from the fourth ventricle.

Site of formation
Choroid plexus of the lateral ventricle
1. Lateral ventricle Superiorly Interventricular foramina 2. Third ventricle Cerebral aqueduct Absorbed 3. Fourth ventricle Absorbed Superiorly

3.2 Lateral foramina (Luschka) 3.1 Median foramen (Magendie) 4. Subarachnoid space

3.2 Lateral foramina (Luschka)

Inferiorly

Circulation of CSF in subarachnoid space :

Superior cistern

Chiasmatic cistern
Interpeduncular cistern
Median foramen of 4th ventricle

Pontine cistern

Cerebellomedullary cistern

Median sagittal section to show the subarachnoid cisterns & circulation of CSF

Factors that facilitate the flow of CSF in subarachnoid space ;

1. Pulsation of the cerebral & spinal arteries
2. Movements of the vertebral column 3. Respiration & coughing 4. Changing of the positions

Absorption of CSF into dural venous sinuses

Main sites - arachnoid villi (project into dural venous sinuses, especially, superior sagittal sinus) Arachnoid villi are covered by endothelium of the venous sinus Arachnoid villi tend to be grouped together & form elevations known as arachnoid granulations CSF pressure >> the pressure in the sinus The rate of absorption of CSF through the arachnoid villi controls the CSF pressure

CLINICAL APPLICATION
Hydrocephalus
The term hydrocephalus is derived from the Greek words "hydro" meaning water and "cephalus" meaning head. It is excessive accumulation of fluid in the brain.

BLOOD SUPPLY OF THE BRAIN

OBJECTIVES

Illustrate and describe the formation of the circle of willis Describe the blood supply of the brain
Arterial supply Venous drainage

Blood Supply of The Brain

The brain receives it arterial supply from two pairs of vessels, the vertebral and internal carotid arteries which are interconnected in the cranial cavity to produce an arterial circle (of Willis).

Internal carotid artery

Internal Carotid Artery

Begins bifurcation of Com Carotid A Perforates base of skull carotid canal Enters middle cranial fossa beside dorsum sellae In the cavernous sinus
Horizontal

Emerge out medial side of Ant clinoid process perforates dura & arachnoid mater enters subarachnoid space Turns posteriorly below optic nerve Turns upward lateral to optic chiasma Now is under anterior perforated susbtance Divides into ANTERIOR & MIDDLE cerebral arteries

Posterior communicating artery

Middle cerebral artery

Anterior cerebral artery Internal carotid artery in cavernous sinus

Posterior cerebral artery Basilar artery Internal carotid artery In temporal bone

External carotid artery

Vertebral artery Common carotid artery

Vertebral Artery
Branch of first part of subclavian A Passes foramen transvesarium C6 C1 Enters through foramen magnum perforates dura & arachnoid mater enters subarachnoid space Turns upward, forward, medially medulla oblongata Lower border of pons joins opposite side
BASILAR artery

Posterior communicating artery

Middle cerebral artery

Anterior cerebral artery Internal carotid artery in cavernous sinus

Posterior cerebral artery Basilar artery Internal carotid artery In temporal bone

External carotid artery

Vertebral artery Common carotid artery

Blood Supply of The Brain

VERTEBRAL
Basilar Posterior cerebral artery

INTERNAL CAROTID
Middle cerebral Anterior cerebral Anterior communicating artery Posterior communicating artery

CIRCLE OF WILLIS

Branches of : VERTEBRAL
Basilar PCA Pontine Labyrinthine Ant Inf CA Sup cerebellar Choroidal

INTERNAL CAROTID
ACA MCA Ophthalmic Ant ComA Post Com A Choroidal

 CEREBRAL (ICA)
Ophthalmic Post Communicating Choroidal Ant Cerebral
Cortical Central Communicates with
Ant Comm Art Post Cerebral

CRANIAL (VERT)
Meningeal Post Spinal Ant Spinal Post Inf Cerebellar Medullary Pontine Labyrinthine Ant Inf Cerebellar Sup Cerebellar Post Cerebral
Cortical Central Choroidal

(BASILAR)

Mid Cerebral
Cortical Central

Circle of Willis
Interpeduncular fossa base of brain Anastomosis
2 internal carotid arteries 2 vertebral arteries

In the subarachnoid space

INFERIOR VIEW

Anterior communicating artery

Anterior cerebral artery

Posterior communicating artery Posterior cerebral artery

Internal carotid artery

Middle cerebral artery

Sup cerebellar A
Basilar A Ant Inf cerebellar A

Post Inf cerebellar A

Vertebral arteries

Anterior cerebral artery

Middle cerebral artery

Posterior cerebral artery

Superior parietal lobule

Central sulcus
Superior frontal gyrus

Frontal pole Parietooccipital sulcus

Frontal pole

Anterior cerebral artery

ANTERIOR CEREBRAL ARTERY

LOBE FRONTAL LOBE PARIETAL LOBE AREA Motor lower limb and perineum pericentral lobule Sensory lower limb and perineum paracentral lobule

Anterior cerebral artery & anterior communicating artery

Lentiform nucleus
lentiform

Caudate nucleus Internal capsule (ANT) Hypothalamus (ANT)

caudate

Internal capsule

Temporal pole

Middle cerebral artery

Central branches

Central branches

Lateral striate arteries

Medial striate arteries

Left middle cerebral artery

Right middle cerebral artery

MIDDLE CEREBRAL ARTERY

LOBE FRONTAL AREA Motor except for paracentral lobule Motor speech esp left side PARIETAL Sensory except for paracentral lobule Sensory speech TEMPORAL Auditory

Middle cerebral artery & anterior choroidal artery

Lentiform nucleus
lentiform

Caudate nucleus Internal capsule (ANT & POST)

caudate

Internal capsule

Inferior temporal gyrus

Posterior cerebral artery Inferior temporal gyrus

POSTERIOR CEREBRAL ARTERY

LOBE OCCIPITAL TEMPORAL AREA Visual Olfactory

Posterior cerebral artery & posterior communicating artery

Hypothalamus
Thalamus (ANT) Cerebral peduncle
Internal capsule thalamus

Cerebral peduncle

Posterior lateral arteries

Thalamus (POST)
Geniculate bodies Cerebral peduncle
thalamus

Lateral Geniculate bodies Cerebral peduncle

ARTERIES to specific brain areas

Corpus striatum Internal capsule Thalamus Midbrain Pons Medulla oblongata Cerebellum Middle & lateral striate Anterior & Middle cerebral artery

PComA, basilar, PCA PCA, supCerebellarA, basilar Basilar, Ant, inf, supCerebellarA, Vertebral, ASA,PSA,PICA, basilar supCerebellar, AICA,PICA

VENOUS DRAINAGE of THE BRAIN

EXTERNAL
Superior cerebral Superficial middle cerebral Deep middle cerebral

INTERNAL
Thalamo striate choroidal

SPECIFIC
Midbrain Pons Medulla oblongata cerebellum

Superior Sagittal sinus

Superior cerebral

Transverse sinus

Superficial Middle cerebral

Superior Sagittal sinus

Internal cerebral Great cerebral Straight sinus

Inferior Sagittal sinus

basal

Occipital sinus

Superior Sagittal sinus

Superior anastomotic V

Superior cerebral

Inferior anastomotic V

Superficial Middle cerebral Transverse sinus

Superior Sagittal sinus

Inferior Sagittal sinus

Internal cerebral Great cerebral Straight sinus

Site of junction with transverse sinus

Occipital sinus basal

EXTERNAL CEREBRAL VEIN

VEIN Superior cerebral Superficial middle cerebral Deep middle cerebral Sup anas V Inf anas V AREA DRAINS INTO Superior sagittal sinus Cavernous sinus

Lateral surface of cerebral hemisphere Insula

Joined by ant cerebral & striatebasal vein

Superior sagittal sinus Inferior sagittal sinus

INTERNAL CEREBRAL VEIN

VEIN AREA DRAINS INTO

Thalamostriate Basal ganglia, thalamus, Choroidal internal capsule,Tela choroidae of 3rd ventricle,hippo campus

Internal cerebral vein - great cerebral vein straight sinus DURAL VENOUS SINUS

VEIN of specific areas

Midbrain Basal, great cerebral

Pons
Medulla oblongata Cerebellum

Basal, cerebellar
Anterior & posterior spinal Great cerebral

Superior cerebral vein Superior sagittal sinus

Great cerebral vein Straight sinus

Middle cerebral vein Confluence of sinus

Superior petrosal sinus

Inferior sagittal sinus

Medial aspect of hemisphere

Cavernous sinus
Inferior petrosal sinus

Transverse sinus (R & L) IntJugular vein Sigmoid sinus (R & L)

IntJugular vein

Inferior sagittal sinus

Superior sagittal sinus

Falx cerebri

Tentorium cerebelli Superior petrosal sinus

*
Confluence of sinus Straight sinus

Inferior petrosal sinus

Sigmoid sinus

Transverse sinus

Cavernous sinus

Superior petrosal sinus

Inferior petrosal sinus

Jugular foramen Sigmoid sinus

Straight sinus
Superiorsa gittal sinus Confluence of sinus

Transverse sinus

Cavernous sinus
Lateral to body of sphenoid bone Connected to opposite intercavernous S Receives blood
Middle cerebral V

Drains into
Int Jugular V via Inf petrosal sinus Transverse S via Sup petrosal S Dural Venous sinuses emissary veins extracranial V

CLINICAL APPLICATION
Stroke or cerebrovascular accident: Blockage in the artery cerebral infarction
Carotid artery Basilar artery

Bleeding within the brain intracerebral haemorrhage

Aneurysm Subarachnoid haemorrhage Intracerebral haemorrhage - hypertension

Damages one side of the body - contralateral

CVA due to blockage

CVA due to haemorrhage

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