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CSF SPACES
OF THE BRAIN
SUYOGYA
-Resident,
Radiology
Basic Neurovascular
histology:
Lack external elastic
lamina
Relatively deficient in
tunica media and
adventitia
Diseases of the cerebral
vasculature are different
from those of other
vascular distributions
due in large part to the
structural differences of
the cerebral arteries.
Internal carotid system (anterior circulation): Ipsilateral cerebral hemisphere, except for the medial
surface of the occipital lobe and the medial and inferior
surfaces of the temporal lobe.
Structures perfused by the anterior circulation include
evolutionarily younger parts of the brain including
the neocortex of the cerebral hemispheres.
These structures are highly sensitive to ischemia and
reperfusion hemorrhage if the occluded vessel is opened
later than 6 to 8 hours after symptom onset.
Vertebral-basilar system:
- Medial surface of the occipital lobe and the medial and
inferior surfaces of the temporal lobe.
- Brainstem and cerebellum.
- Structures perfused by the posterior circulation include the more
primitive brainstem and cerebellum, which may be more
resistant to ischemia and the clinical sequelae of infarction.
- Because of these, attempts to reperfuse the posterior circulation
during ischemic stroke are not as strictly limited by time from
symptom onset.
- Infarction in the posterior circulation can lead to the
locked-in syndrome.
SEGMENTS OF ICA:
C1 : cervical segment
- none
C2 : petrous segment
caroticotympanic artery
vidian artery
C6 : Supraclinoid segment
ophthalmic artery
superior hypophyseal
artery
C7 : communicating segment
posterior
communicating artery
anterior choroidal
artery
Cavernous segment:
meningohypophyseal
anterior cerebral
Three subsegments and two genu
The trunk
abducens nerve is inferolateral to ICA.artery
inferolateral trunk
middle cerebral artery
C5 : clinoid segment none
C3 : lacerum segment
- none
C4 : cavernous
segment
Aberrant
ICA
Congenital variant.
Cervical part of ICA is
lost, which is replaced
by enlarged
caroticotympanic
artery.
Radiologist failing to diagnose this condition may
lead to massive/fatal bleeding when operated or
biopsied.
OPHTHALMIC ARTERY:
First intradural branch of
ICA
Aneurysms above the ICASAH- neurosurgical
intervention
Aneurysms below ICA- No
SAH- generally not treated
unless complications arise
like Carotid cavernous
fistula
Heubner's artery:
Very closely related to AcoA.
Occlusion sometimes occurs during clipping of an
anterior commissure aneurysm resulting in an
ischemic
infarction
of the head
From
ICA bifurcation
to of the caudate that
manifests
in the days after the surgical procedure.
ACoA
Courses horizontally from
lateral to medial direction.
Perforating branches
( including the
recurrent artery of
Heubner and medial
lenticulostriate artery)
supply the anterior limb of
the internal capsule, the
inferior portions of head of
the caudate and anterior
globus pallidus.
A1 segment
A2 SEGMENT
ACoA junction to
bifurcation
Courses cephalad and
curves around the
genu of CC and gives
terminal branches
Branches
Rec artery of
Heubner
Orbitofrontal artery
Frontopolar artery
Pericallosal artery
Continuation of ACA over CC
Posteriorly anastomose with splenial artery of PCA
MIDDLE CEREBRAL
ARTERY
Larger of the two
terminal branches.
Supplies most of the
temporal lobe,
anterolateral frontal
lobe, and parietal lobe
Major segments
Horizontal/sphenoidal(
M1) segment
Insular( M2) segment
Opercular ( M3)
segment
Most frequently involved artery in ischemic stroke.
Cortical (M4)
Most commonly catheterized artery in the brain.
M1
SEGMENT
Sylvian triangle:
Anterosuperior point: Top of the most anterior identifiable opercular
branch
Posterosuperior point: Top of the most posterior identifiable
opercular branch
Anteroinferior point- Most anterior part of the trunk of MCA
Superior insular line- Join the Anterosuperior and Posterosuperior
point
Inferior insular line- Join the Posterosuperior and anteroinferior point
Anterior insular line- Join the Anterosuperior and anteroinferior point.
Vertebral and
basilar arteries
The VAs supply the posterior
circulation of the brainstem,
cerebellar hemispheres, and
posterior cerebral
hemispheres.
These arteries typically arise
from the SCAs bilaterally.
Anatomic segments:
Extraosseous segment (V1),
the foraminal segment (V2),
the extradural segment
(V3), and the intradural
segment
The larger (V4
of the two VAs is sometimes
denoted as dominant, making the most
common relationship a left dominant
Intraspinal branches of
vertebral artery:
1. Anterior spinal artery
2. Posterior spinal
artery
3. PICA
4. Medullary arteries
Basilar artery:
Blood supply of
pons and Pontine
syndrome:
1. Paramedian
branches
2. Short
circumferential
branches
3. Long
circumferential
branches
4. Enforcement from
the AICA and SCA.
Artery of Percheron:
Single dominant thalamoperforating artery arises
from the p1 segment and supplies the rostral
midbrain and bilateral medial thalami.
Formation of CSF:
80%- Mostly from choroid plexuses of lateral ventricles, 3 rd
ventricle and 4th ventricle.
20%- From interstitial spaces of brain through ependymal
epithelium and from the blood capillaries of pia arachnoid.
Rate of CSF secretion- 0,3-0.4 ml/min
Total CSF volume is CSF 90-150. Intracranial = 125 ml
(Ventricles= 25 ml and cranial subarachnoid space=100 ml)
Normally 50% of the total volume of CSF is replaced every five to
six hours.
CSF Spaces
The brain is surrounded by cerebrospinal fluid (CSF)
within the sulci,fissuresandbasal cisterns. CSF is
also found centrally within theventricles.
The sulci, fissures, basal cisterns and ventricles together
form the 'CSF spaces', also known as the 'extra-axial
spaces'.
Circulation
Lateral ventricle foramen of monro
3rd ventricle Aqueduct of sylvius 4th
ventricle foramen of Magendie,
foramen of luschka SA spaces.
From 4th ventricle some CSF trickles down
to central canal of spinal cord.
Absorbed through arachnoid villi and
arachnoid granulations into venous
sinuses of dura mater
AC-shaped structure.
Curves from aninferior
hornthroughbodyin the parietal lobe
ending at the interventricular
foramen.
Two extensions: Posterior hornthat
extends backward into the occipital
lobe. Anterior hornthat extends
farther into the frontal lobe
The expanded area where the body
and the inferior and posterior horns
meet is called theatrium. Splenium
of corpus callosum arbitrarily
separates the body from trigone
Each lateral ventricle represents
Ventricles of brain
Series of communicating cavities lined by ependymal
epithelium and contain CSF.
Communicate with SA spaces around brain and around
spinal cord and with central canal of spinal cord.
Left lateral ventricle (1st ventricle)
Right lateral ventricle
Third ventricle
Fourth ventricle
Posterior horn
Inferior horn
Dimensions:
Frontal horn of LV at the level of foramen Monro:
<40yrs: <12mm
>40yrs: <15mm
Ventriculohemispheric ratio:
<33% in adults
<40% in children.
Third ventricle
Interventricular foramina
communicating opening b/w lateral
ventricle and 3rd ventricle.
Lateral wall-Thalamus,
hypothalamus
Post wall indented by pineal gland
The lateral walls of the third
ventricle are joined by an
interthalamic adhesion, or massa
intermedia, a band of grey matter
that extends from one thalamus to
the other.
Width of 3rd
ventricle
<5mmchildren
<7mm-<60
Reasonable
as
yrs to use 7 mm
rd
an average
width
of
3
<9mm->60
ventricle during the second
decade yrs
and add 1 mm for
Choroid plexuses
Vascular plexus of piamater which
enters ventricles invaginating
ependymal wall modified as a
secretory epithelium and secretes
CSF.
Supplied by the Anterior and posterior
choroidal artery.
Situated in the body, inferior horn of lateral
ventricle, 3rd ventricle and 4th ventricle
The venous blood drains into the internal
cerebral veins great cerebral vein
Straight sinus.
4th ventricle
Rhomboid fossa
Situated b/w pons and upper half of medulla in front and
cerebellum behind.
Triangular in sagittal ; bean shaped in axial (Posterior
indentation formed by facial colliculus)
3 openings
Median aperture of Magendie-situated in lower part of roof
Lateral aperture of Luschka at the end of each lateral recess
Recesses: lateral, median dorsal and lateral dorsal
SUBARACHNOID CISTERNS
Large SA spaces at certain places.
Acts as the cushion around the medulla and other brain
structures.
Pulsations of arteries within the cistern helps to force
the CSF.
Cistern has density of CSF.
Pontine cistern:
Pontine cistern:
The 5thcranialnerve, the
superior cerebellar artery,
the4th8thand 7thcranial
nerves, the loop of the
anterior-inferior cerebellar
artery
The 9th, 10thand
11thcranial nerves in close
relationship with the
posterior-inferior cerebellar
artery
The 12thcranial nerve and
the basilar artery.
Sylvian cistern
contains the M1 segment
of the middle cerebral
artery, the origin of the
lenticulostriate branches
and the first portion of the
basal vein.
Interpeduncular cistern:
Bifurcation of the basilar
artery and the apparent
origin of the 3rdcranial
nerve.
Retrothalamic cistern:
Also considered the "wings"
of the ambient cistern, are
the lateral extensions of
the ambient cisterns
located posterior to the
pulvinar nuclei
Cisterna Magnaor
cerebello-medullary
cistern:
It is the biggest of the
subarachnoid cisterns.
Located under the
cerebellum and behind the
medulla oblongata.
It communicates with the
fourth ventricle (via the
median aperture or
foramen of Magendie), the
medullary subarachnoid
space, and the pericerebellar subarachnoid
space.
THANK YOU
Questions
1. Segments of ACA
2. Segments of MCA
3. Segments of VA
4. Aberrant ICA
5. Artery of Percheron
6. Parts of lateral ventricle
7. Name of Ventral cisterns
8. Name of Dorsal cisterns
9. Name of communicating cisterns