Anatomy of meninges, ventricles, cerebrospinal fluid
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Transcript of Anatomy of meninges, ventricles, cerebrospinal fluid
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MENINGES, VENTRICLES, CEREBROSPINAL FLUID AND BOOLD SUPPLY OF THE BRAIN
Dr. Israa M. SulaimanDr. Mohammed Faez
Department of AnatomyIMS/MSU
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OBJECTIVES
• Illustrate and describe the Meninges’s three membranes.
• Describe the structure of the meninges, its blood supply and nerve supply.
• Illustrate and describe the venous blood sinuses
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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.
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The Meninges
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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"
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The Meninges
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Sagittal section showing the duramater
1) Falx cerebri
2) Tentorium cerebelli
3) Falx cerebelli
4) Diaphragma sellae
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Superior view showing the duramater
1) Falx cerebri
2) Tentorium cerebelli
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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.
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DURA MATER Endosteal layer ;
o Periosteum - inner surface of the skull bones
o 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.
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duramater
Superior cerebral veins beneath arachnoid
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Coronal section of the upper part of the head
Endosteal layer
Meningeal layer
They are closely united except along certain lines; they are separated to form venous sinuses
Superior sagittal sinus
(Dural venous sinus)Dura mater
Subdural space
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DURA MATER
Dura mater septa:1. Falx cerebri 2. Falx cerebelli3. Tentorium cerebelli 4. Diaphragma sella
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Sagittal section showing the duramater
1) Falx cerebri
2) Tentorium cerebelli
3) Falx cerebelli
4) Diaphragma sellae
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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.
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Falx cerebriSuperior sagittal sinus
Inferior sagittal sinus Straight
sinus
Tentorium cerebelli
*
Frontal crest
Crista galli
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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.
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Tentorium cerebelli
Falx cerebri
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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.
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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
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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.
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Dural Blood Supply
Dural Arterial Supply• The dura mater’s 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.
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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
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Superior cerebral veins beneath arachnoid
Arachnoid mater
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Arachnoid mater
Arachnoid villi Arachnoid mater
Subarachnoid space
Arachnoid granulations
Subdural space
Arachnoid projects into venous sinuses
- sites for CSF diffuses into bloodstream
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• Superior cerebral veins, traverse the subdural space to reach the superior sagittal sinus and its lacunae
SUBDURAL SPACE :
Superior cerebral veins beneath arachnoid
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Subdural haematoma
*
Dura
Arachnoid
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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
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Median sagittal section to show the subarachnoid cisterns & circulation of CSF
Superior cistern
Interpeduncular cistern
Cerebellomedullary cistern
Chiasmatic cistern
Pontine cistern
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*
Subarachnoid haemorrage
Dura
Arachnoid
Pia mater
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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.
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Pia mater
Pia mater
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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
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Coronal section of the interventricular foramen showing the choroid plexus of 3rd & lateral ventricles
Ependyma
Choroid plexus of 3rd ventricle
Choroid plexus of lateral ventricle
Pia mater of tela choroidae
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Read About
The Venous Blood Sinuses
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VENTRICLES
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OBJECTIVES
• Illustrate and describe the ventricles.• Describe the structure of the ventricles.• Illustrate and describe the cerebrospinal
fluid (CSF) formation, absorption and circulation.
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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).
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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).
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Lateral view to show the ventricular system of the CNS
Central canal of medulla oblongata & spinal cord
Fourth ventricle
Lateral ventricle
Third ventricle
Interventricular foramen (Monro)
Cerebral aqueduct
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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
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Lateral ventricle
Frontal lobe
Parietal lobe
Temporal lobe
Occipital lobe
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C-shaped cavity & may be divided into :
2. Anterior horn
1. Body
3. Posterior horn
4. Inferior horn
Third ventricle
Fourth ventricle
Lateral view of the ventricular cavities of the brain
Lateral ventricle
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Anterior horn
Inferior horn
Posterior horn
Lateral view to show the ventricular system of the CNS
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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
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Frontal lobe
Parietal lobe
Temporal lobe
Occipital lobe
Third ventricle
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Third ventricle
Hypothalamus
Coronal section of the brain (posterior view)
Third ventricle
Thalamus
ROOF
FLOOR
Lateral wall
Body of fornix
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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.
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Cerebellum
Pons
Medulla oblongata (superior half)
Sagittal section of the 4th ventricle
Cerebral aqueduct
Central canal (spinal cord)
Fourth ventricle
Fourth ventricle
ANTERIORPOSTERIOR
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Frontal lobe
Parietal lobe
Temporal lobe
Occipital lobe
Fourth ventricle
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Pons
Medulla oblongata (superior half)
Fig. : Sagittal section of the 4th ventricle
Cerebral aqueduct
ANTERIOR
POSTERIOR
Superior part of the roof ;
Superior medullary velum
Inferior part of the roof ;
Inferior medullary velum
Roof or posterior wall of fourth ventricle :
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Floor or rhomboid fossa of fourth ventricle :
Formed by ;
1. Posterior surface of the pons
2. Cranial ½ of the medulla oblongata
Medial sulcus
(divides the floor into symmetrical halves)
Medial eminence
Sulcus limitans
Facial colliculus
Stria medullaris
(strands of nerve fibers)
Hypoglossal triangle
Vagal triangle
Posterior view of the 4th ventricle
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CENTRAL CANAL
Opens superiorly into the fourth ventricle
Fourth ventricle
Inferior ½ of medulla oblongata
Entire length of spinal cord
Central canal
(Lined with ependyma but no choroid plexus in the central canal)
Extends ;
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Frontal lobe
Parietal lobe
Temporal lobe
Occipital lobe
CENTRAL CANAL
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Conus medullaris-Terminal ventricle
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CEREBROSPINAL FLUID
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• 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)
CHOROID PLEXUS
Lateral ventricle
Third ventricle
Fourthventricle
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Coronal section of the cavities of the lateral and 3rd ventricles
Cavity Of Lateral Ventricle
Cavity Of Third Ventricle
Pia Mater
Ependyma
CN
THALAMUS
CORPUS CALLOSUM
Choroid Plexus of The Lateral Ventricle
Pia Mater of Tela Choroidae
BODY OF FORNIX
Choroid Plexus of The Third Ventricle
Blood supply derives from choroidal branches of the internal carotid & basilar arteries
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Arachnoid mater
Pia mater
Ependyma
CEREBELLUMCavity of fourth ventricle
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
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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”
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Physical characteristics and composition of the CSF
Appearance Clear and colourlessVolume 130 mlRate of production 0.5 ml/minPressure 60-150 mm of waterComposition protein 15-45 mg/100 ml glucose 50-85 mg/ 100 ml chloride 720-750 mg/100 mlNo. of cells 0-3 lymphocytes/cu mm
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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
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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
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Choroid plexus of the 4th ventricle
Choroid plexus of the 3rd ventricle
12
3
5
3.2
3.1
4
Superiorly = lateral aspect of each cerebral hemisphere
Inferiorly = subarachnoid space around the brain & spinal cord
Choroid plexus of the lateral ventricle
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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.
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Choroid plexus of the lateral ventricle
Site of formation
1. Lateral ventricle
2. Third ventricle
Interventricular foramina
3. Fourth ventricle
Cerebral aqueduct
3.2 Lateral foramina (Luschka)
3.1 Median foramen (Magendie)
3.2 Lateral foramina (Luschka)
4. Subarachnoid space
Inferiorly
Superiorly
Absorbed
Superiorly
Absorbed
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Median sagittal section to show the subarachnoid cisterns & circulation of CSF
Superior cistern
Interpeduncular cistern
Cerebellomedullary cistern
Chiasmatic cistern
Pontine cistern
Circulation of CSF in subarachnoid space :
Median foramen of 4th ventricle
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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
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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
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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.
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BLOOD SUPPLY OF THE BRAIN
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OBJECTIVES
• Illustrate and describe the formation of the circle of willis
• Describe the blood supply of the brain– Arterial supply– Venous drainage
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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).
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Internal carotid artery
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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
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Vertebral artery
Common carotid artery
External carotid artery
Internal carotid arteryIn temporal bone
Internal carotid artery in cavernous sinus
Basilar artery
Posterior cerebralartery
Posterior communicatingartery
Middle cerebralartery
Anterior cerebralartery
Basilar artery
Posterior cerebralartery
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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
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Vertebral artery
Common carotid artery
External carotid artery
Internal carotid arteryIn temporal bone
Internal carotid artery in cavernous sinus
Basilar artery
Posterior cerebralartery
Posterior communicatingartery
Middle cerebralartery
Anterior cerebralartery
Basilar artery
Posterior cerebralartery
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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
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• VERTEBRAL– Basilar– PCA– Pontine– Labyrinthine– Ant Inf CA– Sup cerebellar– Choroidal
• INTERNAL CAROTID– ACA – MCA – Ophthalmic– Ant ComA– Post Com A– Choroidal
Branches of :-
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• CEREBRAL (ICA)– Ophthalmic– Post Communicating– Choroidal– Ant Cerebral
• Cortical• Central • Communicates with
– Ant Comm Art– Post Cerebral
– Mid Cerebral• Cortical• Central
• CRANIAL (VERT)– Meningeal– Post Spinal– Ant Spinal– Post Inf Cerebellar– Medullary
• (BASILAR)– Pontine– Labyrinthine– Ant Inf Cerebellar– Sup Cerebellar– Post Cerebral
• Cortical• Central • Choroidal
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Circle of Willis
• Interpeduncular fossa – base of brain
• Anastomosis – 2 internal carotid
arteries– 2 vertebral arteries
• In the subarachnoid space
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INFERIOR VIEW
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Vertebral arteries
Basilar A
Posterior cerebral artery
Posterior communicating artery
Internal carotidartery
Middle cerebral artery
Anterior cerebral artery
Anterior communicating artery
Post Inf cerebellar A
Sup cerebellar A
Ant Inf cerebellar A
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Middle cerebral artery
Anterior cerebral artery
Posterior cerebral artery
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Anterior cerebral artery
Superior frontal gyrus
Central sulcus
Parieto-occipitalsulcus
Frontal pole
Superior parietal lobule
Frontal pole
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ANTERIOR CEREBRAL ARTERYLOBE AREA
FRONTAL LOBE
Motor – lower limb and perineum - pericentral lobule
PARIETAL LOBE
Sensory – lower limb and perineum - paracentral lobule
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Lentiform nucleus
Caudate nucleus
Internal capsule (ANT)
Hypothalamus (ANT)
lentiform
caudate
Internalcapsule
Anterior cerebral artery & anterior communicating artery
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Middle cerebral artery
Central branches
Temporal pole
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Left middle cerebral artery
Right middle cerebral artery
Medialstriatearteries
Lateralstriatearteries
Central branches
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MIDDLE CEREBRAL ARTERYLOBE AREA
FRONTAL Motor – except for paracentral lobule
Motor speech – esp left side
PARIETAL Sensory – except for paracentral lobule
Sensory speech
TEMPORAL Auditory
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Lentiform nucleus
Caudate nucleus
Internal capsule (ANT & POST)
lentiform
caudate
Internalcapsule
Middle cerebral artery & anterior choroidal artery
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Posterior cerebral artery
Inferior temporal gyrus
Inferior temporal gyrus
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POSTERIOR CEREBRAL ARTERYLOBE AREA
OCCIPITAL Visual
TEMPORAL Olfactory
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Hypothalamus
Thalamus (ANT)
Cerebral pedunclethalamus
Cerebralpeduncle
Internalcapsule
Posterior cerebral artery & posterior communicating artery
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Thalamus (POST)
Geniculate bodies
Cerebral pedunclethalamus
Cerebralpeduncle
Posterior lateral arteries
Lateral Geniculatebodies
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Corpus striatum Middle & lateral striate
Anterior & Middle cerebral arteryInternal capsule
Thalamus PComA, basilar, PCA
Midbrain PCA, supCerebellarA, basilar
Pons Basilar, Ant, inf, supCerebellarA,
Medulla oblongata
Vertebral, ASA,PSA,PICA, basilar
Cerebellum supCerebellar, AICA,PICA
ARTERIES to specific brain areas
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VENOUS DRAINAGE of THE BRAIN
• EXTERNAL– Superior
cerebral– Superficial
middle cerebral
– Deep middle cerebral
• INTERNAL– Thalamostriate
– choroidal
• SPECIFIC– Midbrain– Pons– Medulla
oblongata– cerebellum
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Superior cerebral
SuperficialMiddlecerebral
basal
SuperiorSagittalsinus
Transverse sinus
SuperiorSagittalsinus
InferiorSagittalsinus
Great cerebral
Internal cerebral
Straight sinus
Occipital sinus
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Superior cerebral
SuperficialMiddle cerebral
SuperiorSagittalsinus
Transverse sinus
Superior anastomotic V
Inferior anastomotic V
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basal
SuperiorSagittalsinus
InferiorSagittalsinus
Great cerebral
Internal cerebral
Straight sinus
Occipital sinus
Site of junction with transversesinus
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EXTERNAL CEREBRAL VEINVEIN AREA DRAINS INTO
Superior cerebral Lateral surface of
cerebral hemisphere
Superior sagittal sinus
Superficial middle cerebral
Cavernous sinus
Deep middle cerebral
Insula Joined by ant cerebral & striate-basal vein
Sup anas V Superior sagittal sinus
Inf anas V Inferior sagittal sinus
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INTERNAL CEREBRAL VEINVEIN AREA DRAINS INTO
Thalamostriate Basal ganglia, thalamus, internal capsule,Tela choroidae of 3rd ventricle,hippocampus
Internal cerebral vein - great cerebral vein – straight sinus
DURAL VENOUS SINUS
Choroidal
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VEIN of specific areas
Midbrain Basal, great cerebral
Pons Basal, cerebellar
Medulla oblongata Anterior & posterior spinal
Cerebellum Great cerebral
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Superior sagittal sinus
Inferior sagittal sinus
Straight sinus
Superior cerebral vein
Medial aspect of hemisphere
Great cerebral vein
Transverse sinus
(R & L)
Sigmoid sinus (R & L)
Confluence of sinus
IntJugular vein
IntJugular vein
Cavernous sinus
Middle cerebral vein
Inferior petrosal sinus
Superior petrosal sinus
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Falx cerebriSuperior sagittal sinusInferior sagittal sinus
Straight sinus
Tentorium cerebelli
*
Superior petrosal sinus
Inferior petrosal sinus
Sigmoid sinus
Confluence of sinus
Transverse sinus
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Straight sinus Transverse
sinus
Sigmoid sinus
Confluence of sinus
Jugular foramen
Cavernous sinusSuperior petrosal sinus
Inferior petrosal sinus
Superiorsagittal sinus
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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
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• 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
CLINICAL APPLICATION
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CVA – due to blockage
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CVA – due to haemorrhage
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THANK YOU