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ANATOMY OF THE CEREBRAL VENTRICLES Francois du Toit Diagnostic Radiology Kimberley Hospital.

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Presentation on theme: "ANATOMY OF THE CEREBRAL VENTRICLES Francois du Toit Diagnostic Radiology Kimberley Hospital."— Presentation transcript:

1 ANATOMY OF THE CEREBRAL VENTRICLES Francois du Toit Diagnostic Radiology Kimberley Hospital

2 The Cerebral Ventricles  Fluid filled (CSF) spaces within the brain  2 Lateral ventricles in each hemisphere  3 rd ventricle, Cerebral Aquaduct, 4th ventricle midline  Ependyma (thin epithelial membrane lining)

3 The Cerebral Ventricles

4 THE LATERAL VENTRICLE

5 The Lateral Ventricles Lies within each cerebral hemisphere: Frontal Horn (anterior) Body (atrium) Temporal Horn (inferior) Occipital Horn (posterior) Interventricular Foramen (of Monroe) connects each lateral ventricle with the 3rd ventricle at junction of anterior horn & body

6 The Lateral Ventricles

7

8 FRONTAL HORN THE LATERAL VENTRICLE

9 Frontal (anterior) Horn  Extends into frontal lobe  Roof & Ant extremity formed by: Corpus Collosum (Rostrum & Genu) Tapetum  Floor & Lateral Wall Caudate Nucleus  Medial Wall Septum Pellucidum

10

11 Roof / Anterior Border

12

13 Frontal (anterior) Horn  Extends into frontal lobe  Roof & Ant extremity formed by: Corpus Collosum (Rostrum & Genu) Tapetum  Floor & Lateral Wall Caudate Nucleus  Medial Wall Septum Pellucidum

14 Floor of Anterior Horn

15

16 Frontal (anterior) Horn  Extends into frontal lobe  Roof & Ant extremity formed by: Corpus Collosum (Rostrum & Genu) Tapetum  Floor & Lateral Wall Caudate Nucleus  Medial Wall Septum Pellucidum

17 Medial Wall of Anterior Horn

18 BODY (atrium) THE LATERAL VENTRICLE

19 Body of Lateral Ventricle  In Parietal Lobe  Roof & Lateral Wall Corpus Callosum Tapetal Fibres  Medial wall Septum Pellucidum  Floor (medial) Thalamus  Floor (lateral) Body of Caudate Nucleus  Thalamostriate vein in between  Body of Fornix lies above the thalamus  Between the fornix and the thalamus  Choroid plexus lies invaginated into the cavity of the ventricle in a groove - the choroidal fissure

20 Roof / Anterior Border

21 Body of Lateral Ventricle  In Parietal Lobe  Roof & Lat Corpus Callosum Tapetal Fibres  Medial wall Septum Pellucidum  Floor (medial) Thalamus  Floor (lateral) Body of Caudate Nucleus  Thalamostriate vein in between  Body of Fornix lies above the thalamus  Between the fornix and the thalamus  Choroid plexus lies invaginated into the cavity of the ventricle in a groove - the choroidal fissure

22 Body of Lateral Ventricle  In Parietal Lobe  Roof & Lat Corpus Callosum Tapetal Fibres  Medial wall Septum Pellucidum  Floor (medial) Thalamus  Floor (lateral) Body of Caudate Nucleus  Thalamostriate vein in between  Body of Fornix lies above the thalamus  Between the fornix and the thalamus  Choroid plexus lies invaginated into the cavity of the ventricle in a groove - the choroidal fissure

23 Body of Lateral Ventricle Caudate Nucleus Thalamus

24 The Lateral Ventricles

25 Body of Lateral Ventricle  In Parietal Lobe  Roof & Lat Corpus Callosum Tapetal Fibres  Medial wall Septum Pellucidum  Floor (medial) Thalamus  Floor (lateral) Body of Caudate Nucleus  Thalamostriate vein in between  Body of Fornix lies above the thalamus  Between the fornix and the thalamus  Choroid plexus lies invaginated into the cavity of the ventricle in a groove - the choroidal fissure

26 Thalamus Body of Fornix Choroid Plexus The Lateral Ventricles

27 TEMPORAL HORN (inferior) THE LATERAL VENTRICLE

28 Temporal (inferior) Horn  Extends anteriorly into Temporal Lobe  Lateral wall Fibres of Tapetum  Roof Tail of Caudate Nucleus  Floor Hippocampus pes hippocampi anterior crus of the fornix arising from this

29 Temporal Horn of Lateral Ventricle Tapetum

30 Temporal (inferior) Horn  Extends anteriorly into Temporal Lobe  Lateral wall Fibres of Tapetum  Roof Tail of Caudate Nucleus  Floor Hippocampus pes hippocampi anterior crus of the fornix arising from this

31

32 Temporal (inferior) Horn  Extends anteriorly into Temporal Lobe  Lateral wall Fibres of Tapetum  Roof Tail of Caudate Nucleus  Floor Hippocampus pes hippocampi anterior crus of the fornix arising from this

33 Crus of Fornix Hippocampus Pes

34

35 OCCIPITAL HORN (Posterior) THE LATERAL VENTRICLE

36 Occipital (posterior) Horn  Posterior Extension of Lateral ventricle  Extends into Occipital Lobe  Arises from trigone of lateral ventricle  posterior convexity of the body of the lateral ventricle  May be absent / poorly developed / extend the full depth  12% bilaterally well developed

37 THE CHOROID PLEXUS

38 Choroid Plexus of Lateral Ventricle  Responsible for most of the production of CSF  Extends from Inferior horn, through body, to interventricular foramen  NO CHOROID PLEXUS in Occipital & Frontal Horn  Continuous with Choroid Plexus of 3rd ventricle  Invaginated into Lateral Ventricles medially (Choroidal Fissure)

39 Choroid Plexus of Lateral Ventricle

40  Blood supply: Ant Choroidal a. (Branch of ICA) Post Choroidal a. (Branch of post Cerebral a.)  Venous drainage: Sup Choroidal vein (begins at inferior horn and passes anteriorly to IV foramen) Joins Sup Thalamostriate v. to form Internal Cerebral vein at IV foramen

41

42 3 rd Ventricle  Slit-like space between Thalami  Width = 2-10mm (increasing with age)  Thin anterior wall – Lamina Terminalis between ant commissure (above) to optic chiasm (below)  Extension inferiorly into optic chiasm = supraoptic recess  Floor = Structures of hypothalamus including pituitary whose hollow stalk is the infundibular recess of the ventricle  Fold of Pia containing CP = Tela Choroidea Narrow Anterior Apex at IV Foramen Wider Posterior  If Fluid accumulates = Cavum Velum Interpositum

43 Third Ventricle Thalamus

44 3 rd Ventricle  Slit-like space between Thalami  Width = 2-10mm (increasing with age)  Thin anterior wall – Lamina Terminalis between ant commissure (above) to optic chiasm (below)  Extension inferiorly into optic chiasm = supraoptic recess  Floor = Structures of hypothalamus including pituitary whose hollow stalk is the infundibular recess of the ventricle  Fold of Pia containing CP = Tela Choroidea Narrow Anterior Apex at IV Foramen Wider Posterior  If Fluid accumulates = Cavum Velum Interpositum

45 Lamina Terminalis Optic Chiasm Anterior Commisure

46 3 rd Ventricle  Slit-like space between Thalami  Width = 2-10mm (increasing with age)  Thin anterior wall – Lamina Terminalis between ant commissure (above) to optic chiasm (below)  Extension inferiorly into optic chiasm = supraoptic recess  Floor = Structures of hypothalamus including pituitary whose hollow stalk is the infundibular recess of the ventricle  Fold of Pia containing CP = Tela Choroidea Narrow Anterior Apex at IV Foramen Wider Posterior  If Fluid accumulates = Cavum Velum Interpositum

47

48 3 rd Ventricle  Slit-like space between Thalami  Width = 2-10mm (increasing with age)  Thin anterior wall – Lamina Terminalis between ant commissure (above) to optic chiasm (below)  Extension inferiorly into optic chiasm = supraoptic recess  Floor = Structures of hypothalamus including pituitary whose hollow stalk is the infundibular recess of the ventricle  Fold of Pia containing CP = Tela Choroidea Narrow Anterior Apex at IV Foramen Wider Posterior  If Fluid accumulates = Cavum Velum Interpositum

49

50 3 rd Ventricle  Slit-like space between Thalami  Width = 2-10mm (increasing with age)  Thin anterior wall – Lamina Terminalis between ant commissure (above) to optic chiasm (below)  Extension inferiorly into optic chiasm = supraoptic recess  Floor = Structures of hypothalamus including pituitary whose hollow stalk is the infundibular recess of the ventricle  Fold of Pia containing CP = Tela Choroidea Narrow Anterior Apex at IV Foramen Wider Posterior  If Fluid accumulates = Cavum Velum Interpositum

51 Cavum Velum Interpositum

52 3 rd Ventricle  Posteriorly - extends as small pineal recess into pineal stalk, and above this into suprapineal recess  Roof - anteriorly, the anterior commissure, column of fornix and IV foramen. Behind this the body of the fornix, with Choroid plexus invaginating below the fornix  60% of people - thalami connected across the ventricle via massa intermedia (non-neural connection)

53

54 3 rd Ventricle  Posteriorly - extends as small pineal recess into pineal stalk, and above this into suprapineal recess  Roof - anteriorly, the anterior commissure, column of fornix and IV foramen. Behind this the body of the fornix, with Choroid plexus invaginating below the fornix  60% of people - thalami connected across the ventricle via massa intermedia (non-neural connection)

55 Fornix Ant Commisure Choroid Plexus

56 3 rd Ventricle  Posteriorly - extends as small pineal recess into pineal stalk, and above this into suprapineal recess  Roof - anteriorly, the anterior commissure, column of fornix and IV foramen. Behind this the body of the fornix, with Choroid plexus invaginating below the fornix  60% of people - thalami connected across the ventricle via massa intermedia (non-neural connection)

57 THE CEREBRAL AQUEDUCT

58 Cerebral Aquaduct  Narrow channel connecting post end of 3rd ventricle with sup end of 4th ventricle  1.5cm in length. 1-2mm in diameter  Passes through Brainstem with Tectum posterior to it and Tegmentum and Cerebral Peduncles anteriorly  Nuclei of CN III,IV,V surround aqueduct and are called the periaqueductal grey matter

59 Cerebral Aqueduct

60

61

62 4 th Ventricle  Aqueduct widens Posterior to the Pons  Narrows again in inferior part of medulla as central canal of the medulla & of spinal cord  Floor = diamond shaped (rhomboid fossa) Formed by post surface of pons and upper part of medulla  Roof  SUPERIOR superior cerebellar peduncle with sup medullary velum between INFERIOR inf cerebellar peduncle and the inf medullary velum Over these lies the cerebellum

63 4 th Ventricle

64

65  Aqueduct widens Posterior to the Pons  Narrows again in inferior part of medulla as central canal of the medulla & of spinal cord  Floor = diamond shaped (rhomboid fossa) Formed by post surface of pons and upper part of medulla  Roof  SUPERIOR superior cerebellar peduncle with sup medullary velum between INFERIOR inf cerebellar peduncle and the inf medullary velum Over these lies the cerebellum

66 4 th Ventricle Roof

67 Foramina 4 th Ventricle

68 Foramina of 4 th Ventricle  3 Openings in lower part of roof one median aperture (of Magendie) large opening in inf medullary velum beneath the cerebellum, which communicates with the cisterna magna two lateral apertures (of Luschka) at apex of lateral recesses of the ventricle open anteriorly just behind CN VIII into the pontine cistern  Choroid plexus invaginates the lower part of its roof and is supplied by inferior cerebellar a.

69 Foramen of Magendie

70 4th Ventricle Foramina  3 Openings in lower part of roof one median aperture (of Magendie) large opening in inf medullary velum beneath the cerebellum, which communicates with the cisterna magna two lateral apertures (of Luschka) at apex of lateral recesses of the ventricle open anteriorly just behind CN VIII into the pontine cistern  Choroid plexus invaginates the lower part of its roof and is supplied by inferior cerebellar a.

71 Foramen of Luschka

72 4th Ventricle Foramina  3 Openings in lower part of roof one median aperture (of Magendie) large opening in inf medullary velum beneath the cerebellum, which communicates with the cisterna magna two lateral apertures (of Luschka) at apex of lateral recesses of the ventricle open anteriorly just behind CN VIII into the pontine cistern  Choroid plexus invaginates the lower part of its roof and is supplied by inferior cerebellar a.

73 Choroid Plexus of 4 th Ventricle

74 CSF PRODUCTION & FLOW

75 CSF Production & Flow  Total Volume of CSF = 150ml (25ml is within and around the spinal cord)  Produced at 0.4ml/min  Production independent of CSF pressure  Principally produced by Choroid Plexus of lateral ventricles

76 CSF Flow  Flows through Interventricular foramen into 3rd ventricle  Via Cerebral Aqueduct to 4 th Ventricle  Via Midline Aperture (of Magendie) into Cisterna Magna  Via Lateral Apertures into Pontine Cistern  From Basal Cisterns  some fluid flows down and bathes the spinal cord  The Remainder  passes upward through tentorial hiatus and diffuses over surface of the cerebral hemispheres

77 CSF Flow

78 Into 3 rd Ventricle (Monroe)

79 Into 4 th Venticle (Cerebral Aqueduct)

80 Into Cisterna Magna (Magendie)

81 Down to Spinal Cord

82 Upwards over Cerebral Hemispheres

83 CSF Absorbtion  CSF is absorbed through the Arachnoid Villi herniations of arachnoid through holes in the dura into venous sinuses most numerous in sup sagittal sinus discrete in children with age they aggregate into visible clumps called arachnoid granulations these indent the inner table of the skull beside the dural venous sinuses

84 Arachnoid Villi

85 CSF Absorbtion  1/3 CSF absorbed along similar spinal villi OR escapes along nerve sheaths into perineural lymphatics  This absorption is passive and dependent on hydrostatic pressure differences

86 ANATOMICAL VARIANTS

87 Cavum Velum Interpositum  Fluid Collects in Tela Choroidea Narrow apex anterior Wider Posteriorly

88 Cavum Velum Interpositum

89 Cavum Septum Pellucidum  Two potential spaces between leaflets of Septum Pellucidum ANTERIOR Cavum Septum Pellucidum POSTERIOR Cavum Vergae  Obliterate Postero-anteriorly during development  CSP present in 100% of fetusses  85% Obliterate by 3-6months  Absent CSP in fetus associated with significant CNS abnormalities

90 Cavum Vergae  Seperation of the leaflets of septum pellucidum  Posterior extension to the splenium of corpus collosum  Because of ordered obliteration – CSP almost always accompanies a Cavum Vergae

91 Cavum Vergae Cavum Septum Pellucidu m Cavum Vergae

92 References  Anatomy for Diagnostic Imaging, 3 rd Edition Stephanie Ryan, Michelle McNicholas, Stephen Eustace  Atlas of Human Anatomy, 2 nd Edition Frank H. Netter  


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