1. The Meninges and Blood Vessels of Brain and Spinal Cord, and the Cerebrospinal Fluid

2. The Meninges of Brain and Spinal Cord
The spinal cord and brain are surrounded by three membranes, the meninges. Named from the outside inward they are the dura mater, arachnoid, and pia mater.

3. The meninges of spinal cord
Spinal dura mater
Spinal arachnoid mater
Spinal pia mater

4. Spinal dura mater Characters
Above, attached to circumference of foramen magnum
Below, becomes thinner at level of S2, invests filum terminale to attach at back of coccyx

5. Epidural space Subdural space
Position: lies between spinal dura mater and periosteum of vertebral canal
Contents: a quantity of loose connective tissue, fat, lymphatic vessels and vertebral venous plexus, the spinal nerves on each side pass through the epidural space which is applicable for block anesthesia
Subdural space

6. Spinal arachnoid mater
Characters
A thin, delicate, tubular membrane loosely investing spinal cord
Above, it is continuous with cerebral arachnoid mater

7. Subarachnoid space
Position: lies between pia and arachnoid maters containing cerebrospinal fluid
Terminal cistern : the largest part of subarachnoid space extending from termination of spinal cord to level of S2, where it is occupied by nerves of cauda equina, so it is the best site for a lumbar puncture

8. Lumbar spinal puncture (spinal tap)

9. Spinal pia mater
A delicate vascular membrane that closely invests the spinal cord
Denticulate ligament: consist of 21 pairs triangular ligaments extending from spinal cord on each side between anterior and posterior roots of spinal nerves to spinal dura mate; these ligaments help to fix position of spinal cord.
Filum terminale: an extension of pia beyond conus medullaris

10. The Meninges of Brain Cerebral dural mater Cerebral arachnoid mater
Cerebral pia mater

11. Cerebral dural mater Characters
A thick and dense inelastic membrane that composed of two layers, an inner or meningeal and outer or endosteal
It is in loose contact with calvaria, and most strongly adherent to base of skull

12. Four septa Cerebral falx
Tentorium of cerebellum－in front there is a gap, the tentorial incisure , for passage of midbrain
Cerebellar falx
Diaphragma sellae

13. Sinuses of duramater Superior sagittal sinus Inferior sagittal sinus
Straight sinus
Confluence of sinus

14. Transverse sinus
Sigmoid sinus
Superior petrosal sinuses
inferior petrosal sinuses

15. Position: lies on each side of sella turcica
Cavernous sinus
Position: lies on each side of sella turcica
Relations of cavernous sinus:
Internal carotid artery and abducent nerve run through the sinus
Oculomotor and trochlear nerves and ophthalmic and maxillary divisions of trigeminal nerve lie in the lateral wall of the sinus

16. Cavernous sinus nerves

17. The flowing of the blood in dural sinus
Sup. sagittal sinus
Inf. sagittal sinus
Straight sinus
Confluence of sinus
Transverse sinus
Sup. petrosal sinus
Sigmoid sinus
Cavernous sinus
Inf. petrosal sinus
Internal jugular vein

18. Cerebral arachnoid mater
Characters: a delicate membrane covering brain loosely, passing over sulci and entering only cerebral longitudinal and transverse fissures

19. Arachnoid granulations － project into sinuses of dura mater, serve as sites where cerebrospinal fluid diffuses into bloodstream

21. Subarachnoid cisterns
Cerebellomedullary cistern
Interpeduncular cistern
Pontine cistern
Superior cistern

23. Cerebellomedullary cistern

24. Cerebral pia mater
Closely invests brain surface, in some areas the pia invaginates into ventricles to take part in the formation of choroids plexus

25. Circulation of cerebrospinal fluid (CSF)
Cerebrospinal fluid is a clear colorless fluid, which acts as a transport medium for nutrients and vaster products and provides a protective fluid cushion for the central nervous system.
Production: produced by the choroids plexuses within the lateral, third and fourth ventricles

26. Circulation of cerebrospinal fluid
interventricular foramina
CSF drains from lateral ventricle
third ventricle
mesencephalic aqueduct
median and two lateral apertures
fourth ventricle
arachnoid granulations
subarachnoid space
superior sagittal sinus
vein

27. Blood vessels of brain and spinal cord

28. Arteries of brain Two sources
Internal carotid artery: supplies anterior 2/3 of cerebral hemisphere and parts of diencephalon
Vertebral artery: supplies postterior 1/3 of cerebral hemisphere and parts of diencephalon, brain stem and cerebellum

29. Internal carotid artery
Hypophysial a.
Ophtalmic a.
Anterior cerebral artery
Middle cerebral artery
Anterior choroidal artery
Posterior communicating artery

30. Anterior cerebral artery
Joined the fellow of the opposite side by the anterior communicating artery
Cortical branches: supply all medial surface of the cerebral cortex as far back as the parietooccipital sulcus and superior border of the suprolateral surface of the cerebral hemisphere
Central branches: supply caudate nucleus, anterior part of lentiform nucleus and anterior limb of internal capsule

32. Middle cerebral artery
Cortical branches: supply most of superolateral surface of cerebral hemisphere and insular lobe
Central branches: supply lentiform and caudate nuclei, genu and posterior limb of internal capsule (lenticulostriate artery)

34. Anterior choroidal artery: passes backward, enters inferior horn of lateral ventricle, and ends in choroid plexus. It supplies lateral geniculate body, posterior limb of internal capsule, middle 3/5 of crus cerebri,and globus pallidus
Posterior communicating artery: runs backward to join posterior cerebral artery

37. Vertebral artery Cranial branche Branches of basilar artery
Anterior and posterior spinal arteries
Posterior inferior cerebellar artery
Branches of basilar artery
Anterior inferior cerebral artery
Labyrinthine artery
Pontine arteries
Superior cerebellar artery
Posterior cerebral artery

38. Blood Supply to the Brain Stem
The brain stem (medulla, pons
midbrain) receives the bulk of its
blood supply from the
vertebrobasilar system. Except
for the labyrynthine branch,
all other branches supply the
brain stem and cerebellum
The posterior cerebral has only
a small contribution, its main
target being the posterior
cerebral hemispheres

39. Branches of the Basilar Artery
1. Anterior Inferior Cerebellar Arteries
(AICA), originates near the lower border
of the Pons just past the union of the
vertebral arteries.
Distribution:
a. supplies anterior inferior surface and
underlying white matter of cerebellum
b. contributes to supply of central
cerebellar nuclei
c. also contributes to upper medulla
and lower pontine areas

40. Branches of the Basilar Artery
2. Pontine arteries, numerous smaller
branches that can be subdivided into
Paramedian and Circumferential pontine
arteries. The Circumferential can be
further subdivided into Long and Short
pontine arteries.
Distribution:
a. paramedian pontine - basal pons
b. circumferential pontine - lateral pons
and middle cerebellar peduncle, floor
of fourth ventricle and pontine tegmentum

41. Branches of the Basilar Artery
3. Superior Cerebellar arteries, originates
near the end of the Basilar artery,
close to the Pons-Midbrain junction.
Runs along dorsal surface of cerebellum
Distribution:
a. cerebellar cortex, white matter and
central nuclei
b. Additional contribution to rostral
pontine tegmentum, superior cerebellar
peduncle and inferior colliculus

42. Branches of the Basilar Artery
4. Posterior cerebral arteries, the terminal
branches of the Basilar artery. They
appear as a bifurcation of the Basilar,
just past the Superior Cerebellar arteries
and the oculomotor nerve.
Curves around the midbrain and reaches
the medial surface of the cerebral
hemisphere beneath the splenium of the
corpus callosum
Distribution:
a. mainly neocortex and diencephalon
b. some contribution to interpeduncular
plexus

43. Branches of the Basilar Artery
5. Labyrynthine arteries, may branch
from the basilar, but variable in its
origin. Supplies the region of the inner
ear

44. Posterior cerebral artery
Cortical branches: supply medial and inferior surfaces of temporal lobe and occipital lobe
Central branches: supply dorsal thalamus, medial and lateral geniculate bodies, hypothalamus and subthalamus

45. Cerebral arterial circle ( circle of Willis )
Formation: formed by anterior communicating artery, both anterior cerebral arteries, internal carotid arteries, posterior communicating arteries, and posterior cerebral arteries
Position: lies on sella turcica around optic chiasma, tuber cinereum and mamillary bodies

46. Area of oxygendeprives brain
Blockage
Thrombus
Plaque

47. Microaneurysm
Lenticulostriate arteries
Subarachnoid hemorrhage

48. Intracerebral
hemorhage
Arteriovenous
malformation

49. Classification of cerebral vein
Superficial cerebral veins
Superior cerebral veins
Inferior cerebral veins
Superficial middle cerebral veins
Deep cerebral veins
Internal cerebral vein
Basal vein (Rosenthal)
Great cerebral vein (Of Galen)

50. Veins of brain Superficial cerebral veins
Drain blood from cortex and subcortical medullary substance and empty into adjacent sinuses of dura mater

52. Veins of brain
Deep cerebral veins: drain deeper parts of hemispheres, basal nuclei, internal capsule, diencephalon and choroid plexus, ultimately form great cerebral vein which enter straight sinus