1. Meninges, CSF & Ventricular system

2. Objectives Describe the arrangement of the meninges and their relationship to brain and spinal cord. Explain the occurrence of epidural, subdural and subarachnoid spaces. Locate the principal subarachnoid cisterns, and arachnoid granulations. Describe the ventricles of brain and importance of their choroids plexus. Summarize the pathway of cerebrospinal fluid (CSF) circulation Identify brain ventricles in CT scan, MRI.

3. MENINGES The brain and spinal cord are invested by three concentric membranes ; The outermost layer is the dura matter. The middle layer is the arachnoid matter. The innermost layer is the pia matter.

4. 1. Dura Mater - Composed of two layers a) Periosteal – outer layer, attaches to bone. b) Meningeal – inner layer, closer to brain. Two layers fused, except to enclose the dural sinuses 2. Arachnoid Layer - ‘spider’ web like. 3. Pia Mater - delicate, follows convolutions. Cranial Meninges - 3 layer protective membrane

5. Cranial Meningeal Spaces Epidural space Potential space superior to dura. Subdural space Potential space between dura and arachnoid mater. Subarachnoid space Filled with CSF Contains the blood vessels supplying brain.

6. In the cranial vault, the epidural space is normally closed since the dura is attached to the periosteum which is attached to the inner surface of the skull In the spinal cord the epidural space is filled with adipose tissue.

7. DURA MATER  The cranial dura is a two layered tough, fibrous membrane that surrounds the brain.  It is formed of two layers; periosteal and meningeal.  The periosteal layer is attached to the skull.  The meningeal layer is folded forming the dural folds; falx cerebri, and tentoriam cerebelli.  Sensory innervation of the dura is mostly from the three branches of the trigeminal and vagus nerves & C1 to C3.

8. DURA MATER  Two large reflection of dura extend into the cranial cavity 1.The falx cerebri, In the midline,  It is a vertical sickle shaped sheet of dura, extends from the cranial roof into the great longitudinal fissure between the two cerebral hemispheres.  It has an attached border adherent to the skull.  And a free border lies above the corpus callosum.

9. DURA MATER 2. A horizontal shelf of dura, The tentorium cerebelli,  It lies between the posterior part of the cerebral hemispheres and the cerebellum.  It has a free border that encircles the midbrain.  In the middle line it is continuous with the falx cerebri,

10. Arachnoid Mater& Pia Mater  The arachnoid mater is a soft, translucent membrane loosely envelops the brain.  The arachnoid mater is separated from the dura by a narrow subdural space.  The pia mater is the innermost, thin, delicate & highly vascular membrane that is closely adherent to the gyri and fitted into the sulci.  Between the pia and arachnoid mater lies the subarachnoid space which contains; fibrous trabeculae, main blood vessels and CSF.

12. Subarachnoid Space  It is varied in depth forming; subarachnoid cisterns.  The cisterna magna, or cerebllomedullary cistern which lies between the inferior surface of the cerebellum and the back of the medulla.  At this cistern CSF flows out of the fourth ventricle.

13. Subarachnoid Space The interpeduncular cistern, which is located at the base of the brain, where the arachnoid spans the space between the two cerebral peduncles. This cistern contains the optic chiasma & circulus arteriosus of Willis.

15. Pontine cistern(Prepontine cistern or cisterna pontis). Surrounds the ventral aspect of the pons. It contains: The basilar artery and the origin of the anteroinferior cerebellar artery. The origin of the superior cerebellar arteries. The sixth (VI) cranial nerve Subarachnoid Space

16. CSF CSF is clear, colorless, and odorless fluid produced within the ventricles secreted by the Choroid plexus.Choroid plexuses are areas where the lining wall of the ventricle is very thin and has a profusion of capillaries provides mechanical support – protection from pressure changes. In adults, the total volume of CSF is about 150 ml Between 400 and 500 mL of CSF is produced and reabsorbed daily. Thus the CSF turns over about 3.7 times a day. This continuous flow into the venous system dilutes the concentration of larger, lipoid soluble molecules penetrating the brain and CSF.venous system

17. Choroid Plexus The lining ependyma of each ventricle comes into contact with the surface pia mater allowing the invagination of a mass of blood capillaries --- combination of these capillaries, pia and ependyma constitutes the choroid plexus.

19. Pia and Ependyma Ependyma Pia The “hollow” brain Diagrammatic Cross Section

20. Pia and Ependyma In some locations pia mater and ependyma come together. A plexus of blood vessels “invaginates” the thin layer. Cerebrospinal fluid enters the ventricle across this membrane.

21. CSF Formation The cerebrospinal fluid is formed mainly in the choroid plexuses of the lateral, third, and fourth ventricles; Some originate from the ependymal cells lining the ventricles and from the brain substance through the perivascular spaces.

22. Choroid Plexus lateral ventricles –continuous through Interventricular foramen with the small plexus in the third ventricle. –secretes the bulk of the CSF fourth ventricle –separate from that in the third and lateral ventricles –only makes a small contribution to the total amount of CSF

23. Circulation  The circulation begins with its secretion from the choroid plexuses in the ventricles  The fluid passes from the lateral ventricles into the third ventricle through the interventricular foramina  It then passes into the fourth ventricle through the narrow cerebral aqueduct.  The circulation is aided by the arterial pulsations of the choroid plexuses and by the cilia on the ependymal cells lining the ventricles.  From the fourth ventricle, the fluid passes slowly through the median aperture and the lateral foramina of the lateral recesses of the fourth ventricle and enters the subarachnoid space

25. CSF Drainage The CSF returns to the vascular system by entering the dural venous sinuses via the arachnoid granulations (or villi).dural venous sinusesarachnoid granulations The arachnoid villi act as one-way valves between the subarachnoid space and the dural sinuses. The rate of absorption correlates with the CSF pressure.

27. CSF Drainage Flows along the cranial nerves and spinal nerve roots into the lymphatic channels; this flow may play a substantial role in CSF reabsorption, in particular in the neonate, in which arachnoid granulations are sparsely distributed.cranial nervesneonate

28. Summary Filtered from blood in: – Choroid plexuses Circulates in through ventricles, canals, & between meninges Returned to blood at superior sagittal sinus mainly in addition to other venous sinuses Along nerves to extra cranial lymphatics Through venous plexuses in vertebral canal and around spinal cord

30. VENTRICULAR SYSTEM Comprises of: –two lateral ventricles –third ventricle –cerebral aqueduct –the fourth ventricle

31. VENTRICULAR SYSTEM from the rightfrom above Central canal

32. The Lateral Ventricle Is the cavity inside the cerebral hemisphere The 2 lateral ventricles are the largest of the ventricles. They are irregular in shape. Each consists of a central part, with anterior, posterior and inferior horns.

33. Lateral ventricles C-shaped cavity within each cerebral hemisphere Consists of: –anterior horn - frontal lobe –body --- parietal lobe –posterior horn ---- occipital lobe –inferior horn ---- temporal lobe

34. Anterior horn (Frontal lobe) Is anterior to the interventricular foramen(of Monro). Its roof and anterior border are formed by the corpus callosum, Its vertical medial wall by the septum pellucidum. The floor is formed by the head of the caudate nucleus.

36. Central part Triangular in shape, having : Roof: corpus callosum; Medial wall: by the posterior part of the septum pellucidum Floor and inferolateral wall: by parts of the caudate nucleus, thalamus, choroid plexus and fornix.

39. Thalamus Thalamus and Basal ganglia Brain stem

40. Amygdaloid body Thalamus Tail of Caudate nucleus Head of Caudate nucleus Lentiform nucleus Body of Caudate nucleus

41. Posterior Horn Extends into the occipital lobe. Its roof is formed by fibers of the corpus callosum. It is the most variably developed and may even be absent.

42. Cingulate sulcus Posterior horn of lateral ventricle Collateral eminence Collateral sulcus Splenium of corpus callosum Tapetum of corpus callosum Optic radiation Callosal radiation

43. Inferior Horn It traverses the temporal lobe. Its roof is formed by the white substance of the cerebral hemisphere. Along the medial border is the stria terminalis and the tail of the caudate nucleus. The floor and the medial wall are formed by the fimbria, the hippocampus and the collateral eminence. The amygdaloid nucleus bulges into the terminal part of the inferior horn.

45. Third Ventricle It is a narrow cavity between the 2 thalami. is a narrow vertical cleft between the 2 lateral ventricles It communicates with the 2 lateral ventricles through the interventricular foramen and with the 4 th ventricle through the cerebral aquiduct. Comprises of: –Anterior wall –Two side walls –Floor –Roof

47. Third Ventricle Anterior wall: –lamina terminalis –anterior commissure Roof: The roof is formed by the tela choroidea Floor: –optic chiasma –tuber cinereum median eminence –infundibulum –mamillary bodies –posterior perforated substance –tegmentum of the cerebral peduncles Two side walls: –Thalamus Interthalamic adhesion (60% of brains) –Hypothalamus Supraoptic nucleus – ADH Paraventricular nucleus – Vasopressin/Oxytocin –Subthalamus Subthalamic nucleus

48. Tela choroidea Reflection of two layers of pia matter –Medially b/w interventricular foramina –Laterally across the upper surface of thalamus Tela choroidea (double fold of pia)

49. Third Ventricle

52. Aqueduct (of Sylvius) Cavity within midbrain Continuous above with third ventricle leads through the midbrain into the cavity of the fourth ventricle

53. Fourth ventricle The fourth ventricle is a cavity which lies posterior to the pons and upper half of the medulla oblongata and anterior to the cerebellum. It is continuous with the cerebral aqueduct (mesencephalic or Sylvius) above and the central canal of the spinal cord in the lower half of the medulla. On each side, a narrow prolongation, the lateral recess, projects around the brainstem; its lateral aperture (Foramen of Luschka) lies below the cerebellar flocculus.

54. Fourth ventricle The fourth ventricle has lateral boundaries, a roof and a floor. The lateral boundaries are formed on each side by the superior cerebellar peduncle, the inferior cerebellar peduncle and the cuneate and gracile tubercles.

55. Roof of the fourth ventricle The upper part is formed by the superior medullary velum The lower part is formed by the inferior medullary velum

56. The floor of the fourth ventricle, also known as rhomboid fossa, is formed by the dorsal surfaces of the pons and medulla oblongata

57. 57

58. 58 Applied Anatomy TB meningitis – block of aqueduct of Sylvius - hydrocephalus

59. 59 Normal Brain

60. 60 Normal Ventricles

61. 61 Hydrocephalus

62. 62 Normal ventricles and hydrocephalus