Ventricular System, Cerebrospinal Fluid, Meninges, and Dural

Venous Sinuses
NEUROANATOMY (2ND Shifting) | (Evangelista, Flores, Gaa, Ilogon) | (November 20, 2018)

OUTLINE  Ventricles: four fluid-filled cavities within the brain

I. Ventricles of the Brain C. Straight Sinus  Lined throughout with ependyma
A. Lateral Ventricle D. Transverse Sinus  Filled with cerebrospinal fluid (CSF)
B. Third Ventricle E. Sigmoid Sinuses
 Developmentally derived from the cavity of neural tube (Fig 1 & 2)
C. Cerebral Aqueduct F. Occipital Sinus
 2 Lateral Ventricles
D. Fourth Ventricle G. Cavernous Sinuses
 Interventricular foramina/ Foramen of Monro - connects
E. Central Canal of the H. Superior and Inferior
the two lateral ventricles with the 3rd ventricle
Spinal Cord and Medulla Petrosal Sinuses
Oblongata I. Confluence of the Sinuses  Third Ventricle
II. Cerebrospinal Fluid V. Meninges in the Spinal Cord  Cerebral Aqueduct/ Aqueduct of Sylvius - connects 3rd
A. Formation A. Dura Mater ventricle to the 4th ventricle
B. Circulation B. Arachnoid Mater  Fourth Ventricle
C. Absorption C. Pia Mater  continuous with central canal of the spinal cord and through
D. Functions VI. Spaces the three foramina in its roof, with the subarachnoid space
III. Meninges of the Brain A. Epidural Space  Terminal ventricle - small dilation at the inferior end of the
A. Dura Mater B. Subdural central canal of the spinal cord
B. Arachnoid Mater C. Subarachnoid A. LATERAL VENTRICLE
C. Pia Mater VII. Clinical Significance of
IV. Dural Venous Sinuses Spaces
A. Superior Sagittal Sinus VIII.References
B. Inferior Sagittal Sinus IX. Appendix
OBJECTIVES
 Locate the meninges of the spinal cord.
 Identify the different spaces present in the central nervous
system
 Define epidural, subdural, and subarachnoid hemorrhage.
 Learn the causes, onset, and treatment of epidural, subdural,
and subarachnoid hemorrhage.

I. VENTRICLES OF THE BRAIN

Figure 2. Lateral View of Brain showing C-shaped Lateral Ventricles

 2 large lateral ventricles
 present in each cerebral hemisphere & roughly C-shaped
 Divided into body, which occupies the parietal lobe and from which
anterior, posterior and inferior horns extend into the frontal,
occipital and temporal lobes, respectively (Fig 2)
 Interventricular foramen/ Foramen of Monro - connection of lateral
ventricles to the 3rd ventricle
 Lies in the anterior part of the medial wall of the ventricle
 bounded anteriorly by anterior column of the fornix and posteriorly
by the anterior end of thalamus (Appendix B)
Body
 Extends from the interventricular foramen posteriorly as far as the
posterior end of the thalamus, where it becomes continuous with
the posterior and inferior horns
 Boundaries/Walls (Figure 3, B):
 Roof – formed by the undersurface of the corpus callosum
 Floor- formed by the body of the caudate nucleus and the lateral
margin of the thalamus
 Superior surface of the thalamus is obscured in its medial part by
the body of the fornix
 Medial wall - formed by the septum pellucidum anteriorly;
posteriorly, roof and the floor come together on the medial wall
Anterior Horn
 Extends forward into the frontal lobe; continuous posteriorly with the
body of ventricle at the interventricular foramen
 Boundaries (Figure 3, A):
 Roof - formed by the undersurface of the anterior part of the
corpus callosum
 Floor - formed by the rounded head of the caudate nucleus
 Medially, a small portion of the floor is formed by the superior
surface of the rostrum of the corpus callosum
Figure 1. Origin and Circulation of CSF(pink); ventricles (red boxes\  Medial wall - formed by the septum pellucidum and the anterior
column of the fornix
S 00 // T 00 Allado, Mutia, Tamayo, Tan 1 of 13
 Posterior Horn Choroid plexus of lateral ventricles (Fig 5)
 Extends posteriorly into the occipital lobe  Projects into the ventricle on its medial aspect; a vascular fringe
 Boundaries (Figure 3, C): composed of pia mater covered with the ependymal lining of the
 Roof and Lateral wall- formed by the fibers of the tapetum of ventricular cavity
the corpus callosum
 Lateral to the tapetum are the fibers of the optic radiation  Irregular lateral edge of the tela choroidea
 Medial wall- has two elevations: superior and inferior swellings  Tela choroidea- two-layered fold of pia mater situated between
 Superior swelling- also referred to as the bulb of posterior the fornix superiorly and the upper surface of the thalamus
horn; caused by the splenial fibers of the corpus callosum,  FUNCTION: produce CSF
called the forceps major, passing posteriorly into the
 Continued into the inferior horn and projects through the choroidal
occipital lobe
 Inferior swelling- also called as calcar avis; produced by the fissure at the junction of the body of the lateral ventricle and the
inferior horn
calcarine sulcus
 Choroidal fissure- slit-like gap between the body of the fornix and
Inferior Horn the superior surface of the thalamus
 Extends anteriorly into the temporal lobe (Fig 3)  through it, the blood vessels of the plexus invaginate the ia
 Boundaries (Figure 3C, 4, 5): matter of the tela choroidea and ependyma of lateral ventricle
 Roof- formed by the inferior surface of the tapetum of the corpus
callosum and by the tail of the caudate nucleus Note: Choroid plexus is formed from parts of tela choroidea w/c
 tail of the caudate nucleus passes anteriorly to the end in the extends to the ventricles. Tela choroidea is a 2-fold layer of pia
amygdaloid nucleus matter. Hindi Pia mater (in general) nagpoproduce ng CSF.
 Stria terminalis- found medial to the tail of the caudate
nucleus and also ends anteriorly in the amygdaloid nucleus
 Floor- formed laterally by the collateral eminence, produced by
the collateral fissure; medially by the hippocampus
 Hippocampus- composed of gray matter
 Pes hippocampus- expanded and slightly furrowed anterior
end of the hippocampus (feet-like anterior end of
hippocampus)
 Alveus- thin layer of white matter covering the ventricular
surface of the hippocampus; formed from the axons of the
cells of the hippocampus
 Fimbria- convergence of axons on the medial border of the
hippocampus, forming a nerve bundle; continuous posteriorly
with the posterior column of the fornix
 Temporal part of the choroidal fissure- interval between
stria terminalis and fimbria. This is where the lowest part of
the choroid plexus invaginates the ependyma from the medial
side and closes the fissure

Figure 4. Sagittal View of Ventricles enclosing the Limbic System

Figure 5. Coronal Section of the Cavities of the Third and Lateral Ventricles
B. THIRD VENTRICLE
 Slit-like cleft between the two thalami
 Communicates anteriorly with the lateral ventricles through the
interventricular foramina (of Monro) and posteriorly with the
Figure 3. Coronal Section of the Brain Showing Relations of Lateral Ventricles fourth ventricle through the cerebral aqueduct (of Sylvius) (Fig 6)

NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses 2 of 13
 Boundaries (Figure 7):
 Anterior wall- formed by a thin sheet of gray matter, the Lamina
terminalis, across which runs the anterior commissure
 Posterior wall- formed by the opening into the cerebral
aqueduct
 Lateral wall- formed by the medial surface of thalamus
superiorly and the hypothalamus inferiorly, separated by the
hypothalamic sulcus
 limited superiorly by stria medullaris thalami
 lateral walls are joined by interthalamic connection
 Superior wall/ Roof- formed by a layer of ependyma that is
continuous with the lining of the ventricle superiorly related to the
fornix and corpus callosum
 Inferior wall/ Floor- formed by optic chiasma, tuber cinereum,
infundibulum and mammillary bodies
Choroid plexus of 3rd ventricle
 Formed from the tela choroidea situated above the roof of the
ventricle (Figure 5)
 Projects downward on each side of the midline, invaginating the
Ependymal roof of the ventricle
 FUNCTION: produce CSF
 BLOOD SUPPLY of tela choroidea and choroid plexuses of the third
and lateral ventricles: choroidal branches of the internal carotid
and basilar arteries
 Venous blood drains into the internal cerebral veins, which unite
to form the great cerebral vein
 Great cerebral vein- joins the inferior sagittal sinus to form the
straight sinus
Figure 6. Frontal View of Brain Showing the Ventricular Cavities
Figure 7. Sagittal View of Brain Showing Walls of 3rd Ventricle
NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses
C. CEREBRAL AQUEDUCT
 a.k.a Aqueduct of Sylvius
 narrow channel about 3⁄4 of an inch (1.8 cm) long
 connects the third ventricle with the fourth ventricle (Figure 6)
 lined with ependyma and is surrounded by a layer of gray matter
called the central gray
 DIRECTION OF FLOW OF CSF: 3rd ventricle → 4th ventricle
 No choroid plexus
D. FOURTH VENTRICLE
 tent-shaped cavity filled with cerebrospinal fluid
 situated anterior to the cerebellum and posterior to the pons and the
superior half of the medulla oblongata (Figure 7)
 lined with ependyma and is continuous above with the cerebral
aqueduct of the midbrain and below with the central canal of the
medulla oblongata and the spinal cord
Figure 8. Posterior View of the 4th ventricle showing Foramen Magendie and
Foramen Luschka
 Boundaries (Figure 8):
 Lateral boundaries
 caudal part = inferior cerebellar peduncle
 cranial part= superior cerebellar peduncle
 Roof/ Posterior wall – tent-shaped and projects into the
cerebellum
 superior= medial borders of the 2 superior cerebellar
peduncles and a connecting sheet of white matter called
superior medullary velum
 inferior = inferior medullary velum, which consists of a thin
sheet devoid of nervous tissue and formed by the ventricular
ependyma and its posterior covering of pia mater
 Median aperture / Foramen of Magendie – large aperture at the
midline of the inferior part of roof
 Lateral openings of the 4th ventricle/ Foramina of Luschka-
anterior opening of lateral recesses around the sides of medulla
 Cavity of the 4th ventricle communicates with the subarachnoid
space through a single median opening (Foramen of
Magendie) and 2 lateral apertures (Foramina of Luschka)
 IMPORTANCE OF OPENINGS: permit the CSF to flow from
ventricular system into the subarachnoid space (Figure 9)
 Floor/ Rhomboid Fossa- diamond-shaped floor formed by the
posterior surface of pons and cranial half of medulla oblongata
(Figure 10)
(Recall posterior surface of pons)
 Median sulcus- divides the floor into symmetrical halves
 Medial eminence- elevation on each side of the sulcus
 Sulcus limitans- lateral boundary of medial eminence
 Vestibular area- lateral to sulcus limitans and above the
vestibular nuclei; inferior part lies lateral to the vagal triangle
 Facial colliculus- slight swelling at the inferior end of the medial
eminence that is produced by the fibers from the motor nucleus
of the facial nerve looping over the abducens nucleus
 Substantia ferruginea- bluish-gray area at the superior end of
sulcus limitans; produced by cluster of nerve cells containing
melanin pigment
 Stria medullaris - strands of nerve fibers derived from arcuate
nuclei; emerging from median sulcus, pass laterally over the
medial eminence and the vestibular area and enter inferior
cerebellar peduncle to reach cerebellum
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Figure 9. Sagittal Section of 4th Ventricle showing origin and flow of CSF
 Inferior to the stria medullaris, the following features should be
recognized in the floor of the ventricle:
 Hypoglossal triangle- most medial; indicates the position of
underlying hypoglossal nucleus
 Vagal triangle- lateral to hypoglossal triangle; superior to the
dorsal motor nucleus of vagus
 Area postrema- narrow area between vagal triangle and lateral
margin of the ventricle, just rostral to the opening into the central
canal
Choroid plexus of 4th Ventricle
 has a T-shape; vertical part of T is double (Figure 9)
 suspended from inferior half of the roof of the ventricle
 formed from highly vascular tela choroidea
 BLOOD SUPPLY to the plexus is from the posterior inferior
cerebellar arteries
 FUNCTION: Produce CSF
Figure 10. Posterior View of the Cavity of the 4th Ventricle
E. CEREBRAL CANAL OF THE SPINAL CORD AND MEDULLA
OBLONGATA
 opens superiorly into the 4th ventricle
 Inferiorly = extends through the inferior half of the medulla
oblongata and through the entire length of the spinal cord
 Terminal ventricle- expanded portion of central canal at the
 level of conus medullaris of spinal cord (Figure 1)
 closed at the lower end, filled with CSF and lined with ependyma
 Gray commissure- gray matter surrounding the central canal
 No choroid plexus
II. CEREBROSPINAL FLUID
 found in the ventricles of the brain and in the subarachnoid space
around the brain and spinal cord
 possesses inorganic salts similar to those in blood plasma (Table 1)
 Glucose content is about half that of blood, and there is only a trace
of protein
 few cells are present = Lymphocytes
 pressure is kept remarkably constant but may be raised by straining,
coughing, or compressing the internal jugular veins in the neck
NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses
Table 1. Physical Characteristics and Composition of CSF
Characteristics
Appearance Clear and colorless
Volume 150 mL
Rate of Production 0.5 mL/min
Pressure (Spinal tap with patient 60-150 mm of water
in lateral recumbent position)
Composition
Protein 15-45 mg/ 100 mL
Glucose 50-85 mg/ 100 mL
Chloride 720=750 mg/ 100 mL
Number of Cells 0-3 lymphocytes mm3
A. FORMATION
 CSF is formed mainly in the choroid plexuses of the lateral, third, and
fourth ventricles
 Some originates from the ependymal cells lining the ventricles and
from the brain substance through the perivascular spaces
 Choroid plexuses- have a much-folded surface consisting of a core
of vascular connective tissue covered with cuboidal epithelium of
ependyma (Figure 8)
 Free surfaces are covered with microvilli
 blood of the capillaries is separated from the ventricular lumen by
endothelium, basement membrane, and surface epithelium
 epithelial cells are fenestrated and permeable to large molecules
of choroid plexuses actively secrete CSF, creating a small
pressure gradient
 actively transport nervous system metabolites from CSF into the
blood = reason why potassium, calcium, magnesium, bicarbonate,
and glucose concentrations are lower in CSF than in blood plasma
(Table 1)
 CSF is produced continuously at a rate of 0.5 L/min; Turnover time =
5 hrs. production of CSF is NOT PRESSURE REGULATED (as in
the case of blood pressure)
 CSF continues to be produced even if reabsorption mechanisms are
obstructed
Figure 11. Microscopic structure of the choroid plexus showing the path
taken by fluids in the formation of cerebrospinal fluid
B. CIRCULATION
Circulation (See Figure 1 and Figure 12)
1. Secretion from choroid plexuses in the ventricles and a small
amount from the brain surface
2. Fluid passes from lateral ventricles into the 3rd ventricle through
the interventricular foramina
3. Passes into the 4th ventricle through the narrow cerebral
aqueduct o circulation is aided by the arterial pulsations of the
choroid plexuses and by the cilia on the ependymal cells lining
the ventricles
4. Passes slowly through the median aperture and the lateral
foramina of the lateral recesses of the 4th ventricle and enters
the subarachnoid space
5. Moves through the cerebellomedullary cistern and pontine
cisterns and flows superiorly through the tentorial notch of the
tentorium cerebelli to reach the inferior surface of the cerebrum
6. Moves superiorly over the lateral aspect of each cerebral
hemisphere, assisted by the pulsations of the cerebral arteries
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7. Some CSF moves inferiorly in the subarachnoid space around
the spinal cord and cauda equina = fluid is at dead end and its
circulation relies on the pulsations of the spinal arteries and the
movements of the vertebral column, respiration, coughing, and
the changing of the positions of the body
 CSF not only bathes the ependymal and pial surfaces of the brain
and spinal cord but also penetrates the nervous tissue along the
blood vessels
Figure 12. Circulation of CSF; dashed lines – course of fluid w/in cavities of CNS
C. ABSORPTION
Subarachnoid Hemorrhage
 Main sites for absorption of CSF
 Project into the dural venous sinuses, especially the superior
sagittal sinus
 Tend to be grouped to form elevations - Arachnoid Granulations
 Each arachnoid villus is a diverticulum (Arachnoid Diverticulum) of
the subarachnoid space that pierces the dura mater
 Arachnoid diverticulum is capped by a thin cellular layer, which is
covered by the endothelium of the venous sinus
 Arachnoid granulations increase in number and size with age and
tend to become calcified with advanced age
Figure 13. Coronal Section of the Superior Sagittal Sinus Showing an Arachnoid
Granulation
 Absorption of CSF into the venous sinuses occurs when the
pressure exceeds the venous pressure in the sinus
 Fine tubules lined with endothelium permit a direct flow of fluid from
the subarachnoid space into the lumen of the venous sinuses
 Should the venous pressure exceed the CSF pressure,
compression of the tips of the villi closes the tubules and prevents
the reflux of blood into the subarachnoid space – arachnoid villi thus
serve as valves
 Rate of absorption of CSF through the arachnoid villi controls the
CSF pressure
NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses
D. FUNCTIONS
 Cushions and protects the central nervous system from mechanical
trauma
 Provides mechanical buoyancy and support for the brain (slightly
denser than CSF)
 Serves as a reservoir that assists in the regulation of the contents of
the skull due to its close relationship with the nervous tissue and
blood
 If brain volume or blood volume increases, CSF volume decreases
 Nourishes the CNS (CSF is an ideal physiologic substrate)
 Assists in the removal of products of neuronal metabolism in the
CNS
 Serves as a pathway for pineal secretions to reach the pituitary
gland
Clinical Significance of CSF
 Blockage of CSF flow due to tumor and inflammation can lead to
non-communicating or obstructive hydrocephalus
 Common sites of obstruction:
 Interventricular foramina
 Cerebral aqueduct
 Median and lateral aperture
 Compensatory hypoplasia of brain leading to seizures and
intellectual disability
III. MENINGES OF THE BRAIN
A. DURA MATER
 Composed of two layers which are closely united except along
certain lines where they separate to form venous sinuses
Layers of Dura Mater
 Endosteal Layer
 The periosteum covering the inner surface of the skull bones.
 The layer which does NOT become continuous with the dura
mater of spinal cord in the foramen magnum
 However, it becomes continuous with the periosteum on the
outside of the skull bones around the margins of all foramina in
the skull
 It is also continuous with the sutural ligaments at the sutures
 Strongly adherent to the bones over the base of the skull
 Meningeal Layer
 The “Dura Mater Proper”
 Dense, strong fibrous membrane which covers the brain
 Unlike the endosteal layer, it is continuous with the foramen
magnum with the dura mater of the spinal cord
 Provides tubular sheaths for the cranial nerves to pass through
the foramina in the skull. Outside the skull these sheaths fuse
with the epineurium of the nerves
 Sends inward 4 SEPTA:
 Divide the cranial cavity into freely communicating spaces
that lodge the subdivisions of the brain
 Functions in restricting the displacement of the brain
associated with the acceleration and deceleration when the
head is moved
Figure 14. Layers of Dura Mater (Green = Endosteal Layer; Black = Meningeal
Layer)
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 Falx Cerebri Diaphragma Sellae (Figure 15)
 Sickle-shaped fold of dura mater that lies in the midline between the  Small, circular fold of dura mater that forms roof for sella turcica
two cerebral hemispheres  Allows the passage of the stalk hypophysis cerebri through its small
 narrow anterior end is attached to internal frontal crest & crista galli opening in the center
 Its broad posterior part blends in the midline with the upper surface Dural Nerve Supply
of the tentorium cerebelli
 Superior sagittal sinus runs in the upper margin of falx cerebri  The branches of the ff. pass to the dura mater:
 Inferior sagittal sinus runs the lower concave of falx cerebri  Trigeminal
 Straight sinus runs along the attachment of falx cerebri and tentorium  Vagus
cerebelli  First three cervical spinal nerve
 Branches from the sympathetic trunk
Tentorium Cerebelli
 A crescent-shaped fold of dura mater that roofs over the posterior  The dura possesses numerous sensory endings that are sensitive
cranial fossa to stretching, which produce the sensation of headache
 Covers the upper surface of the cerebellum and supports the occipital Dural Blood Supply
lobes of the cerebral hemispheres  Internal Carotid
 Tentorial notch is a gap found in the anterior edge which serves as  Maxillary
a passage of the midbrain and produces an inner free border and an  Ascending Pharyngeal
outer attached or fixed border (Figure 15)  Occipital
 Fixed border is attached to the posterior clinoid processes, the  Vertebral arteries
superior borders of the petrous bones, and the margins of the
grooves for the transverse sinuses on the occipital bone  Middle Meningeal Artery
 Free border runs forward at its two ends, crosses the attached  Most important since it can be damaged in head injuries
border and is affixed to the anterior clinoid process on each side  Arises from maxillary artery in the infratemporal fossa
 3rd and 4th cranial nerves pass forward at the point where the two  Enters the cranial cavity through the foramen spinosum and then
borders cross to enter the lateral wall of the cavernous sinus lies between the meningeal and endosteal layers of the dura
 Close to the apex of the petrous part of the temporal bone, the lower  Runs forward and laterally in a groove on the upper surface of
layer of the tentorium is pouched forward beneath the superior the squamous part of the temporal bone.
petrosal sinus to form a recess for the trigeminal nerve and the  The anterior branch deeply grooves or tunnels the anterior-
trigeminal ganglion inferior angle of the parietal bone, its course corresponds roughly
 Falx cerebri – attached to UPPER surfaces of tentorium; falx to the line of the underlying precentral gyrus of the brain.
cerebelli – attached to the LOWER surfaces of the tentorium  The posterior branch curves backward and supplies the posterior
 straight sinus runs along its attachment to the falx Cerebri part of the dura mater
 superior petrosal sinus runs along its attachment to petrous bone  Meningeal veins lie in the endosteal layer of dura
 transverse sinus runs along its attachment to occipital bone  The middle meningeal vein follows the branches of the middle
Falx Cerebelli meningeal artery and drains into the pterygoid venous plexus or
 Small, sickle-shaped fold of dura mater attached to the internal the sphenoparietal sinus
occipital crest The veins lie lateral to the arteries


 Projects forward between the two cerebellar hemispheres

 Its posterior fixed margin contains the occipital sinus

Figure 15. Falx Cerebri. Tentorium Cerebelli, Falx Cerebelli

Figure 17. Dural Blood Supply
B. ARACHNOID MATER
 delicate, impermeable membrane covering the brain
 Lying between:
 Internally: Pia Mater
 Externally: Dura Mater
 Subdural space
 Potential space that separates arachnoid mater from the dura by
a potential space
 filled by a film of fluid
 Subarachnoid space
 Separates arachnoid mater from the pia
 filled with cerebrospinal fluid
 Flattened Mesothelial Cells
 Covers the outer and inner surfaces of the arachnoid
Figure 16. Sinuses of the skull (blue)  The arachnoid bridges over the sulci on the surface of the brain

NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses 6 of 13
 in certain situations, the arachnoid and pia are widely separated to  Emissary veins
form the subarachnoid cisternae.  Connect dural venous sinuses with the diploic veins of the skull
 cisterna cerebellomedullaris and the veins of the scalp (also valveless)
 lies between the inferior surface of the cerebellum and the roof of
the fourth ventricle.
 cisterna interpeduncularis
 lies between the two cerebral peduncles.
 All the cisternae are in free communication with:
 one another
 with the remainder of the subarachnoid space.
 In certain areas, the arachnoid projects into the venous sinuses to
form arachnoid villi.
 most numerous along the superior sagittal sinus
 Aggregations of arachnoid villi: arachnoid granulations
 Arachnoid villi serve as sites where the cerebrospinal fluid
diffuses into the bloodstream.
Subarachnoid Space
 Separates arachnoid mater from the pia
 filled with cerebrospinal fluid
 Delicate strands of fibrous tissue
 connects the arachnoid to the pia mater across the fluid-filled
subarachnoid space
 Structures passing to and from the brain to the skull or its foramina
must pass through the subarachnoid space.
 All the cerebral arteries and veins lie in the space, as do the cranial
nerves.
 The arachnoid fuses with the epineurium of the nerves at their point
of exit from the skull
 In the case of the optic nerve: Figure 13. Coronal Section of the Brain Showing the Emissary Vein and Diploic
 the arachnoid forms a sheath for the nerve, which extends into Vein
the orbital cavity through the optic canal and fuses with the
sclera of the eyeball.
 Thus, the subarachnoid space extends around the optic nerve as
far as the eyeball.
Cerebrospinal fluid
 produced by the choroid plexuses within the lateral, third, and fourth
ventricles of the brain.
 It escapes from the ventricular system of the brain through the three
foramina in the roof of the 4th ventricle and so enters the
subarachnoid space.
 It now circulates both upward over the surfaces of the cerebral
hemispheres and downward around the spinal cord.
 The spinal subarachnoid space extends down as far as the second
sacral vertebra.
 Eventually, the fluid enters the bloodstream by passing into the
arachnoid villi and diffusing through their walls.
 Functions:
 removing waste products associated with neuronal activity
 provides a fluid medium in which the brain floats.
 This mechanism effectively protects the brain from trauma. Figure 19. Dural Venous Sinuses
 now believed to play a role in hormonal transport. A. SUPERIOR SAGITTAL SINUS
C. PIA MATER  Occupies the upper fixed border of the falx cerebri
 Vascular membrane  Begins anteriorly at the foramen cecum
 Also covered by flattened mesothelial cells  where it occasionally receives a vein from the nasal cavity
 Closely invests the brain, covering the gyri and descending into the
deepest sulci  Runs posteriorly, grooving the vault of the skull
 Extends out over the cranial nerves and fuses with their epineurium  At the internal occipital protuberance, it deviates to one or the other
 Cerebral arteries entering the substance of the brain carry a sheath side (usually the right) and becomes continuous with the
of pia with them corresponding transverse sinus.
 Forms the tela choroidea of the roof of the 3rd and 4th ventricles of  The sinus communicates through small openings with two or
the brain three irregularly shaped venous lacunae on each side
 Fuses with the ependyma to form the choroid plexuses in the  Numerous arachnoid villi and granulations project into the lacunae,
lateral, 3rd, and 4th ventricles of the brain which also receive the diploic and meningeal veins
IV. DURAL VENOUS SINUSES  The superior sagittal sinus in its course receives the superior
cerebral veins
 Situated between the layers of the dura mater
 At the internal occipital protuberance, it is dilated to form the
 FUNCTION: Receive: blood from the brain through the cerebral confluence of the sinuses
veins and CSF from subarachnoid space through the arachnoid villi
 Here, the superior sagittal sinus usually becomes continuous
 Blood ultimately drains into the internal jugular veins in the neck with the right transverse sinus
 lined by endothelium  it is connected to the opposite transverse sinus and receives the
 Walls are thick but devoid of muscular tissue occipital sinus
 Without valves
NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses 7 of 13

Figure 20. Superior View of Skull Showing the Venous Sinuses
B. INFERIOR SAGITTAL SINUS
 Occupies the free lower margin of the falx cerebri
 Runs backward and joins the great cerebral vein at the free margin
of the tentorium cerebelli to form the straight sinus
 FUNCTION: Receives a few cerebral veins from the medial surface
of the cerebral hemispheres.
C. STRAIGHT SINUS
 Occupies the line of junction of the falx cerebri with the tentorium
cerebelli
 Formed by the union of the inferior sagittal sinus with the great
cerebral vein
 Ends by turning to the left (sometimes to the right) to form the
transverse sinus.
D. TRANSVERSE SINUS
 Paired structures that begin at the internal occipital protuberance
 Right sinus: usually continuous with the superior sagittal sinus
 Left sinus: continuous with the straight sinus.
 Each sinus occupies the attached margin of the tentorium cerebelli,
grooving the occipital bone and the posteroinferior angle of the
parietal bone.
 Receive:
 superior petrosal sinuses
 inferior cerebral and cerebellar veins
 diploic veins
 End by turning downward as the sigmoid sinuses
E. SIGMOID SINUSES
 Direct continuation of the transverse sinuses.
 Each sinus turns downward and medially and grooves the mastoid
part of the temporal bone
 It is here that the sinus lies posterior to the mastoid antrum.
 The sinus then turns forward and then inferiorly through the
posterior part of the jugular foramen to become continuous with the
superior bulb of the internal jugular vein.
F. OCCIPITAL SINUS
 Small sinus occupying the attached margin of the falx cerebelli
 Commences near the foramen magnum, where it communicates
with the vertebral veins and drains into the confluence of sinuses.
G. CAVERNOUS SINUSES
 Situated in the middle cranial fossa on each side of the body of the
sphenoid bone.
 Numerous trabeculae cross their interior, giving them a spongy
appearance, hence the name.
 Each sinus extends from the superior orbital fissure in front to the
apex of the petrous part of the temporal bone behind.
 The internal carotid artery, surrounded by its sympathetic nerve
 plexus, runs forward through the sinus.
 Internal carotid artery and nerves are separated from the blood
by an endothelial covering
NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses
 The abducent nerve also passes through the sinus.
 The third and fourth cranial nerves and the ophthalmic and maxillary
divisions of the trigeminal nerve run forward in the lateral wall of the
sinus.
 The sinuses lie between the endothelial lining and the dura mater.
 Tributaries:
 Superior and inferior ophthalmic veins
 Inferior cerebral veins
 Sphenoparietal sinus
 Central vein of the retina
 The two sinuses communicate with each other by means of the
 anterior and posterior intercavernous sinuses, which run in the
diaphragma sellae anterior and posterior to the stalk of the
hypophysis cerebri.
 The superior and inferior petrosal sinuses are small sinuses
situated on the superior and inferior borders of the petrous part of
the temporal bone on each side of the skull.
H. SUPERIOR AND INFERIOR PETROSAL SINUSES
 Small sinuses on the superior and inferior borders of the petrous
part of the temporal bone.
 Superior petrosal sinuses: drains the cavernous sinuses into the
transverse sinuses
 Inferior petrosal sinuses: drains the cavernous sinuses into the
internal jugular veins
I. CONFLUENCE OF THE SINUSES
 The superior sagittal sinus is dilated at the internal occipital
protuberance to form the confluence of the sinuses
 Becomes continuous with the right transverse sinus.
 Connected to the opposite transverse sinus
 FUNCTION: Receives the occipital sinus
 Cavernous Sinus (CS) > drains to superior petrosal sinus >
sigmoid sinus > transverse sinus > confluence of sinuses >
superior sagittal sinus
(CS can be drained by inferior petrosal sinus to internal jugular
veins)
 Inferior sagittal sinus > straight sinus > confluence of sinuses >
superior sagittal sinus
V. MENINGES IN THE SPINAL CORD
A. DURA MATER
 Dense, strong, fibrous membrane
 Encloses the spinal cord and cauda equina.
 Continuous with the mengingeal layer of dura covering the brain
through the foramen magnum.
 Ends inferiorly on the filum terminale at the lower border of S2.
 Dural sheath lies loosely on the vertebral canal.
 Separated from the wall of the canal by the extradural space.
 Extends along each nerve root and becomes continuous with
epineurium.
 Epineurium: connective tissue surrounding each spinal nerve.
 Inner surface is in contact with the arachnoid mater.
Figure 21. Dura mater
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 B. ARACHNOID MATER
 Delicate impermeable membrane.
 Covers the SC
 Lies between pia mater internally and dura mater externally.
 Separated from the pia mater by a wide space, the subarachnoid
space.
 Continuous with the arachnoid covering of the brain through the
foramen magnum.
 Ends on the filum terminale inferiorly, at the level of S2 lower
border.
 Continues along the spinal nerve roots.
 Forms small lateral extensions of the subarachnoid space.
Figure 22. Arachnoid Mater and Other Meninges
C. PIA MATER
 Vascular membrane that closely covers SC.
 Thickened on either side between the nerve roots to form
ligamentum denticulatum.
 Ligamentum denticulatum: passes laterally to adhere to the
arachnoid and dura.
 Allows SC to be suspended in the middle of the dural sheath.
 Extends along each nerve root and becomes continuous with the
connective tissue surrounding each spinal nerve.
Figure 23. Pia Mater and Ligamentum Denticulatum
VII. SPACES
A. EPIDURAL (EXTRADURAL) SPACE
 Separates the dural sheath of the spinal cord and the walls of the
vertebral canal
 Contains loose areolar tissue & internal vertebral venous plexus
Figure 24. Epidural space (yellow)
NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses
B. SUBDURAL SPACE
 Potential space:
 Space between 2 adjacent structures that are normally pressed
together.
 Contains tissue fluid.
 Filled with cerebrospinal fluid.
 Separates arachnoid mater from the meningeal layer of dura mater.
 Meningeal layer of dura mater is usually adherent to the
underlying arachnoid mater via series of tight junctions.
 Does NOT exist under normal circumstances.
C. SUBARACHNOID SPACE
 Interval between arachnoid mater and pia mater.
 Present where these meninges envelop the brain & spinal cord.
 Filled with cerebrospinal fluid
 Contains large blood vessels of the brain.
 Transversed by a network of fine trabeculae, formed of delicate
connective tissue
Figure 25. Subarachnoid Space around the cerebral hemisphere. [Snell]
 Completely surrounds the brain and extends along the olfactory
nerves to the mucoperiosteum of the nose
 Extends along the cerebral blood vessels as they enter and leave
the substance of the brain.
 Stops where the vessels become an anteriole or venule.
 Subarachnoid space expands to form subarachnoid cisterns in
cases where arachnoid does not closely follow the surface of the
brain around the base of the brain.
 Subarachnoid cisterns:
 Cerebellomedullary cistern: lies between the inferior surface of
the cerebellum & the roof of the 4th ventricle
 Interpeduncular cistern: lies between the 2 cerebral peduncles
 Pontine cistern: lies on the ventral aspect of pons
 Inferiorly, extends beyond the lower end of the SC and invests the
cauda equina.
 Ends at the level between S2-S3.
 Surrounds the cranial and spinal nerves and follows them to the
point where they leave the skull and vertebral canal.
 Here, the arachnoid and pia mater fuse with the perineurium of
each nerve.
Figure 26. Lower limit of the Subarachnoid Space
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 Subdural Hemorrhage
VIII. CLINICAL SIGNIFICANCE
 Causes:
 Intracranial hemorrhage can result from trauma or cerebral vascular  Tearing of the bridging veins between brain surface and dural
lesions. sinus due to relatively minor trauma
 Some blood may be present in the subarachnoid space
4 varieties
 Tearing of the superior cerebral veins where they enter the
1. Epidural hemorrhage
sagittal sinus.
2. Subdural hemorrhage
 Results usually from a blow to the front or back of the head
3. Subarachnoid hemorrhage
4. Cerebral hemorrhage  Causes excessive anteroposterior displacement of the brain in
the skull.
Epidural Hemorrhage
 Skull fracture that causes a torn meningeal vessel may result in
extradural accumulation of blood that can rapidly compress the
brain.
 Leads to:
 Herniation
 Death
 Results from injuries to the meningeal arteries or veins.

Figure 27. Epidural Hemorrhage
 Anterior division of the middle meningeal artery is the common
artery to be damaged.
 Mechanism:
 Arterial or venous injury > bleeding > strips meningeal layer of
dura from internal surface of the skull > intracranial pressure
rises > enlarging blood clot exerts local pressure on underlying
area > blood may pass through the fracture line to form a small
swelling on side of the head.
 Treatment is done by surgically evacuation to relieve the pressure.
 Burr hole
 Onset and Course:
 Rapid deterioration after a lucid interval following a head trauma
Figure 29. Subdural Hemorrhage from cerebral veins at the site of entrance
into venous sinus on the right side.
 More common than middle meningeal hemorrhage.
 Can be caused by a sudden minor blow.
 Once vein is torn, blood under low pressure begins to accumulate in
the potential space between the dura and arachnoid.
 In few patients, it is bilateral.
 Children and aged adults with brain atrophy are at greater risk
 Onset and Course
 Time course is variable with slow deterioration
 Depressed level of consciousness sometimes with hemiparesis
 Treatment:
 Burr hole

Figure 30. Subdural Hemorrhage from cerebral veins at the site of entrance into
venous sinus on the right side.
Subarachnoid Hemorrhage
 Usually results from leakage or rupture of a congenital aneurysm
on the cerebral arterial circle/circle of Willis.
 Aneurysms may be congenital (berry aneurysm) or the result of
infection (mycotic aneurysm).
 Berry aneurysms- common in the circle of Willis or in the middle
cerebral trifurcation
Figure 28. Epidural Hemorrhage from middle meningeal artery of vein on left  Ruptured aneurysms- usually bleed into the subarachnoid
side. space; sometimes into the brain substance
NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses 10 of 13
Figure . Subarachnoid hemorrhage as white densities (left) and Berry Aneurysm
with communicating artery as thrombosed part (right)
 Arterial Spasm- complication of subarachnoid hemorrhage can
lead to infarcts
 Often occur in younger persons
 Found on the surface of the brain, deep in the brain substance,
or in the meninges
 Less commonly caused by an arteriovenous malformation,
angioma, or contusion and laceration of the brain and meninges.
 Angioma: abnormal growth produced by the dilatation or new
formation of blood vessels.
 Symptoms are acute.
 Severe headache
 Focal neurologic signs may be present
 Stiffness of the neck
 Loss of consciousness.
 If derived from arteriovenous malformation w/ bleeding:
 Repeated seizures due to ischemia or sudden onset of deficit
caused by bleeding may occur.
 Diagnosis:
 Can be established by the used of computed tomography or
CT.
 Dense areas of the blood in subarachnoid space can be
identified.
 MRI
 Withdrawal of heavily blood-stained cerebrospinal fluid through
lumbar puncture.
 Replaced by CT.

Figure 31. Partially thrombosed aneurysm (left) and arteriovenous malformation

(right)

IX. REFERENCES
 Snell, R.S. (2010). Clinical Neuroanatomy (7th ed.). Philadelphia,
PA: Lippincott Williams & WilkinsArial
 2021B trans
 2022C ppt

NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses 11 of 13
 X. APPENDIX

APPENDIX A:
A: Coronal section of the upper part of the head showing the layers of the scalp, sagittal suture of the skull, falx cerebri,
venous sinuses, arachnoid granulations, emissary veins, and relation of the cerebral blood vessels to the subarachnoid
space. B: Interior of the skull showing the dura mater and its contained venous sinuses.

NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses 12 of 13
 APPENDIX B:
A: Circulation of CSF (2021B trans)

NEUROANATOMY Ventricular System, Cerebrospinal Fluid, Meninges, and Dural Venous Sinuses 13 of 13