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The ventricular system of the


Kirum Gonzaga Gonza

Outline (scope)
This lecture will cover:

• The definition of brain ventricles, their location and

• The production, circulation and absorption of
cerebrospinal fluid (CSF)
• The subarachnoid cisterns and their clinical significance
• The blood-CSF barrier
• The contents and functions of CSF
• Some clinical correlates regarding the ventricular
system of the brain
To describe:

• The structure and function of the ventricular system of

the brain

• The composition and function of cerebrospinal fluid


• The production, circulation and absorption of CSF

• The important clinical correlates regarding the

ventricular system of the brain
Brain ventricles
• Ventricles are cavities within the brain

• They are lined by ependymal cells that contain

choroid plexuses

• The choroid plexuses produce cerebrospinal

fluid (CSF) that bathe the surface of the brain
and spinal cord
Cerebral spinal fluid
• Cerebral spinal fluid (CSF) is a clear colorless fluid
that bathes the surface of the brain and spinal
cord (CNS)
• It is produced by the choroid plexuses within the
ependymal lining of brain ventricles (i.e., the
lateral, third and fourth ventricles)
• It circulates through the ventricular system and
exits via a median and two lateral apertures into
the subarachnoid space, where it bathes the
surfaces of the brain and spinal cord
• Some will circulate within the central canal of
the spinal cord

• The fluid acts as a transport medium for

nutrients and waste products and provides a
protective fluid cushion for the central
nervous system.
The ventricles and flow of CSF
• Lateral ventricles- the cavity within each cerebral
• Third ventricle- the cavity within the diencephalon
– CSF passes from the lateral ventricles to the third ventricle
via the interventricular foramen of Monro
• Fourth ventricle- the cavity within the hind brain
– CSF passes from the third ventricle to the fourth ventricle
via the cerebral/mesencephalic aqueduct
– The cerebral aqueduct is the cavity of the midbrain
– CSF exits the fourth ventricle to the subarachnoid space via
a median aperture (foramen of Magendie) and two lateral
apertures (foramina of Luschka)
Production of CSF
• Production is at a rate of about 0.5 ml per minute

• 50-70% of CSF is produced in the brain by

modified ependymal cells in the choroid
plexuses of the lateral, third and fourth

• The remainder (30-50%) are formed around

blood vessels and along ventricular walls (i.e.,
originates as tissue fluid in the brain substance)
Circulation of CSF
• CSF circulates from the lateral ventricles to the
foramen of Monro (interventricular foramen),
third ventricle, aqueduct of Sylvius (cerebral
aqueduct), fourth ventricle, foramen of Magendie
(median aperture) and foramen of Luschka
(lateral apertures), finally pouring into the
subarachnoid space over brain and spinal cord.

• Movement of CSF is dependent on forces

generated by pulsations of blood vessels,
respiration and posture.
Absorption of CSF
• The CSF is absorbed into venous sinus blood via arachnoid
– CSF is absorbed into the arachnoid villi that project
into the dural venous sinuses, especially the superior
sagittal sinus
– The arachnoid villi are grouped together to form
arachnoid granulations
– Absorption of CSF into the venous sinuses occurs
when the CSF pressure exceeds that in the sinus
– However, when venous sinus pressure exceeds that of
CSF, the arachnoid villi collapse, preventing the
passage of blood constituents into the CSF
• There is also some absorption of CSF by cells in the walls of
the ventricles
• Arachnoid granulations - project into sinuses of dura mater, serve as
sites where cerebrospinal fluid diffuses into bloodstream
Circulation and absorption of CSF
CSF drains from lateral ventricle interventricular foramina third ventricle

mesencephalic aqueduct median and two lateral apertures

fourth ventricle

subarachnoid space arachnoid granulations superior sagittal sinus vein

Subarachnoid space:
• Position: lies between pia and
arachnoid maters containing
cerebrospinal fluid
• Subarachnoid cisterns: expanded
parts of subarachnoid space
containing relatively larger
volumes of CSF - clinically
significant for CSF tap
• 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 (spinal tap)
Subarachnoid cisterns:
– Cerebellomedullary
cistern (cisterna
– Interpeduncular
– Pontine cistern
– Superior cistern
– Chiasmatic cistern
– Terminal cistern
Lumbar spinal puncture (spinal tap)
Cerebellomedullary cistern (cisterna magna)
The blood-CSF barrier
• The blood-CSF barrier is where selective
exchange of materials between blood and CSF
takes place

• It is made up of continuous tight junctions

called zona occludens
Contents of CSF
CSF contains:
• Glucose (at about 60-70% plasma concentration)
• Small amounts of proteins

• NB: The mode of passage of the above contents

into the CSF remains unknown


PROTEIN mg/dl mg/dl RATIO

Prealbumin 1.7 23.8 14

Albumin 15.5 3600 236
Ceruloplasmin 0.1 36.6 366
Transferrin 1.4 204 142
Immunoglobulin G 1.2 987 802

Immunoglobulin A 0.13 175 1346

Functions of CSF
• The CSF is a constantly circulating fluid medium
– Bathes the CNS
– Acts as a shock absorber for the CNS
• provides a protective fluid cushion for the central
nervous system
• provides a mechanical barrier to cushion the brain and
spinal cord against trauma
– Acts as a transport medium for nutrients
• supply nutrients to the central nervous system
– Removes metabolic wastes
Clinical correlates
• A condition characterized by swelling of the head as a
result of accumulation or stagnation of CSF
• Types?
• Differences between childhood and adult
• Can be caused by:
– Excessive production of CSF
– Poor drainage or retention of CSF as a result of partial or
complete blockage of its circulatory pathway
• E.g. TB meningitis may lead to blockage of cerebral aqueduct,
causing hydrocephalus
• Aqueductal stenosis – may be congenital or acquired
MRI or CT Scan of Normal Ventricles and Hydrocephalus


Lumber puncture/spinal tap
• Collection of CSF for laboratory analysis
• Sites?
• Procedure?
• Meaning for (1)oozing, and (2)hemorrhagic
(blood-stained) CSF?
Intrathecal administration of drugs
• Injection of drugs into the subarachnoid space
• In which situations?