NEURO ANATOMY & PHYSIOLOGY 1

Cranial Meninges, CSF, Blood Supply, Venous Drainage, BBB

CRANIAL MENINGES 1. Falx Cerebri

 Shape: Sickle like; has an apex & base
 There are connective tissue layers that surround the
 Borders: Upper & lower
brain and the spinal cord and provide protection to
 Attachments
these fragile tissues
o Apex - crista galli
1. Pia Mater (Inner)
o Upper border - superior sagittal sulcus
2. Arachnoid Mater (Middle)
o Lower border - free & related to corpus
3. Dura Mater (Outer)
callosum
o Base - attached to the apex of
PIAMATER
tentorium cerebella
 Innermost layer of meninges
 Covers the surface of the brain and spinal cord  Related Sinuses
o Superior sagittal sinus (upper border)
 A delicate, vascular layer of connective tissue
o Inferior sagittal sinus (lower border)
 Connected to the arachnoid by arachnoid trabeculae
o Straight sinus (base)
 Denticulate ligaments
 Consist of two lateral flattened bands of pial
2. Tentorium Cerebelli
tissue
 Shape: Crescentic
 Adhere to the spinal dura mater with 21 pairs of
 Tent shaped fold, forming the roof of the
attachments.
posterior cranial fossa
 Filum terminale
 Separates cerebellum from occipital lobes
 Consists of an extension of the pia mater.
of cerebrum
 Extends from the conus medullaris (distal end
 Broadly divides cranial cavity into
of the spinal cord) to the end of the dural sac
o Supratentorial compartment
(interna) and from the dural sac to the coccyx
o Infratentorial compartment
(externa)—the coccygeal ligament
 Margins
i. Free Anterior Margin
ARACHNOID MATER
o U shaped and free
 Located between the dura mater and the pia mater
o Ends of U attached anteriorly to
 Delicate, Avascular connective tissue membrane
the anterior clinoid processes
 Loosely adhered to the dura mater by dural border
o This margin bounds the tentorial
cells and the pressure of the underlying
notch which is occupied by
cerebrospinal fluid (CSF).
- Mid–brain
- Anterior part of superior
DURAMATER (Pachymeninx)
vermis
 Outermost layer of meninges
ii. Outer or Attached Margin
 Consists of 2 layers
o Outer or Endosteal layer – serves as internal o Convex
o Attached to following sites
periosteum or endosteum or endo-cranium
- Posterior clinoid process
for the skull bones.
- Superior petrosal sulcus
o Inner or Meningeal layer – surrounds the
- Transverse sulcus
brain. It is continuous with the spinal dura
 Related Sinuses
mater.
o Straight sinus
o Superior petrosal sinus
Dural Folds
o Transverse sinus
 Meningeal layer of dura mater extends inwards
 Trigeminal or Meckel’s cave
into cranial cavity to form 4 folds:
o Recess of duramater
1. Falx Cerebri
2. Tentorium cerebelli o Formed by evagination of the inferior
layer of the Tentorium over the
3. Falx Cerebelli
trigeminal impression on petrous
4. Diphragma sellae
temporal bone
o Contains trigeminal ganglion
 NEURO ANATOMY & PHYSIOLOGY 2
Cranial Meninges, CSF, Blood Supply, Venous Drainage, BBB

MENINGEAL SPACES
3. Falx Cerebelli 1. Subarachnoid space
 Small sickle-shaped fold situated between  Lies between the pia mater and the arachnoid
two cerebellar hemispheres  Terminates at the level of the second sacral vertebra
 Base of sickle – attached to posterior part of  Contains the CSF
inferior surface of Tentorium cerebelli.  Surrounds the entire brain and spinal cord
 Apex – frequently divided into two parts
which are lost on the sides of the foramen 2. Subdural space
magnum.  In the cranium, the subdural space is traversed by
 Posterior margin “bridging” veins
o Convex and attached to the internal  Laceration of these “bridging veins” results in
occipital crest subdural hemorrhage
o It lodges the occipital sinus  In the spinal cord, it is a clinically insignificant
 Anterior margin is concave and free potential space

4. Diaphragma Sellae 3. Cranial Epidural space

 Small, circular, horizontal fold of  A potential space between the dura mater and the
duramater bones of the cranial vault
 Forms roof of the Sella turcica/  Contains the meningeal arteries and veins
Hypophyseal fossa
o Anteriorly – attached to tuberculum 4. Spinal Epidural space
sellae  Located between the spinal dura mater and the
o Posteriorly – attached to dorsum sellae vertebral periosteum
o Each side – continuous with middle  Contains fatty areolar tissue, lymphatics, and venous
cranial fossa plexuses
 Diphragma has central aperture through  May be injected with a local anesthetic to produce a
which stalk of hypophysis cerebri passes paravertebral (“saddle”) nerve block
 It lodges the anterior & posterior inter
cavernous sinus
 It covers the pituitary gland & is perforated VENTRICLES OF BRAIN
by  Brain has hollow fluid-filled cavities called Ventricles
o Infundibulum of pituitary gland  Lined with ependyma and contain CSF
o 3rd cranial nerve  Contain choroid plexus, which produces CSF
o Internal carotid artery  Communicate with the subarachnoid space via three
foramina in the fourth ventricle
 Consist of four fluid-filled communicating cavities
within the brain

1. Lateral Ventricles
 Two in number
 Located within the cerebral hemispheres
 Communicate with the third ventricle via the
interventricular foramina (of Monro)

2. Third Ventricle
 A slit-like vertical midline cavity of the
diencephalon
 Communicates with the lateral ventricles via the
interventricular foramina and with the fourth
ventricle via the cerebral aqueduct
 NEURO ANATOMY & PHYSIOLOGY 3
Cranial Meninges, CSF, Blood Supply, Venous Drainage, BBB

3. Cerebral aqueduct (aqueduct of Sylvius)  Injection of isotonic & hypotonic saline

 Lies in the midbrain stimulates CSF formation
 Connects the third ventricle with the fourth  Hypertonic saline decreases CSF formation and
ventricle CSF pressure
 Lacks choroid plexus
Circulation
4. Fourth Ventricle
 Lies between the cerebellum and the brainstem

Functions
CEREBROSPINAL FLUID 1. Protection
 It’s a clear, colorless and transparent fluid that circulates 2. Buoyancy
through ventricles of brain, subarachnoid space and 3. Excretion of waste products
central canal of spinal cord 4. Regulation of cranial content volume
 It is the part of extra cellular fluid (ECF)
Collection
Properties 1. Lumbar Puncture
1. pH: 7.35  In this the needle is introduce d into the
2. Specific gravity: 1.007 subarachnoid space in the lumbar region
3. Glucose: 66% of plasma glucose 2. Cisternal Puncture
4. Total Protein: <45 mg/dl in the lumbar cistern  In this a needle between the occipital bone and
5. Normal Pressure: 80 to 180 mm of water atlas so that it enters the cisterna magna
6. Reaction: Alkaline
Blood-Cerebrospinal Fluid Barrier
Composition  It is the barrier between the blood and cerebrospinal
fluid that exists at the choroid plexus
 function of this barrier is same as of BBB
 It does not allow the movement chemical agents,
pathogens, bile pigments etc
 It allows the movement of only those substances
which are allowed by BBB like Oxygen, Carbon
Dioxide, Water etc

Formation
 Produced by the choroid plexus at a rate of 500 to 700
ml/day
 Total CSF volume is approximately 140 ml
 Substances affecting the formation of CSF
 Pilocarpine, stimulate the secretion of CSF
 NEURO ANATOMY & PHYSIOLOGY 4
Cranial Meninges, CSF, Blood Supply, Venous Drainage, BBB

ARTERIES OF BRAIN VEINS OF BRAIN

 Provide the brain with 20% of the oxygen used by the  Devoid of valves and lie along the surface sulci
body; 15% of the cardiac output goes to the Brain.  Drain from the cortex and subcortical substance
 Have a normal blood flow of 50 ml/100 g of brain tissue  Terminate in the dural sinuses
per minute 1. Superficial Cerebral Veins
 Arteries are  Drain into the superior sagittal sinus (bridging
1. Internal Carotid Artery veins)
2. Vertebral Artery  Laceration of these vessels results in subdural
hemorrhage (hematoma)
Note: Refer the Chapter – Blood Supply of Head and Neck for the
details 2. Deep Cerebral Veins
 Drain the deep subcortical structures of the
CEREBRAL ARTERIAL CIRCLE (OF WILLIS) cerebral hemispheres: septal area, thalamus,
 Formed by and basal nuclei
1. Anterior Communicating Artery i. Internal cerebral veins
2. Anterior Cerebral Artery ii. Great cerebral vein (of Galen)
3. Internal Carotid Artery
4. Posterior Communicating Artery
5. Posterior Cerebral Artery DURAL VENOUS SINUSES
 Gives off penetrating arteries to supply the inferior General Features
aspect, hypothalamus, subthalamus, thalamus, and  These are venous spaces; the walls are formed by
the midbrain duramater
 Inner lining of endothelium
 No muscle in their walls
 No valves
 Receive blood from the brain, meninges and bones
of skull
 Cerebrospinal fluid is poured into some of them
 They transmit the venous blood to the Internal
Jugular Vein
 They communicate with the internal vertebral
venous plexus through the foramen magnum
 Cranial venous sinuses communicate with veins
outside the skull through Emissary veins
 These communications help to keep the pressure of
blood in the sinuses constant.
 23 venous sinuses
 Paired: 08 (8 x 2 = 16)
 Unpaired: 07

Paired Venous Sinuses Unpaired Venous Sinuses

One sinus each on right and

Median in position
left side
 NEURO ANATOMY & PHYSIOLOGY 5
Cranial Meninges, CSF, Blood Supply, Venous Drainage, BBB

1. Cavernous 1. Superior Sagittal Sinus  It lies at the junction of the Falx Cerebri and
2. Superior Petrosal Sinus 2. Inferior Sagittal Sinus Tentorium cerebelli
3. Inferior Petrosal Sinus 3. Straight Sinus  It receives
4. Transverse Sinus 4. Occipital Sinus  Inferior Sagittal sinus
5. Sigmoid Sinus 5. Anterior  Great cerebral vein
6. Sphenoparietal Sinus Intercavernous Sinus  It ends at internal occipital protuberance by
7. Petrosquamous Sinus 6. Posterior becoming the left transverse sinus
8. Middle Meningeal Intercavernous Sinus
Sinus / Veins 7. Basilar Plexus of Veins Transverse Sinus
 Paired sinus, one each side
Superior Sagittal Sinus  Extends horizontally in the attached border of
 It lies in the attached upper convex border of Falx Tentorium cerebelli.
Cerebri  Right sinus receives - Superior Sagittal Sinus
 It begins anteriorly at the crista galli by union of tiny  Left sinus receives - Inferior Sagittal Sinus
meningeal veins  Each sinus end by becoming continuous with
 Communicates with sigmoid sinus
 Veins of frontal sinus  Receive following tributaries
 Occasionally with veins of nose through  Superior Petrosal sinus
foramen caecum  Cerebellar veins
 As the sinus runs upwards and backwards –  Occipital diploic vein
becomes progressively larger in size
 Triangular in cross section Occipital Sinus
 Ends behind at the internal occipital protuberance by  Smallest dural sinus
turning to one side (usually right) and becomes  Situated in the attached margin of the Falx Cerebelli
continuous with the right Transverse sinus  Continues with the internal vertebral plexus
 It generally communicates with the opposite sinus Sphenoparietal Sinus
 The junction of all these sinuses is called the  It is a paired sinus, on each side
Confluence of Sinuses  It lies on the edge of the lesser wing of sphenoid
 The Inferior of sinus shows
 Openings of superior cerebral veins Superior Petrosal Sinus
 Openings of venous lacunae (usually 3 on each  It is a paired sinus situated on the upper border of
side) the petrous bone
 Arachnoid villi and granulations – project into  It lies at the attachment border of tentorium cerebelli
lacunae and into sinus  It continues with cavernous sinus anterior & with
 Numerous fibrous bands crossing the inferior transverse sinus posterior
angle of the sinus
 Tributaries Inferior Petrosal Sinus
 Superior cerebral veins  It is a paired sinus situated between the petrous bone
 Parietal Emissary veins & basilar part of occipital bone
 Venous lacunae  It communicates with cavernous sinus anterior &
 Diploic and meningeal veins with superior bulb of internal jugular vein posterior
 Veins from the nose
Sigmoid Sinus
Inferior Sagittal Sinus  It is wide S - shaped sinus which begins at the lateral
 It occupies the posterior 1/2 or 2/3 of the lower free & of transverse sinus.
border of Falx Cerebri  Sinus ends by passing through the jugular foramen
 It ends posteriorly by joining the straight sinus where it becomes continues with internal jugular
 It receives cerebral veins from the medial surface of vein
the cerebral hemisphere  Tributaries
 Posterior condylar emissary vein
Straight Sinus  Mastoid emissary vein
 NEURO ANATOMY & PHYSIOLOGY 6
Cranial Meninges, CSF, Blood Supply, Venous Drainage, BBB

Communic
Right & Left Anterior and posterior
CAVERNOUS SINUS ate with
Cavernous intercavernous sinuses
 Position: it lies on the side of the body of sphenoid each other
Sinuses Basilar plexus of veins
 Size: 2 cm long and 1 cm wide through
 Borders
 Floor and medial wall – Endosteal dura mater  All these communications are valve less, and blood can
 Roof and lateral wall – meningeal dura mater flow through them in either direction
 Anteriorly – extends upto medial end of superior
orbital fissure Thrombosis of Cavernous Sinus
 Posteriorly – upto apex of Petrous temporal bone  Caused by sepsis in the
 Dangerous area of the face
Relations  In nasal cavities
Optic tract
Structures in the walls of the sinus (above to downwards) Optic Chiasma
Lateral Wall Medial Wall Superiorly Olfactory tract
Internal carotid artery
1. Oculomotor nerve 1. Internal Carotid Artery
Anterior perforated substance
2. Trochlear nerve with venous and
Foramen lacerum
3. Ophthalmic nerve sympathetic plexus
4. Maxillary nerve around it Inferiorly Junction of body of greater wing of
sphenoid bone
5. Trigeminal ganglion 2. Abducent nerve
Sphenoid air sinus
Medially
Pituitary gland/ Hypophysis cerebri
Tributaries
Trigeminal ganglion
From Orbit From Brain From Meninges Laterally
Uncus of temporal lobe
1. Superior 1.Superficial 1. Sphenoparietal Below
Ophthalmic middle cerebral sinus Mandibular nerve
Laterally
vein vein 2. Frontal trunk of
Superior orbital fissure
2. Inferior 2.Inferior middle Anteriorly
Apex of the orbit
ophthalmic cerebral veins meningeal vein
Apex of Petrous temporal bone
vein from temporal Posteriorly
Crus of cerebri of mid brain
3. Central vein of lobe
 Paranasal sinuses
the retina
Communication between cavernous sinus and
Internal Carotid Artery may be produced by head
Draining Channels
injury
Into 
Transverse Through Superior Petrosal sinus Eyeball protrudes and pulsates with each heart beat
Sinus – “Pulsating Exophthalmos”

Inferior Petrosal sinus

Into Internal
Through Plexus around the
Jugular Vein
internal carotid artery

Emissary veins passing -

foramen ovale, foramen
Into Pterygoid
Through lacerum
Plexus of Veins
Emissary sphenoidal
foramen
Into Facial
Through Superior ophthalmic vein
Vein
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Cranial Meninges, CSF, Blood Supply, Venous Drainage, BBB

EMISSARY VEINS BLOOD - CSF BARRIER

 Fine veins which pass through the emissary
foramina in the wall of the skull  The blood-CSF barrier is composed of epithelial cells of
 Sites the highly vascular choroid plexus located within the
1. Parietal emissary vein ventricles. These cells are connected through tight
2. Mastoid emissary vein junctions
3. Posterior condylar emissary vein  The choroid plexus produces CSF. The tight junctions
4. Emissary vein through foramen ovale between the cells serve to selectively allow substances
5. Hypoglossal emissary vein access to the CSF.
6. Plexus of vein surrounds the internal carotid  Transport mechanisms across the barrier are similar to
artery those of the BBB
 Importance: It's possible for infection outside the
skull (in the scalp & face) to spread to the dural
venous sinuses through the emissary veins leading
to septic thrombosis of the sinuses

BLOOD BRAIN BARRIER (BBB)

 Composed of endothelial cells packed tightly together to

form tight junctions that prevent passage of most
molecules
 Barrier is reinforced by an underlying basement
membrane and astrocytes
 Parts of Brain outside BBB: Pineal gland, Chemoreceptor
trigger zone

Substances that cross BBB

 Very few substances can cross the BBB into brain
tissue
 Water can freely diffuse
 Glucose (the primary energy source of the brain) and
amino acids require carrier-mediated transport.
 Nonpolar lipid-soluble substances (e.g., free
unconjugated bilirubin) cross more readily than
polar water-soluble ones.
 Other active transport systems are present to pump
weak organic acids, halides, and extracellular K+
across the BBB.