THE VENTRICLES, CHOROID

PLEXUS, & CEREBROSPINAL

FLUID
DEVELOPMENT
• 3RD WOG – neural canal & central canal
• 24 – 26 days closure of the anterior (rostral) &
posterior (caudal) neuropores, respectively
• Neural tube lined by differentiating
neuroepithelial cells undergoing cell division
that give rise to the ependymal cells lining the
mature ventricular system & central canal
 VESICLES VESICLES & VENTRICULAR CAVITY

Pontine
flexure

Cervical
flexure Cephalic flexure

Telencephalic flexure

5 WEEKS OF GESTATION 6 WEEKS OF GESTATION

8.5 WEEKS OF GESTATION
DEVELOPMENT FORAMEN OF MAGENDIE & LUSCHKA

2nd & 3rd months of development

DEVELOPMENT CHOROID PLEXUS

- found in both lateral ventricles, III & IV ventricles

- artery invaginate thru the tela choroidea giving rise to
primordial choroid plexus inside the ventricular system;
villi development
- begins to secrete CSF by the end of 1st trimester
circulating thru the ventricular system & subarachnoid
space
 DEVELOPMENT CHOROID PLEXUS

- arteries involved in the development of choroid plexus:

IV ventricle - branches of posterior inferior
cerebellar artery (PICA)
III ventricle - branches of medial posterior
choroidal artery
Lat. ventricle - branches of the lateral posterior
choridal artery & the anterior
choroidal artery
 A-f. Monroe
P- splenium
VENTRICLES Body R- corpus callosum
M- septum pellucidum
F- fornix,c.plexus, thalamus
Anterior horn Atrium, lateral ventricle
A/R- corpus callosum
M- septum pellucidum Posterior horn
L/F- caudate nucleus R- corpus callosum
M- calcarine fissure

Interventricular
Foramen (Monroe) Cerebral
Aqueduct
(Sylvius)
Fourth L- cerebellar
Third ventricle peduncle
R- thin ependyma ventricle F- rhomboid
L- thalami fossa
F- hypo- & subthalamus Foramen of
A- l. terminalis, Ant. Comm.
Inferior horn Magendie

Foramen of Luschka Central canal

*The only openings between the ventricles of the brain and the subarachnoid space
surrounding the brain are the foramina of Luschka & Magendie in the fourth ventricle
THIRD VENTRICLE BOUNDARY

Tela choroidea (choroid plexus)

Anterior commissure
Dorsal thalamus &
Lamina terminalis
Hypothalamus

Suprapineal
recess

Supraoptic Posterior
recess commissure

Pineal
recess

Infundibular
recess Optic chiasm
Infundibulum
- Cerebral aqueduct of

Sylvius or Iter
- only 1.5 mm in diam.
- contains no choroid
plexus
- surrounded by a
sleeve of gray matter
containing small
neurons; known as
periaqueductal gray
or central gray
IV VENTRICLE
-Hemorrhage into the ventricles from ruptured aneurysm, AVM or HPN bleed
-Mass lesion obstructing the flow of CSF producing hydrocephalus
-Inflammation & infectious process
-Congenital anomaly involving the Iter as in stenosis or atresia
(desmosomes)

- Tanycytes: transport
substances between
ventricles & the blood
EPENDYMOMA
- 5% - 6% of all glial neoplasms; originates from the ependymal cells
- majority (60%-75%) are located in the posterior fossa
- most frequent found in children younger than 5 years of age
- signs & symptoms depend on the location of the tumor
- characteristic histologic feature is the perivascular rosettes
- treatment primarily is surgery followed by focal irradiation
Choroid plexus:
- extend from the inferior horn of the lateral ventricle into the atrium
(glomus choroideum), along the floor of the body of the lateral ventricle,
continues through the interventricular foramen, and attaches to the roof
of the III ventricle
- it is also found in the IV ventricle attaching to the caudal roof and
extends laterally into the foramen of Luschka
- the endothelial cells of the capillaries along the layers of the choroid
plexus have numerous fenestrations allowing exchange of molecules
between blood plasma & the extracellular fluid in the connective tissue
 (Zonulae occludentes)

Blood-CSF Barrier
BLOOD-BRAIN-BARRIER
- A physiologic barrier to the
movement of many substances
into or out of the brain
- endothelial cells of brain capillaries
form a continuous lining membrane
joined by numerous tight
(occluding) junctions & have no
intercellular pores or fenestrations
- in turn are surrounded by the end-
feet of astrocytes
- Normal condition: BBB prohibits
movement of high-molecular
weight substances (proteins,
penicillin, dopamine, vital dyes,
etc.)
- important in the administration of
medicines targeted for the brain
CHOROID PLEXUS BLOOD SUPPLY

• Blood supply to the choroid plexus is via the

choroidal arteries and the posterior cerebellar
arteries
• CP in the inferior horn, atrium & body of the lateral ventricle
is served by the ant. choroidal artery (br. of ICA) & the lateral
posterior choroidal artery (br. of P2)
• CP in the III ventricle is served by the medial posterior
choroidal artery (br. Of P2)
• CP in the IV ventricle is served by brs. of the posterior inferior
cerebellar artery (PICA)
• CP extending out into the foramen of Luschka into the SAS is
served by anterior inferior cerebellar artery (AICA)
Choroid Plexus Tumors:
- CP papillomas or carcinomas
- common between birth and 10
years
- occurs in the IV ventricle in 50%-
60%
- signs & symptoms: increased ICP
due to hydrocephalus
- treatment is by surgery & for the
malignant one is a combination of
chemotherapy followed by surgery
and a combination of chemotherapy
& radiation
CEREBROSPINAL FLUID (CSF)
- Normal CSF:
pressure 70 – 200 mm H2O
clear, colorless
sugar 45-80 mg% (40%-60% of blood glucose)
protein 15 – 45 mg/dL
total/diff. cell count 0-5/ml
(leukocytes)
average volume 120 ml in adult
production 450-500 ml/day
- produced by the choroid plexus &
absorbed by arachnoid villi or
pacchionian bodies found in the
superior sagittal sinus back into
the circulation
 CSF Findings in Various CNS Disorders

DISORDER PRESSURE APPEARANCE GLUCOSE PROTEIN CELLS

Acute
Pyogenic increased cloudy/turbid decreased increased Inc. PMNs

Chronic
TB, Fungal, increased Clear or cloudy decreased increased inc. lymphos
Part.Tx M
Acute Normal or Mildly
Viral Mildly inc. Clear, colorless normal increased Inc.
lymphos
SAH Bloody, does not Plenty of
increased clot, super- normal increased rbcs
natant xantho.
Traumatic Bloody, clots 4 mg inc. Same as
tap normal spontaneously, normal per 5000 peripheral
No xantho. rbc count
Hydrocephalus:
- obstructive hydrocephalus
- communicating hydrocephalus
- hydrocephalus ex vacuo
- normal pressure hydrocephalus (NPH)