Neuroanatomy Dr.
Bornales ventricular system;
1/16/ 2019
Chapter 15-16 Meninges and Ventricular
System
MRI – most up-to-date imaging study, much
better than CT scan
- As if you are doing an autopsy of a
living specimen
Lateral ventricles – communicate with one
another
- Compose of the frontal ventricular
system, continuous with occipital
- Slit-like and bounded to the caudate
nucleus
(Take note of the size and shape of
normal lateral ventricles)
Hydrocephalus – accumulation of CSF
within the ventricular system.
- Causing enlarged ventricle
- Much more prominent in pediatric
patients, because sutures are not
yet fused
- In adult, the effects are more
detrimental and fatal because the
calvarium cannot accommodate
increasing size of the head.
- If not addressed, brain parenchyma
will be compressed because of the
enlargement of the lateral ventricles
What is the difference between
communicating and non-
communicating hydrocephalus?
Communicating – no obstruction
within the communication of the
non-obstructive
type
Non-communicating – there is
obstruction in the flow of the CSF within
the ventricular system; obstructive type
Remember the components of
Ventricular system, flow, absorption
of CSF (CSF Dynamics)
Normal anatomy of skull, CSF
Dynamics and Ventricular System
Lumbar tap – procedure,
indications, contraindications
- Analysis of normal CSF results
Types of Hydrocephalus
1. Congenital
2. Hydrocephalus ex vacuo - seen in
elderly, parenchyma of the brain
cells atrophy, leaving a larger space
for the ventricular system to occupy
(e.g. Alzheimers disease). Do not
have increased pressure.
3. Infectious and inflammatory
process – caused by exudates (e.g.
common cause is TB meningitis) pus
can be ssen at the base of the brain.
Flow of csf going out can be
obstructed
Anatomy of the ventricular system
- Use a coronal section of the brain
- Lateral ventricles can be seen at
the cerebral level
- Third ventricle can be seen at the
core of the cerebrum bounded by
the diencephalon (dorsal thalamus)
- 4th ventricle seen at the level of the
brain stem (back of pons, upper part
of medulla oblongata)

Foramen Monroe – communicates lateral
and 3rd ventricle, located within the
diencephalon
Third ventricle and 4 th
communicates
through the cerebral aqueduct (2 cm); also
known as the “iter”, sylvian aqueduct
Determine the roof, floor and lateral
boundaries of the frontal, lateral and
occipital horns of the lateral ventricles.
Take note of the structure around the 4th
ventricle: A - cerebellum, P - pons and
medulla
CSF formed by the choroid plexuses found
in all the ventricles. We do not see them in
the foraminae
Most are found in the lateral ventricles
Choroid plexuses – are specialized
capillary system derived from the
outpouching of the pia matter, highly
vascular, lined by endothelial layer same
way as other capillaries
- Blood flow are generally coming
from the circulation
- CSF is derived from the blood
circulation
- CSF will be compartmentalized to
the lateral ventricles so on and so
forth
- From the 4th ventricle, CSF will exit
the ventricular system via 2 foramen
of luschka, 1 foramen of magendi
and 1 central canal of the spinal cord
(minimal).
- CSF will flow from the subarachnoid
space and will flow to the entire
cerebral hemisphere in the
supratentorial level, brain stem and
posterior fossa, downwards to the
interspinal canal.
- If not removed will accumulate in the
subarachnoid space
- CSF is absorbed by the
subarachnoidal villi, which form
packets/ groups of villi called
arachnoidal granulations
- In old age, it can be calcified called
paconian granulations
- CSF will be brought back to the
cisculation through the venous
sinuses, to internal jugular vein, to
superior vena cava and to the entire
circulation
Obstruction will result to dilatation and
enlargement of the ventricles
CSF will accumulate if it is not reabsorbed
or there is problem in the exit of CSF, or
there is something overly producing CSF
like tumors, papilloma of the choroid plexus
Non-communicating hydrocephalus are best
managed surgically
Communicating – TB meningitis, medical
management
Surgical management
1. Ventriculo-peritoneal shunting - CSF
diversion procedure or shunting
2. Ventriculo-atrial shunt
3. Ventriculo-external shunt –
temporary, using a suction collecting
tube (Jackson-Pratt drain)
In pediatric patients, CSF can be
extracted in the fontanels; less risk for
brain herniation
Best access in adults for lumbar tap is Viral – clear; glucose is NORMAL
the lumbar area except for herpes simplex and
MUMPS
TB meningitis –
Lumbar tap – inserted at L2 – L3, L3-L4, xanthochromic/yellowish color
L4- L5
- Best level, L3-L4 SKULL AND BONY CALVARIUM
- In adults Spinal cord will terminate at
L1-L2, vertebral body of L2 Gradenigo’s Syndrome
- Position: fetal , lateral recumbent, Foster Kennedy Syndrome
lateral decubitus
- Assistant is needed, staying in front Remember the structures exiting the
of the patient base of the skull
- Perfect perpendicular position, at the
plane of the bed – spinal canal will Foramen magnum – cervico-
be twisted or not aligned properly medullary junction
- Iliac crest will be the anatomical
landmark Course of the vertebral arteral
- Skin to subarachnoid space (what
structures?) Basillar artery – supplies the
- CSF should be clear, colorless posterior 1/3 of the brain
- Measure the pressure using
Opthalmic Division of Trigeminal
manometer, start collecting using a
Nerve exits the inferior orbital fissure
specimen bottle
- 3 bottles pf CSF: 1st bottle Chemistry
Gradenigo-Lannois – affects
for analysis of CSF, 2nd Microbiology;
temporal petrous bone
staining; 3rd Microscopy for
differential cell count. (Chapter 13)
Frontal lobe – tumor, optic nerve
- CSF should not contain any cells (0- involvement, resulting to optic
3 lymphocytes) normal atrophy on the same side of tumor
- Presence of neutrophil is not normal and papilledema on the opposite
- No RBC; presence will be caused by side due to increased ICP
subarachnoid hemorrhage or
traumatic Foster Kennedy syndrome
Tap
- Glucose – with reference to RBS Olfactory nerve can be affected
- Formula: CSF glucose value / RBS * simultaneously if there is a tumor
100 compressing them
- Normal: 40-60 %
- May be used for therapeutic Pia mater- most adherent to the
management (READ) brain parenchyma but also in the
- Communicating: remove every other spinal cord
day - Boundary between the CNS and
PNS
- Most vascular layer of the meninges
Most common infection: Meningitidis

Bacterial – turbid CSF

Arachnoid mater – histological
characteristcs
venous sinus – receives blood from the
- Meningiomas CNS via the cerebral veins; drains in the
- Holds the dura mater internal jugular vein
MEMORIZE major venous sinuses

Dura mater
Division 1. Endosteal layer – adherent to the Queckenstedt’s test
skull lining
- cannot be seen in the intraspinal canal
CSF blood brain barrier
- ends at the foramen magnum and blends
in the periosteum
2. meningeal / periosteal – blend with the
openings of the skull
- tough connective tissue
- invaginations are found at the falx and
tentorium cerebelli
- overlapping layers form the venous
sinuses – receives blood via the cerebral
veins

Epidural layer – potential space, lens shape

hematoma; high mortality if not surgically
managed
Subdural space – Most meningeal,
emissary vein, blood vessels are found
- Crescent shaped hematoma; low
pressure because of venous
circulation affectation
- They can spontaneously resolve on
its own sometimes
Subarachnoid space – CSF
- Head trauma is most common cause
of subarachnoid hemorrhage
- blood is seen at the base of the
brain
- aneurysmal hemorrhage because
the circle of willis is found in the
base
- blood is admixed in the CSF