Neuroanatomy
and as the falx cerebelli between the cerebellar hemispheres
(eFig. 9.17). A smaller reflection, the diaphragm sellae, covers
the pituitary fossa and underlying pituitary gland.
Deep to the dura mater is the arachnoid (from the Greek
word arachne meaning “spider’s web”) mater. The outer layer
of the arachnoid mater is composed of several layers of
flattened cells that lie adjacent to the meningeal layer of
the dura mater (eFig. 9.19). Strands of connective tissue
extend from this outer layer to form arachnoid trabeculae,
which connect internally to the pia mater (eFig. 9.19). The
pia mater forms a thin, veil-like layer that closely follows
the gyri and sulci on the surface of the brain. The pia and
arachnoid matter are separated by a subarachnoid space
that contains CSF and the major blood vessels supplying
the brain.
CEREBRAL VASCULATURE
Vascular supply to the brain is divided into the anterior
circulation arising from the internal carotid arteries and
Cerebral vein Diploe
Dura mater
Arachnoid
mater
Pia mater
eFig. 9.19  Coronal section of the cranial meninges: dura mater, arachnoid mater, and pia mater. (From Mtui E. Fitzgerald’s Clinical
Neuroanatomy. 7th ed., Fig. 4-5A. Philadelphia: Elsevier; 2016.)
e16
booksmedicos.org
posterior circulation from the vertebral arteries (eFig. 9.20).
The internal carotid arteries arise from the branching of
the common carotid arteries at the level of the fourth cervical
vertebra. Bilaterally the arteries course through the neck
to enter the middle cranial fossa through the carotid canal.
The arteries then make a series of turns to pass through
the petrous portion of the temporal bone and cavernous
sinus before entering the subarachnoid space just lateral to
the optic chiasm. Upon exiting the cavernous sinus, the
internal carotid artery gives rise to the ophthalmic artery
and then continues superiorly to give off the posterior
communicating artery and anterior choroidal arteries before
terminating as the anterior and middle cerebral arteries
(eFig. 9.21).
The two anterior cerebral arteries anastomose proximally
via the anterior communicating artery, anterior to the optic
chiasm (eFig. 9.22). Distal to this connection, the anterior
cerebral artery (ACA) courses along the medial aspect of
the cerebral hemisphere within the longitudinal fissure and
follows the superior border of the corpus callosum to the
Superior sagittal sinus
Epicranial aponeurosis
Sagittal suture
Scalp vessels
Skin
Emissary vein
Periosteum
Meningeal
vessels
Endosteum
Falx cerebri
Calloso-
marginal
artery
Cerebral
cortex