MENINGES

By :
DR. ZAINAB
 The Meninges of Brain

 Cerebral dural mater

 Cerebral arachnoid mater
 Cerebral pia mater
Cerebellomedullary cistern
DURA MATTER
TWO layers
1. ENDOSTEAL
2. MENINGEAL

These layers are closely united

Separate at certain points to form venous sinuses
ENDOSTEAL LAYER
Periosteum, covering the inner surface of the skull
At the foramen magnum it does NOT become
continuous with the spinal cord
Around the margins of foramina it is continuous with
the periosteum on the outside of skull bones
At the sutures it is continuous with the sutural
ligaments
MENINGEAL LAYER
Dura matter Proper
Strong fibrous membrane covering the brain
continuous through the foramen magnum with the
dura matter of the spinal cord
Provides tubular sheaths for cranial nerves
 The meningeal layer sends FOUR septa inward to divide the cranial
cavity into freely communicating spaces
 They restrict the displacement of the brain
1. Falx cerebri
2. Tentorium cerebelli
3. Falx cerebelli
4. Diaphragma sellae
1. FALX CEREBRI
Sickle cell shaped fold of dura matter
Lies between the two cerebral hemispheres
Narrow anterior end is attached to the frontal crest
Broad posterior part blends with the TENTORIUM
CEREBELLI
Superior Saggital sinus runs in the upper margin
Inferior sagital sinus runs in the lower margin
Straight sinus runs along the attachment of tentorium
cerebelli
2. TENTORIUM CEREBELLI
Crescent shaped fold of dura matter that roofs over
Posterior cranial fossa
Covers the upper surface of cerebellum
Supports the occipital lobes
Anterior end has a gap called “TENTORIAL NOTCH”
for passage of mid brain
3. FALX CEREBELLI
Small sickle shaped fold of dura matter
Attached to internal occipital crest
Projects forward between two cerebellar hemispheres
Posterior fixed margin contains OCCIPITAL SINUS
4. DIAPHRAGMA SELLAE
Small circular fold of dura matter
Forms roof of Sella turcica (depression in sphenoid
bone)
Small opening in its center allows passage of the stalk
of hypophysis cerebri
DURAL NERVE SUPPLY
Branches of following nerves pass to the dura:
A. V (trigeminal)
B. X (vagus)
C. First 3 cervical spinal nerves
D. Sympathetic trunk
DURAL ARTERIAL SUPPLY
Internal Carotid
Maxillary
Ascending pharyngeal
Occipital
Vertebral
Most important: MIDDLE MENINGEAL ARTERY
MIDDLE MENINGEAL ARTERY:
Branch of maxillary artery in the infra temporal
fossa
Enters cranial cavity through foramen spinosum,
Then lies between meningeal and endosteal layers
of dura
ANTERIOR PART: supplies area of precentral
gyrus
POSTERIOR PART: supplies the posterior part of
dura matter
MENINGEAL VEINS:
Lie in endosteal layer
Follows branches of middle meningeal artery
Drains into pterygoid venous plexus
Veins lie lateral to arteries
DURAL VENOUS SINUSES
Situated between the layers of the dura matter
MAIN FUNCTION is to receive blood through the
cerebral veins and the CSF from the sub arachnoid
space through ARACHNOID VILLI
The blood in the dural sinuses ultimately DRAINS
into the internal jugular veins in the neck
Dural venous sinuses include the following:
1. Superior sagittal sinus
2. Inferior sagittal sinus
3. Straight sinus
4. Transverse sinus
5. Sigmoid sinus
6. Cavernous sinus
7. Petrosal sinuses
1. SUPERIOR SAGITTAL SINUS :
at upper fixed margin of falx cerebri
receives vein from nasal cavity
Drains into confluence of sinuses

2. INFERIOR SAGITTAL SINUS :

at free lower margin of falx cerebri
receives cerebral veins from medial surface of cerebral
hemisphere
Drains into straight sinus, which further drains into
confluence of sinuses
3. STRAIGHT SINUS :
formed by union of inf. Sagittal sinus with great cerebral
veins
Drains into confluence of sinus
terminates by forming transverse sinus

4. TRANSVERSE SINUS :
receive superior petrosal sinuses, inferior cerebral, cerebellar
veins and diploic veins
Drains into sigmoid sinus, which further drains into Internal
Jugular vein
5. SIGMOID SINUS:
direct continuation of transverse Sinus
forms a groove in mastoid part of temporal bone
Drains into Internal jugular vein
7. CAVERNOUS SINUS:
In middle cranial fossa, on each side of sphenoid bone
Following structures pass through cavernous sinus:
a) Internal carotid artery
b) Abducent nerve
c) 3rd, 4th, 5th (ophthalmic & maxillary divisions) cranial nerves
d) Superior & inferior ophthalmic veins
e) Inferior cerebral veins DRAINAGE:
• Posteriorly: superior
f) Sphenoparietal sinus and inferior petrosal
sinus
g) Central vein of retina • Inferiorly: pterygoid
venous plexus
7. SUPERIOR & INFERIOR PETROSAL SINUS:
on petrous part of temporal bone
Superior part drains into transverse sinus
Inferior part drains into internal jugular vein
 The flowing of the blood in dural sinus

Sup. sagittal sinus

Inf. sagittal sinus Straight sinus Confluence of sinus Transverse sinus

Sup. petrosal sinus

Sigmoid sinus
Cavernous sinus

Inf. petrosal sinus Internal jugular vein

Cerebral arachnoid mater
a delicate membrane
covering brain loosely
Lies b/w pia matter and
dura matter
Separated from dura by
subdural space
Separated from pia by
subarachnoid space
Covered with
mesothelial cells
In certain situations, pia is widely separated from
arachnoid matter, creating spaces due to opening of
sub arachnoid space. These open spaces form
subarachnoid cisternae, and fills with CSF.
1. CISTERNA CEREBELLOMEDULARIS lies between
inferior surface of cerebellum and roof of fourth
ventricle
2. CISTERNA INTERPEDUNCULARIS lies between
two cerebral peduncles
In some areas arachnoid projects into venous sinuses
to form ARACHNOID VILLI
Aggregations of these arachnoid villi are
ARACHNOID GRANULATIONS
Serves as sites where CSF diffuses into blood stream
Substances passing from the brain to the skull must
pass through the Sub arachnoid space
All cerebral nerves, arteries, veins lie in this space
Arachnoid fuses with epineurium of nerves at their
point of exit from the skull
It forms a sheath around optic nerve, extends to the
orbit and fuses with the sclera of eyeball
Thus subarachnoid space extends around the optic
nerve as far as the eyeball
PIA MATTER
Vascular membrane
Covered by mesothelial cells
Pia matter forms the Tela choroida of roof of the third
and fourth ventricles of the brain
fuses with ependyma to form choroid plexuses in
lateral third and fourth ventricles
CLINICAL NOTES
FUNCTIONAL SIGNIFICANCE OF MENINGES
Dura matter:
serves to protect underlying nervous tissue
Protects cranial nerves by forming a sheath that covers
each cranial nerve
Provides protective sheath to each spinal nerve

Falx Cerebri (vertical sheet b/w cerebral hemispheres) & Tentorium

Cerebelli (horizontal sheet b/w cerebrum and cerebellum):
Serve to limit excessive movements of brain within the
skull
Arachnoid matter:
• Loosely covers the brain

Subarachnoid space (filled with CSF):

• Protects the brain and nervous tissues from
mechanical forces applies to skull

Pia matter:
• Supports brain and spinal cord
EPIDURAL HEMORRHAGE
Results from injuries to meningeal arteries and veins
Most common artery damaged: anterior division of
middle meningeal artery
Cause: Can be damaged by a minor head injury
resulting in fracture of skull
Bleeding occurs and strips up the meningeal layer
from internal surface of skull
Intracranial pressure rises
To stop the bleeding, the torn artery or vein must be
ligated
SUBDURAL HEMORRHAGE
Results from tearing of superior cerebral veins at
their point of entrance to superior sagittal sinus
CAUSE: blow on the front and back of head,
causing excessive anteroposterior displacement of
brain
CT SCAN OF EPIDURAL AND SUBDURAL
HEMATOMAS
EPIDURAL HEMORRHAGE:
Blood strips up the meningeal layer from endosteal layer
CT scan shows LENS- SHAPED hyper dense collection of blood
that compresses the brain and displaces the midline structures to
opposite side

SUBDURAL HEMORRHAGE:
Blood accumulates in the space between meningeal layer and
arachnoid. CT scan shows CRESCENT-SHAPED hyperdense
collection of blood
With a larger hematoma, midline structures are displaced to
opposite side
INTRACRANIAL HEMORRHAGE IN INFANT
May occur during birth
May result from excessive molding of head
Bleeding may occur from cerebral veins or venous
sinuses
Excessive anteroposterior compression of head often
tears anterior attachment of falx cerebri from
tentorium cerebelli
HEADCHE
1. Meningeal headache
2. Headaches caused by cerebral tumors
3. Migraine headache
4. Alcoholic headache (direct toxic effect of alcohol on
meninges)
5. Headache due to diseases of teeth, paranasal sinuses
and eyes
1. MENINGEAL HEADACHE
Dura matter receives sensory nerve supply from
Trigeminal and first 3 cervical nerves.
DURA ABOVE TENTORIUM is innervated by
Trigeminal nerve so, Headache is referred to forehead
and face
DURA BELOW TENTORIUM is innervated by
Cervical nerves, and headache is referred to head and
neck
MENINGITIS: causes severe headache over the entire
head and back of neck
HEADACHE CAUSED BY CEREBRAL TUMORS
An expanding tumor with increased Intracranial
pressure produces severe, continuous, and progressive
headache caused by irritation and stretching of dura
TUMOR ABOVE TENTORIUM: headache referred to
front of the head
TUMOR BELOW TENTORIUM: headache referred
to back of head
MIGRAINE HEADACHE
Maybe U/L or B/L
Associated with visual disturbances due to
sympathetic vasoconstriction of cerebral arteries
supplying the visual cortex
Headache is due to dilatation of other cerebral arteries
and branches of external carotid artery
The disease affects arteries both inside and outside the
skull
Beta-blockers brings relief to patients by reducing
cerebral vasodilation
HEADACHE DUE TO DISEASES OF TEETH,
PARANASAL SINUSES AND EYES
Dental infection and sinusitis are common causes of
headache
Tonic spasm of ciliary muscles of eye, when
attempting to focus on an object for prolonged periods
may cause severe orbital headache
THANKYOU..