Brain and

Environs:
Cranium,
Ventricles, and
Meninges
Tatia Gakharia, MD, PhDs 2023

MENINGES- Anatomy of Dura Matter, Pia Matter, Arachnoid

Matter. Meningeal Spaces. Ventricular System and Cerebrospinal
Fluid. Arteries of the Brain. Veins of the Brain
Gray`s anatomy:4rd ed. Drake, Richard and other page: 861-882;
Hal Blumenfeld 2nd Edition. 2010 by Sinauer Associates. Chapter 5 -125-
137
A mnemonic for the layers of the scalp (SCALP)
The final layers of protection within the skull and surrounding the
brain are the meninges and cerebral spinal fluid

• The three layers of meninges

from inside to outside are
• 1. Pia
• 2. Arachnoid
• 3. Dura
• The cranial meninges are continuous with, and
similar to, the spinal meninges through the
foramen magnum, with one important
distinction-the cranial dura mater consists of
two layers, and only one of these is continuous
through the foramen magnum
Dura mater

• The outer periosteal layer- is firmly attached to the

skull, is the periosteum of the cranial cavity,
contains the meningeal arteries, and is continuous
with the periosteum on the outer surface of the
skull at the foramen magnum and other
intracranial foramina .
• The inner meningeal layer is in close contact with
the arachnoid mater and is continuous with the
spinal dura mater through the foramen magnum.

The two layers of dura separate from each other at

numerous locations to form two unique types of
structures
• dural partitions, which project inward and
incompletely separate parts of the brain
• intracranial venous structures.
Dural partitions-the falx cerebri, tentorium cerebelli, falx cerebelli,
and diaphragma sellae
Dura mater
• Falx cerebri is a crescent-shaped downward projection of meningeal dura mater from the dura lining the calva that passes between
the two cerebral hemispheres. It is attached anteriorly to the crista galli of the ethmoid bone and frontal crest of the frontal bone.
Posteriorly it is attached to and blends with the tentorium cere belli.

• Tentorium cerebelli is a horizontal projection of the meningeal dura mater that covers and separates the cerebellum in the posterior
cranial fossa from the posterior parts of the cerebral hemispheres. It is attached posteriorly to the occipital bone along the grooves for
the transverse sinuses. Laterally, it is attached to Diaphragma sellae .superior border of the petrous part of the temporal bone, ending
anteriorly at the anterior and posterior clinoid processes. The anterior and medial borders of the tentorium cerebelli are free, forming
an oval opening in the midline (the tentorial notch), through which the midbrain passes.
Falx cerebelli is a small midline
projection of meningeal dura mater in
the posterior cranial fossa. It is attached
posteriorly to the internal occipital crest
of the occipital bone and superiorly to
the tentorium cere belli. Its anterior
edge is free and is between the two
cerebellar hemispheres.

Diaphragma sellae The final dural

projection is the diaphragma sellae.
This small horizontal shelf of meningeal
dura mater covers the hypophyseal
fossa in the sella turcica of the sphenoid
bone. There is an opening in the center
of the diaphragma sellae through which
passes the infundibulum, connecting
the pituitary gland with the base of the
brain, and any accompanying blood
vessels.
The portion of the intracranial
cavity above the tentorium is
referred to as supratentorial;
that below is called
infratentorial.

• To understand the
relationship between
the tentorium cerebelli
and the other
intracranial structures
and how the tentorium
is truly “tent” shaped
 Arterial supply
• The arterial supply to the
dura mater travels in the
outer periosteal layer of
the dura and consists of:
• • anterior meningeal
arteries in the anterior
cranial fossa,
• • the middle and
accessory meningeal
arteries in the middle
cranial fossa, and
• • the posterior meningeal
artery and other
meningeal branches in
the posterior cranial
fossa.
Dural innervation
Arachnoid
mater
• The arachnoid mater is a thin, avascular
membrane that lines, but is not adherent
to, the inner surface of the dura
• From its inner surface thin processes or
trabeculae extend downward, cross the
subarachnoid space, and become
continuous with the pia mater. Unlike the
pia, the arachnoid does not enter the
grooves or fissures of the brain, except for
the longitudinal fissure between the two
cerebral hemispheres.
Pia mater
• The pia mater is a thin, delicate
membrane that closely invests
the surface of the brain. It follows
the contours of the brain,
entering the grooves and fissures
on its surface, and is closely
applied to the roots of the cranial
nerves at their origins
 Arrangement of meninges and spaces
• real and potential spaces within the cranial
cavity .

• real space exists between the arachnoid mater

and the pia mater.

• The potential space between dura mater and

bone is the extradural space .
• Normally, the outer or periosteal layer of dura
mater is firmly attached to the bones
surrounding the cranial cavity. This potential
space between dura and bone can become a
fluid-filled actual space when a traumatic event
results in a vascular hemorrhage. Bleeding into
the extradural space due to rupture of a
meningeal artery or a torn dural venous sinus
results in an extradural hematoma.
Subdural space

• Anatomically, a true subdural space does not

exist.

• Blood collecting in this region (subdural

hematoma) due to injury represents a dissection
of the dural border cell layer. Dural border cells
are flattened cells surrounded by extracellular
spaces filled with amorphous material. While very
infrequent, an occasional cell junction may be
seen between these cells and the underlying
arachnoid layer. Bleeding due to the tearing of a
cerebral vein as it crosses through the dura to
enter a dural venous sinus can result in a subdural
hematoma.
Subarachnoid
space
• Deep to the arachnoid mater is the only normally
occurring fluid-filled space associated with the
meninges, the subarachnoid space .It occurs because
the arachnoid mater clings to the inner surface of
the dura mater and does not follow the contour of
the brain, while the pia mater, being against the
surface of the brain, closely follows the grooves and
fissures on the surface of the brain. The narrow
subarachnoid space is therefore created between
these two membranes.
• The subarachnoid space surrounds the brain and
spinal cord and in certain locations it enlarges into
expanded areas (subarachnoid cisterns). It contains
cerebrospinal fluid (CSF) and blood vessels.
 CSF & Ventricles
During early development, the neural tube forms several cavities within
the brain called ventricles .The ventricles contain cerebrospinal fluid
(CSF), which is produced mainly by a specialized vascular structure
called the choroid plexus that lies inside the ventricles .The inner walls
of the ventricles are lined with a layer of ependymal cells, and the
blood vessels of the choroid plexus are lined with similar-appearing
cuboidal cells called choroid epithelial cells
Cerebrospinal fluid produced by
choroid plexus flows from the
lateral ventricles through the
foramen of Monro in each
hemisphere, into the third
ventricle, through the Sylvian
aqueduct, into the fourth
ventricle, out through the
foramina of Luschka and
Magendie, into the
subarachnoid space, and up to
the arachnoid granulations to
be reabsorbed into the
bloodstream.

Cerebrospinal fluid then percolates around the brain and spinal cord in the subarachnoid space
and is ultimately reabsorbed by the arachnoid granulations into the dural venous sinuses, and
thus back into the bloodstream. The normal total volume of cerebrospinal fluid in an adult is
about 150 cc. It is produced by the choroid plexus at a rate of 20 cc/hour, or about 500 cc/day.
The subarachnoid space widens in a few areas to form larger CSF collections called cisterns.
CSF cisterns
The subarachnoid space widens in a few areas to
form larger CSF collections called cisterns. The
following cisterns come up fairly often in clinical
practice :
• Perimesencephalic cisterns Ambient cistern
(cisterna ambiens) Quadrigeminal cistern (cisterna
quadrigemina) Interpeduncular cistern
• Prepontine cistern (pontine cistern)
• Cisterna magna
• Lumbar cistern
CEREBROSPINAL FLUIDis a colorless acellular fluid. It flows through the ventricles and into the subarachnoid space. A. FUNCTION 1. CSF
supports the central nervous system (CNS) and protects it against concussive injury. 2. It transports hormones and hormone-releasing factors. 3. It
removes metabolic waste products through absorption. B. FORMATION AND ABSORPTION. CSF is formed by the choroid plexus. Absorption is
primarily through the arachnoid villi into the superior sagittal sinus.

• C. The composition of CSF is clinically relevant (Table 4-1

Meningitis
Hydrocephalus-ELEVATED
INTRACRANIAL PRESSURE The contents of
the intracranial space are confined by the hard
walls of the bony skull. Of the three residents of
this cavity—cerebrospinal fluid, blood, and
brain tissue

1. Noncommunicating hydrocephalus results from

obstruction within the ventricles (e.g., congenital
aqueductal stenosis).
2. Communicating hydrocephalus results from blockage
within the subarachnoid space (e.g., adhesions after
meningitis).
3. Normal-pressure hydrocephalus occurs when the CSF is
not absorbed by the arachnoid villi. It may occur
secondary to posttraumatic meningeal hemorrhage.
4. Hydrocephalus ex vacuo results from a loss of cells in
the caudate nucleus (e.g., Huntington’s disease)
5. Pseudotumor cerebri (benign intracranial
hypertension) results from increased resistance to CSF
outflow at the arachnoid villi.
Blood supply of brain
Vertebrobasilar
system
• The vertebral artery is a branch of the subclavian artery. It gives rise to the anterior spinal artery (see I.) and the
posterior inferior cerebellar artery (PICA), which supplies the dorsolateral quadrant of the medulla. This quadrant
includes the nucleus ambiguus (CN IX, X, and XI) and the inferior surface of the cerebellum

• The basilar artery is formed by the two vertebral arteries. It gives rise to the following arteries:

• 1. The paramedian branches of the pontine arteries supply the base of the pons, which includes the corticospinal
fibers and the exiting root fibers of the abducent nerve (CN VI).

• 2. The labyrinthine artery arises from the basilar artery in 15% of people. It arises from the anterior inferior
cerebellar artery in 85% of people.

• 3. The anterior inferior cerebellar artery (AICA) supplies the caudal lateral pontine tegmentum, including CN VII,
the spinal trigeminal tract of CN V, and the inferior surface of the cerebellum.

• 4. The superior cerebellar artery supplies the dorsolateral tegmentum of the rostral pons (i.e., rostral to the
motor nucleus of CN V), the superior cerebellar peduncle, the superior surface of the cerebellum and cerebellar
nuclei, and the cochlear nuclei.

• 5. The posterior cerebral artery is connected to the carotid artery through the posterior communicating artery. It
provides the major blood supply to the midbrain. It also supplies the thalamus, lateral and medial geniculate
bodies, and occipital lobe (which includes the visual cortex and the inferior surface of the temporal lobe,
including the hippocampal formation). Occlusion of this artery results in a contralateral hemianopia with macular
sparing
Gray`s anatomy:4rd ed. Drake, Richard and other page: 861-882;
Hal Blumenfeld 2nd Edition. 2010 by Sinauer Associates. Chapter 5 -125-137