Meninges and Dural

Venous Sinuses

Dr Kaini Pfoze
 Headings:
Spinal meninges
Cranial meninges
Dural Folds or Reflections
Dural Venous Sinuses
Cavernous Sinus
The brain and spinal cord are entirely enveloped by
three concentric membranes, the Meninges. They
provide support and protection to the brain and spinal
cord. Named from the outside inward
they are:
1. Dura mater
2. Arachnoid mater
3. Pia mater.
 Spinal Meninges
1. Spinal dura mater
2. Spinal arachnoid mater
3. Spinal pia mater
 Spinal Duramater

Attachment:
Above, attached to
circumference of foramen
magnum
Below, becomes thinner at
level of S2, invests filum
terminale to attach at back
of coccyx
Epidural space Epidural space
Position: lies between spinal dura
mater and periosteum of vertebral
canal
Contents: a quantity of loose
connective tissue, fat, lymphatic
vessels and vertebral venous
plexus, the spinal nerves on each
side pass through the epidural
space which is applicable for block
anesthesia

Subdural space
Space between duramater and
arachnoid mater
 Spinal Arachnoid mater

Characters
A thin, delicate, tubular
membrane loosely investing
spinal cord
Above, it is continuous with
cranial arachnoid mater
 Subarachnoid space

Subarachnoid space
Position: lies between pia and
arachnoid mater . It contains
cerebrospinal fluid.
Terminal cistern : the largest
part of subarachnoid space
extending from termination of
spinal cord to level of S2, where it
is occupied by nerves of cauda
equina, so it is the best site for a
lumbar puncture
Terminal cistern
 Lumbar puncture
Lumbar puncture is a procedure that is often performed in the
emergency department to obtain information about the cerebrospinal
fluid (CSF). Although usually used for diagnostic purposes to rule out
potential life-threatening conditions, it is also sometimes used for
therapeutic purposes. The spinal needle can be safely inserted into the
subarachnoid space at the L3-4 or L4-5 interspace, since this is well
below the termination of the spinal cord in most patients.
 Spinal Pia mater

A delicate vascular membrane

that closely invests the spinal
cord
Denticulate ligament: The
denticulate ligaments are
bilateral triangular extensions of
pia mater. They consist of 21 pairs
extending from spinal cord on
each side, between anterior and
posterior roots of spinal nerves to
spinal dura mater; these
ligaments help to fix the position
of spinal cord.
Filum terminale: an extension
of pia beyond conus medullaris
 The Meninges of Brain
1. Cranial duramater
2. Cranial arachnoid mater
3. Cranial pia mater
 Cranial duramater

Characters Duramater
A thick and dense inelastic
membrane that is
composed of two layers, an
inner or meningeal layer
and outer or endosteal
layer
It is in loose contact with
calvaria, and most strongly
adherent to base of skull
Dural Folds or
Reflections
The meningeal layer of the
dura is reflected inwards to
form four septa that divide
the cranial cavity into
compartments in which Falx cerebri
subdivisions of the brain are
lodged.
1. Falx Cerebri
Tentorium cerebelli
2. Tentorium cerebelli －
3. Falx Cerebelli
4. Diaphragma sellae
Diaphragma sellae

Falx cerebelli
 Falx cerebri

Falx cerebri
Falx cerebri is a vertical sheet of
duramater which extends from the
cranial roof into the great longitudinal
fissure between the cerebral
hemispheres.
The falx cerebri, therefore , has an
attached border that adheres to the
inner surface of the skull and a free
border that lies above the corpus
callosum.
 Tentorium cerebelli
A horizontal shelf of duramater that
extends inwards from the occipito-
temporal region of the skull to lie in
the transverse cerebral fissure.
It lies between the posterior part of the
cerebral hemispheres and the
cerebellum.
The tentorium has a free border that
encircles the midbrain called the
tentorial notch or incisure. Tentorium cerebelli
In the midline the tentorium becomes
continuous with falx cerebri
 Falx cerebelli
Falx cerebelli is a small midline fold of duramater
lying below the tentorium cerebelli. It projects forward
into the posterior cerebellar notch between the
cerebellar hemispheres.
Diaphragma sellae
Diaphragma sellae is a small, circular, horizontal sheet
of duramater which forms a roof to the sella turcica,
and in many cases, almost completely covers the
pituitary gland.
 Cranial Arachnoid mater

Characters: a delicate
membrane covering brain
loosely, passing over sulci
and entering only cerebral
longitudinal and
transverse fissures.
 Arachnoid granulations － project into sinuses of dura mater,
serve as sites where cerebrospinal fluid diffuses into bloodstream

Arachnoid mater
 Cranial pia mater

Closely invests brain

surface, in some areas the
pia invaginates into
ventricles to take part in
the formation of choroid
plexus
 Dural Venous Sinuses
Dural venous sinuses are a complex of venous channels
which lie between the endosteal and meningeal
layer of duramater
Drain the diploe, duramater and brain
They are Valveless
No muscle layer in their walls
The following are the Dural
Venous Sinuses:

Unpaired
1. Superior sagittal sinus
2. Inferior sagittal sinus
3. Straight sinus

4. Occipital sinus
Paired dural venous sinuses
1. Transverse sinus
2. Sigmoid sinus
3. Superior Petrosal sinus
4. Inferior Petrosal sinus
5. Sphenoparietal sinus
6. Cavernous Sinus
 Dural Sinuses
Superior Sagittal
Inferior Sagittal

Great Cerebral

Sup/Inf Petrosal Straight

Confluence

Occipital

Transverse
Sigmoid
 Superior Sagittal Sinus

Sphenoparietal

Cavernous
Basilar

Superior
Petrosal Sigmoid

Straight Transverse
Confluence
 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

 Superior Sagittal Sinus

The superior sagittal sinus runs in the attached, convex

margin of the falx cerebri. It grooves the internal surface of
the frontal bone, the adjacent margins of the two parietal
bones and the squamous part of occipital bone.
It begins near the crista galli, a few mm posterior to the
foramen caecum.
Its primary tributaries are the cortical veins of the frontal
lobes and ascending frontal veins.
The sinus runs backwards and at the internal occipital
protuberance, it deviates to the right and continues as a
Transverse sinus.
 Superior sagittal sinus contd.

It is triangular in cross section

The interior of the superior sagittal sinus possesses the
openings of superior cerebral veins and arachnoid
granulations.
The tributaries are Superior cerebral veins. Veins from the
pericranium, diploic veins and meningeal veins.
The dilated posterior portion of the superior sagittal sinus
is referred to as the confluence of sinuses. This is situated
to one side of the internal occipital protuberance, where
the superior sagittal sinus turns to become a transverse
sinus.
Cavernous Sinus
Headings:
Location
Cavernous sinus
Extent
Relations
Tributaries and
communications
Contents
Applied (Cavernous
Sinus thrombosis)
Cavernous sinus
 Location: lies on both sides of the body of
the Sphenoid bone
 Extent: It extends from the superior orbital
fissure to the apex of the petrous temporal
bone. It has an average length of 2cm and a
width of 1cm.
 Relations of cavernous sinus:
Medial – Pituitary above, sphenoidal air
cells below
Lateral – Temporal lobe of brain, Uncus
Anterior – Superior orbital fissure
Posterior – Apex of petrous temporal lobe
Superior – Optic chiasma
Internal carotid
artery and abducent
nerve run through the
sinus
Oculomotor and
trochlear nerves and
ophthalmic and
maxillary divisions of
trigeminal nerve lie in
the lateral wall of the
sinus

Contents:
1. Oculomotor nerve
2. Trochlear nerve
3. Ophthalmic div of Trigeminal
4. Maxillary div of Trigeminal
5 . Abducent nerve
6. Internal Carotid artery
 CAVERNOUS SINUS & CONTENTS
Pituitary Gland

CN III
CN IV
CN VI Internal
Carotid
CN V1
CN V2
 Cavernous sinus contd.

Tributaries:
Superior ophthalmic vein
Inferior ophthalmic vein
Superficial middle cerebral vein
Inferior cerebral veins
Sphenoparietal sinus
Central vein of retina
Drainage
Superior petrosal sinus---Transverse sinus
Inferior petrosal sinus----Internal jugular vein
 Communications:
Intercavernous sinuses – communication between the
two cavernous sinuses
Pterygoid plexus – via emissary veins passing through
foramen ovale, sphenoidal foramen and foramen
lacerum
Facial vein – via the superior ophthalmic vein
Connections of Facial vein with the Cavernous Sinus
 Directly to cavernous
sinus by superior
ophthalmic vein or
inferior ophthalmic
vein
 Indirectly by pterygoid
venous plexus by
inferior ophthalmic
vein or deep facial
vein
 Infection from the face
can spread to the
cavernous sinus via the
above connections and
cause Cavernous Sinus
Thrombosis
 Cavernous sinus

Superior ophthalmic vein

Angular vein

Inferior ophthalmic vein

Pterygoid venous plexus

Facial vein
Maxillary vein

Deep facial vein Retromandibular vein

Connections of facial vein with Cavernous sinus

 Cavernous sinus thrombosis
 Cavernous sinus thrombosis is usually a late complication of
an infection of the central face or paranasal sinuses.
 Other causes include bacteremia, trauma, and infections of
the ear or maxillary teeth.
 Cavernous sinus thrombosis is generally a fulminant process
with high rates of morbidity and mortality.
 Because of its complex neurovascular anatomic
relationship, cavernous sinus thrombosis is the most
important of any intracranial septic thrombosis.
Fortunately, the incidence of cavernous sinus thrombosis has
been decreased greatly with the advent of effective
antimicrobial agents.
Appearance of cavernous sinus thrombosis……due to involvement
of structures/contents present in the cavernous sinus
 Important topics to remember:
1. Spinal Meninges
Epidural space/epidural block
Lumbar puncture
2. Cranial Meninges
Dural Folds or Reflections
3. Dural Venous Sinuses
Cavernous Sinus and cavernous sinus thrombosis
Thank you