1. The Meninges and Blood Vessels of Brain and Spinal Cord, and the Cerebrospinal Fluid
山东大学医学院 解剖教研室
李振华

2. Meninges of Brain and Spinal Cord
The spinal cord and brain are surrounded by three membranes, the meninges.
Named from the outside inward they are
Dura mater 硬膜
Arachnoid mater 蛛网膜
Pia mater 软膜

3. The Meninges of Spinal Cord
Spinal dura mater 硬脊膜
Spinal arachnoid mater脊髓蛛网膜
Spinal pia mater 软脊膜

4. Spinal Dura Mater 硬脊膜 Characters
A dense, fibrous membrane that encloses the spinal cord and cauda equina
Above, attached to circumference of foramen magnum
Below, becomes thinner at level of S2, invests filum terminale to attach at back of coccyx
On each side, continuous with external membrane of spinal nerves at intervertebral foramina

5. Spinal Dura Mater 硬脊膜 Epidural space 硬膜外隙 Subdural space 硬膜下隙
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 硬膜下隙

6. Spinal Arachnoid Mater 脊髓蛛网膜
Characters
A thin, delicate, tubular membran loosely investing spinal cord
Above, it is continuous with cerebral arachnoid mater

7. Subarachnoid Space 蛛网膜下隙
Position: lies between pia and arachnoid maters containing cerebrospinal fluid
Terminal cistern 终池: 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

8. Lumbar spinal puncture (spinal tap)

9. Spinal Pia Mater 软脊膜
A delicate vascular membrane that closely invests the spinal cord
Denticulate ligament齿状韧带: consist of 21 pairs triangular ligaments extending from spinal cord on each side between anterior and posterior roots of spinal nerves to spinal dura mate; these ligaments help to fix position of spinal cord.
Filum terminale 终丝: an extension of pia beyond conus medullaris

11. The Meninges of Brain Cerebral dural mater 硬脑膜
Cerebral arachnoid mater 脑蛛网膜
Cerebral pia mater 软脑膜

12. Cerebral Dural Mater 硬脑膜
Characters
A thick and dense inelastic membrane that composed of two layers, an inner or meningeal and outer or endosteal
It is in loose contact with calvaria, and most strongly adherent to base of skull

13. Cerebral dural mater 硬脑膜
Four septa
Cerebral falx 大脑镰
Tentorium of cerebellum小脑幕－ in front there is a gap, the tentorial incisure 幕切迹, for passage of midbrain
Cerebellar falx 小脑镰
Diaphragma sellae 鞍隔

14. Cerebral Dural Mater 硬脑膜
Sinuses of duramater 硬脑膜窦
Superior sagittal sinus 上矢状窦
Inferior sagittal sinus 下矢状窦
Straight sinus 直窦
Confluence of sinus 窦汇

15. Cerebral Dural Mater 硬脑膜
Transverse sinus 横窦
Sigmoid sinus 乙状窦
Superior petrosal sinuses 岩上窦
inferior petrosal sinuses 岩下窦

16. Cerebral Dural Mater 硬脑膜
Cavernous sinus 海绵窦
Position: lies on each side of sella turcica
Traversing the cavernous sinus
Internal carotid artery
Abducent nerve
Traversing the lateral wall of the cavernous sinus
Oculomotor nerve
Trochlear nerve
Ophthalmic nerve
Maxillary nerve

17. Cerebral Dural Mater 硬脑膜

18. 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

19. Lateral projection from a magnetic resonance venogram using time-of-flight methods.
Frontal projection from a magnetic resonance venogram using time-of-flight methods.

20. Cerebral Arachnoid Mater 脑蛛网膜
Characters: a delicate membrane covering brain loosely, passing over sulci and entering only cerebral longitudinal and transverse fissures

21. Cerebral Arachnoid Mater 脑蛛网膜
Arachnoid granulations 蛛网膜粒－ project into sinuses of dura mater, serve as sites where cerebrospinal fluid diffuses into bloodstream

22. Subarachnoid Cisterns 蛛网膜下池
Cerebellomedullary cistern 小脑延髓池
Chiasmatic cistern 交叉池
Interpeduncular cistern 脚间池
Pontine cistern 桥池
Superior cistern 上池

23. Cerebellomedullary cistern

24. Intracranial hemorrhages…
Extradural or epidural hemorrhage: blood collects between the calvaria and the periosteal layer of dura

25. Intracranial hemorrhages…
Subdural hematoma: blood collects between the dura and arachnoid

26. Intracranial hemorrhages
Subarachnoid hemorrhage: blood flows into the subarachnoid space and mixes with cerebrospinal fluid

27. Cerebral Pia Mater 软脑膜 Closely invests brain surface
In some areas the pia invaginates into ventricles to take part in the formation of choroids plexus

28. Circulation of Cerebrospinal Fluid (CSF)
Cerebrospinal fluid is a clear colorless fluid
Nourishes brain
Removes waste
Conducts chemical signals between parts of CNS
Liquid cushion for brain and spinal cord
Production: produced by the choroids plexuses within the lateral, third and fourth ventricles

29. Choroid plexus = choroidal epithelium
surrounding brain capillaries
CSF volume = 150 ml
75 ml in cisterns
50 ml in subarachnoid space
25 ml in ventricles
CSF formation = ml/day

30. Circulation of Cerebrospinal Fluid (CSF)
interventricular foramina
CSF drains from lateral ventricle
third ventricle
mesencephalic aqueduct
median and two lateral apertures
fourth ventricle
arachnoid granulations
subarachnoid space
superior sagittal sinus
vein

31. Hydrocephalus 脑积水

32. Hydrocephalus 脑积水

33. MRI scan of head in sagittal plane.
MR scan showing an enhancing mass which is a meningioma growing from the meninges at the edge of the foramen magnum. The tumour is benign but is causing compression of the brain stem and secondary hydrocephalus.

34. Blood Vessels of Brain and Spinal Cord

35. Arteries of Brain Two sources
Internal carotid artery: supplies anterior 2/3 of cerebral hemisphere and parts of diencephalon
Vertebral artery: supplies postterior 1/3 of cerebral hemisphere and parts of diencephalon, brain stem and cerebellum

36. Internal Carotid Artery 颈内动脉
Branches
Anterior cerebral artery 大脑前动脉
Middle cerebral artery 大脑中动脉
Anterior choroidal artery 脉络丛前动脉
Posterior communicating artery 后交通动脉

37. Internal Carotid Artery 颈内动脉
Anterior cerebral artery 大脑前动脉
Joined the fellow of the opposite side by the anterior communicating artery
Cortical branches: supply all medial surface of the cerebral cortex as far back as the parietooccipital sulcus and superior border of the suprolateral surface of the cerebral hemisphere
Central branches: supply caudate nucleus, anterior part of lentiform nucleus and anterior limb of internal capsule

38. Internal Carotid Artery 颈内动脉
Middle cerebral artery 大脑中动脉
Cortical branches: supply most of superolateral surface of cerebral hemisphere and insular lobe
Central branches: supply lentiform and caudate nuclei, genu and posterior limb of internal capsule (lenticulostriate artery)

39. Internal Carotid Artery 颈内动脉
Anterior choroidial artery 脉络丛前动脉：passes backward, enters inferior horn of lateral ventricle, and ends in choroid plexus. It supplies lateral geniculate body, posterior limb of internal capsule, middle 3/5 of crus cerebri and globus pallidus
Posterior communicating artery 后交通动脉: runs backward to join posterior cerebral artery

40. Vertebral Artery 椎动脉 Cranial branches Branches of basilar artery
Anterior and posterior spinal arteries 脊髓前、后动脉
Posterior inferior cerebellar artery 小脑下后动脉
Branches of basilar artery
Anterior inferior cerebral artery小脑下前动脉
Labyrinthine artery 迷路动脉
Pontine arteries 脑桥动脉
Superior cerebellar artery 小脑上动脉
Posterior cerebral artery 大脑后动脉

41. Vertebral Artery 椎动脉 Posterior cerebral artery 大脑后动脉
Cortical branches: supply medial and inferior surfaces of temporal lobe and occipital lobe
Central branches: supply dorsal thalamus, medial geniculate body, hypothalamus and subthalamus

43. Cerebral Arterial Circle ( Circle of Willis )
Formation
Anterior communicating artery
Both anterior cerebral arteries
Internal carotid arteries
Posterior communicating arteries
Posterior cerebral arteries
Position: lies on sella turcica around optic chiasma, tuber cinereum and mamillary bodies

44. Area of oxygendeprives brain
Blockage
Thrombus
Plaque

45. Intracerebral
hemorrhage
Arteriovenous
Malformation
动静脉畸形

46. Lenticulostriate arteries 豆纹动脉
Microaneurysm
微血管动脉瘤
Lenticulostriate arteries
豆纹动脉
Subarachnoid hemorrhage
蛛网膜下腔出血

47. Infarct with Punctate hemorrhage

48. Internal carotid arteriogram
Internal carotid arteriogram. This image is a lateral projection obtained by intra-arterial digital subtraction angiography.
Vertebral arteriogram. This image is a lateral projection obtained by intra-arterial digital subtraction angiography.

49. Veins of Brain Superficial cerebral veins
Drain blood from cortex and subcortical medullary substance and empty into adjacent sinuses of dura mater
Superior cerebral v. ascend over the lateral surface of the cerebral hemisphere and drain into the superior sagital sinus.
Inferior cerebral v. drain into the. transverse sinus and cavernous sinus
Superficial middle cerebral v. drains the lateral surface of the cerebral hemisphere . it empties into the cavenous sinus.
Deep middle cerebral v. drains insula and is joined by the anterior cerebral and striate veins to form the basal vein.

50. Veins of Brain Deep cerebral veins
Drain deeper parts of hemispheres, basal nuclei, internal capsule diencephalon and choroid plexus
Ultimately form great cerebral vein 大脑大静脉 which enter straight sinus

51. Arteries of Spinal Cord
Two sources
Anterior and posterior spinal arteries
Branches of segmental arteries: radicular arteries of posterior intercostals arteries, lumbar arteries, and lateral sacral arteries
Damage area: T1~T4,ventral part of L1
vascular ring ( vasocorona )

52. Arteries of Spinal Cord
Posterior spinal a.
Vascular ring
Anterior spinal a.
Radicular a.

53. Veins of Spinal Cord
Spinal veins: draininto internal vertebral venous plexus