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. The 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 the dura mater, arachnoid, and pia mater.

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
Above, attached to circumference of foramen magnum
Below, becomes thinner at level of S2, invests filum terminale to attach at back of coccyx

5. 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: an extension of pia beyond conus medullaris

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

11. 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

12. 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

13. 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

14. Transverse sinus 横窦
Sigmoid sinus 乙状窦
Superior petrosal sinuses 岩上窦
inferior petrosal sinuses 岩下窦

15. Position: lies on each side of sella turcica
Cavernous sinus 海绵窦
Position: lies on each side of sella turcica
Relations of cavernous sinus:
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

16. 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

17. 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

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

19. Subarachnoid cisterns
Cerebellomedullary cistern 小脑延髓池
Interpeduncular cistern 脚间池
Pontine cistern 桥池
Superior cistern 上池

20. Cerebellomedullary cistern

21. 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

22. Circulation of cerebrospinal fluid (CSF)
Cerebrospinal fluid is a clear colorless fluid, which acts as a transport medium for nutrients and vaster products and provides a protective fluid cushion for the central nervous system.
Production: produced by the choroids plexuses within the lateral, third and fourth ventricles

23. Circulation of cerebrospinal fluid
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

24. Blood vessels of brain and spinal cord

25. 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

26. Internal carotid artery 颈内动脉
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

27. 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

28. 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)

29. Anterior choroidal 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

30. Vertebral artery 椎动脉 Cranial branche 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

31. Posterior cerebral artery
Cortical branches: supply medial and inferior surfaces of temporal lobe and occipital lobe
Central branches: supply dorsal thalamus, medial and lateral geniculate bodies, hypothalamus and subthalamus

32. Cerebral arterial circle ( circle of Willis )
Formation: formed by anterior communicating artery, both anterior cerebral arteries, internal carotid arteries, posterior communicating arteries, and posterior cerebral arteries
Position: lies on sella turcica around optic chiasma, tuber cinereum and mamillary bodies

33. Area of oxygendeprives brain
Blockage
Thrombus
Plaque

34. Microaneurysm
Lenticulostriate arteries
Subarachnoid hemorrhage

35. Intracerebral
hemorhage
Arteriovenous
malformation

36. Veins of brain Superficial cerebral veins
Drain blood from cortex and subcortical medullary substance and empty into adjacent sinuses of dura mater

37. Veins of brain
Deep cerebral veins: drain deeper parts of hemispheres, basal nuclei, internal capsule, diencephalon and choroid plexus, ultimately form great cerebral vein which enter straight sinus

38. Blood vessels of spinal cord
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 )

39. Blood vessels of spinal cord
Spinal veins: drain into internal vertebral venous plexus