Head and Neck and Neuroanatomy

ANA 284

Introduction to Head and Neck

Auza, M I (BSc, MSc)

Department of Human Anatomy

Faculty of Basic Medical Sciences
Bingham University, Karu
 WISDOM QUOTE
"Nothing great can
happen in your life
except you create it,
Accept
responsibility"
 Objectives
• Scalp
• Skull
• Cranial fossa
• The Brain
• Meninges
• Ventricular system
• Cerebrospinal fluid
 Introduction

• The term scalp is

applied to the Soft
tissue which covers
the calvaria or vault
of skull.
 Extent
• The scalp extend from
the top of the forehead
in front to the superior
nuchal line behind.
• Laterally it projects
down to the zygomatic
arch and external
acoustic meatus.
 Layers of Scalp
S - skin
C - Cutaneous tissue
A - Aponeurosis
L - Loose areolar tissue
P - Pericranium
 S = Skin
• The skin of scalp is thick and
hairy except over the forehead.
• It is firmly adherent to
epicranial aponeurosis by dense
connective tissue of superficial
fascia, as in palms and soles.
• Being hairy it contains maximum
number of hair follicles and
associated sebaceous glands.
• As a result, scalp is the
commonest site of sebaceous
cysts.
• It also contains numerous sweat
glands.
 C = Cutaneous
(Superficial/Subcutaneous)
• The superficial fascia of the scalp is made up of dense fibrous
connective tissue that firmly binds the skin to the underlying
occipito-frontalis and its aponeurosis.
• Fibrous septa divide this layer into numerous small pockets
containing lobules of fat.
• The blood vessels and nerves of the scalp lie in this layer.
• The walls of the vessels are adherent to the fibrous network;
hence when blood vessels are torn or cut during an injury, they
are unable to retract and cause profuse bleeding.
• The bleeding, however, can be stopped by pressing against the
underlying bone.
 A = Aponeurosis
• This layer is formed by occipito-frontalis muscle and its aponeurosis.
• The occipito-frontalis muscle consists of four small bellies:
• Two frontal bellies
• Two occipital bellies.
• Since greater part of this layer is formed by aponeurosis, it is called
aponeurotic layer.
• The aponeurosis of occipito-frontalis muscle is also called epicranial
aponeurosis or galea aponeurotica (Latin: galea = helmet).
• The wounds of the scalp do not gape unless epicranial aponeurosis
is cut transversely because the aponeurosis is under tension in the
antero-posterior direction by the tone of occipito-frontalis muscle
Occipito-frontalis muscle: Origin and
Insertion
Frontal bellies
• Origin: Arise from skin and
subcutaneous tissue over the
eyebrows and root of the nose,
• Insertion: Runs backwards to be
inserted into epicranial
aponeurosis in front of coronal
suture.
• They have no bony attachment
of their own.
• The front bellies are longer,
wider, and partly united with
each other along their medial
borders.
Occipito-frontalis muscle: Origin and
Insertion
The occipital bellies
• Origin: Arise from lateral
two-third of the superior
nuchal lines
• Insertion: Extend forwards to
be inserted into the epicranial
aponeurosis.
• The two occipital bellies are
small and separated from each
other by a considerable gap.
• This gap is filled by epicranial
aponeurosis
 Occipito-frontalis muscle: Nerve
supply
Innervation
• The occipital belly on each side is supplied by posterior
auricular branch of facial nerve whereas
• The frontal belly is supplied by temporal branch of the facial
nerve.
Actions
• 1. Alternate contractions of frontal and occipital bellies move the
scalp forwards and backwards over the vault of the skull.
• 2. Acting from above, the contraction of frontal bellies raise the
eyebrows as in surprise.
• 3. Acting from below, the contractions of frontal bellies produce
transverse wrinkles on the forehead as in fright
 L = Loose areolar tissue
• As the name indicates, this layer is made of loose areolar
tissue.
• It serves as a natural plane of cleavage during craniotomy.
• This layer is traversed by emissary veins connecting veins in
the second layer of scalp with intracranial dural venous
sinuses.
 Pericranium
• The fifth layer of scalp is formed by the periosteum of
bones of vault of skull called pericranium.
• It is loosely attached to the bones, but at sutures it is
firmly attached to sutural membrane, which in turn attaches
it to the endocranium (the periosteum covering inner aspect
of the skull bones).
 SCALP: NERVE SUPPLY
A. Sensory supply of the scalp
• The scalp on each side of the
midline is supplied by eight
sensory nerves:
• (a) four in front of the auricle
• (b) four behind the auricle.
• The nerves in front of the
auricle are derived from
trigeminal nerve, whereas
• Those behind the auricle are
derived from the 2nd and 3rd
cervical nerves
 Sensory nerve of the scalp
In front of the auricle Behind the Auricle
Supratrochlear, a branch of Great auricular, derived from
frontal nerve from ophthalmic ventral rami of 2nd and 3rd
division of trigeminal nerve cervical nerves
Supraorbital, a branch of frontal Lesser occipital, derived from
nerve from ophthalmic division of ventral ramus of 2nd cervical
trigeminal nerve nerve
Zygomaticotemporal, a branch of Greater occipital, derived from
zygomatic nerve from maxillary dorsal ramus of 2nd cervical nerve
division of trigeminal nerve
Auriculotemporal, a branch of Third occipital, derived from
mandibular division of trigeminal dorsal ramus of 3rd cervical nerve
nerve
 SCALP: NERVE SUPPLY
B. Motor supply of the scalp
• The scalp on each side of the
midline is supplied by two motor
nerves:
(a) one in front of the ear and
(b) one behind the ear;
Both of these nerves are derived from
the facial nerve.
• Nerve in front of the ear is
temporal branch of the facial nerve.
• It supplies frontal belly of
occipitofrontalis muscle
• Nerve behind the ear is the.
• It supplies occipital belly of
occipitofrontalis muscle.
 ARTERIAL SUPPLY
• The scalp has very rich
blood supply.
• On each side of midline,
• It is supplied by five
arteries:
(a) Three in front of
the auricle
(b) Two behind the
auricle
 Arteries supplying the scalp
In front of the auricle Behind the Auricle
Supratrochlear, a branch Posterior auricular
of ophthalmic artery from artery, a branch of
internal carotid artery external carotid artery
Supraorbital, a branch of Occipital artery, a branch
ophthalmic artery from of external carotid artery
internal carotid artery
Superficial temporal, a
branch of external carotid
artery
 Clinical correlation
• The scalp wounds bleed profusely but heal quickly due to
high vascularity.
• Since all the superficial arteries supplying the scalp ascend
from face and neck.
• Therefore life-threatening scalp-hemorrhage can be
stopped as a first-aid measure, by encircling the head just
above the ears and eyebrows with a string or strong-strap
of cotton and tied tightly
 VENOUS DRAINAGE
• The scalp on each side of the midline is drained by five
veins.
• The veins of the scalp accompany the arteries and have
similar names.
These are as follows:
Supra-trochlear and supraorbital veins:
• They join each other at the medial angle of the eye to form
the angular vein, which continues downwards as the facial
vein behind the facial artery
 VENOUS DRAINAGE
Superficial temporal vein:
• It descends in front of tragus to enter the parotid
gland where it joins the maxillary vein to form the
retromandibular vein, which terminates by dividing into
anterior and posterior divisions.
• The anterior division unites with the facial vein to form
common facial vein, which drains into the internal jugular
vein.
 VENOUS DRAINAGE
Posterior auricular vein:
• It descends behind the auricle and unites with the posterior
division of the retro-mandibular vein to form the external
jugular vein, which drains into the subclavian vein.
Occipital vein:
• It terminates in the suboccipital venous plexus.
NB:
• The veins of the scalp communicate with intracranial dural
venous sinuses through emissary veins.
 Clinical Correlation
• In infants, the veins of the scalp are easily
seen deep to the skin, hence they are the
favored sites for intravenous infusion.
 Emissary Veins
• The veins connecting the veins outside the cranium with
the intracranial dural venous sinuses by passing through
foramina in the cranium are called emissary veins.
• Emissary Veins in the Region of the Scalp On each side of
the midline in the region of the scalp two sets of emissary
veins are encountered, viz.
• 1. Parietal emissary vein, which passes through parietal
foramen and communicates with the superior sagittal sinus.
• 2. Mastoid emissary vein, which passes through mastoid
foramen and communicates with the sigmoid sinus.
 LYMPHATIC DRAINAGE
• The lymphatics from anterior part of the scalp except
the lower half of the forehead drain into preauricular (or
superficial parotid) lymph nodes situated on the surface of
the parotid gland.
• The lymphatics from posterior part of the scalp drain
into posterior auricular (mastoid) and occipital lymph
nodes
 The skull
• The skull is a bony structure that supports the face and
forms a protective cavity for the brain.
• It is comprised of many bones, which are formed by
intramembranous ossification, and joined by sutures (fibrous
joints).
• The bones of the skull can be considered as two groups:
• (A) Those of the cranium
• (B) Those of the face.
 The cranium
• The cranium (also known as the
neurocranium) is formed by the superior
aspect of the skull.
• It encloses and protects the brain,
meninges, and cerebral vasculature.
• Anatomically, the cranium can be subdivided
into a roof and a base:
• Cranial roof – comprised of the frontal,
occipital and two parietal bones. It is also
known as the calvarium.
• Cranial base – comprised of the frontal,
sphenoid, ethmoid, occipital, parietal, and
temporal bones.
• These cranial base bones articulate with
the 1st cervical vertebra (atlas), the facial
bones, and the mandible (jaw).
 Sutures of the Skull
• Sutures are a type of fibrous joint
that are unique to the skull.
• They are immovable and fuse
completely around the age of 20.
• These joints are important in the
context of trauma, as they represent
points of potential weakness in the
skull.
• The main sutures in the adult skull are:
• Coronal suture – fuses the frontal bone
with the two parietal bones.
• Sagittal suture – fuses both parietal
bones to each other.
• Lambdoid suture – fuses the occipital
bone to the two parietal bones.
 Sutures of the Skull
• In neonates, the incompletely
fused suture joints give rise
to membranous gaps between
the bones, known as
fontanelles.
The two major fontanelles are:
• Frontal fontanelle – located
at the junction of the coronal
and sagittal sutures
• Occipital fontanelle – located
at the junction of the sagittal
and lambdoid sutures
 Cranial Fossa
• The floor of the cranial cavity is divided into three distinct
depressions.
They are known as the
• Anterior cranial fossa
• Middle cranial fossa and
• Posterior cranial fossa.
• Each fossa accommodates a different part of the brain.
 Anterior cranial fossa
• The anterior cranial fossa is the most shallow and superior
of the three cranial fossae.
• It lies superiorly over the nasal and orbital cavities.
• The fossa accommodates the anteroinferior portions of
the frontal lobes of the brain.
 Anterior Cranial Fossa: Borders
• The anterior cranial
fossa consists of
three bones:
the frontal bone, eth
moid bone
and sphenoid bone.
 Anterior Cranial Fossa: Borders
• It is bounded as follows:
• Anteriorly and laterally it is bounded by the inner surface of
the frontal bone.
• Posteriorly and medially it is bounded by the limbus of
the sphenoid bone. The limbus is a bony ridge that forms the
anterior border of the prechiasmatic sulcus (a groove running
between the right and left optic canals).
• Posteriorly and laterally it is bounded by the lesser wings of
the sphenoid bone (these are two triangular projections of bone
that arise from the central sphenoid body).
• The floor consists of the frontal bone, ethmoid bone and the
anterior aspects of the body and lesser wings of
the sphenoid bone
 Anterior Cranial Fossa: Contents
• There are several bony landmarks present in
the anterior cranial fossa.
• The frontal bone is marked in the midline by
a body ridge, known as the frontal crest.
• It projects upwards, and acts as a site of
attachment for the falx cerebri (a sheet of
dura mater that divides the two cerebral
hemispheres).
• In the midline of the ethmoid bone,
the crista galli.
• This is an upwards projection of bone, which
acts as another point of attachment for the
falx cerebri.
• On either side of the crista galli is
the cribriform plate which supports
the olfactory bulb and has numerous
foramina that transmit vessels and nerves.
 Anterior Cranial Fossa: Contents
• The anterior aspect of
the sphenoid bone lies within the
anterior cranial fossa.
• From the central body, the lesser
wings arise.
• The rounded ends of the lesser wings
are known as the anterior clinoid
processes.
• They serve as a place of attachment
for the tentorium cerebelli (a sheet of
dura mater that divides the cerebrum
from the cerebellum).
• The lesser wings of the sphenoid
bone also separate
the anterior and middle cranial fossae.
 Anterior Cranial Fossa: Foramina
• The ethmoid bone in particular
contains the main foramina (openings
that transmit vessels and nerves) of
the anterior cranial fossa.
• The cribriform plate is a sheet of bone
seen either side of the crista
galli which contains numerous small
foramina – these transmit olfactory
nerve fibres (CN I) into the nasal
cavity.
• It also contains two larger foramen:
• Anterior ethmoidal foramen –
transmits the anterior ethmoidal
artery, nerve and vein.
• Posterior ethmoidal foramen –
transmits the posterior ethmoidal
artery, nerve and vein.
 Clinical Relevance: Fracture of the
Cribriform Plate
• The cribriform plate of the ethmoid is the thinnest part of the
anterior cranial fossa, and therefore most likely to fracture.
There are two major consequences of cribriform plate fracture:
• Anosmia – the olfactory nerve fibres run through the cribriform
plate, and can be ‘sheared’, resulting in loss of sense of smell.
• CSF rhinorrhoea – the fragments of bone can tear the meningeal
coverings of the brain, causing the leakage of cerebrospinal fluid
into the nasal cavity. This is visible as a clear fluid.
 Middle cranial fossa
• The middle cranial fossa is located, as its name
suggests, centrally in the cranial floor.
• It is said to be “butterfly shaped”,
• With a middle part accommodating the pituitary
gland and two lateral parts accommodating
the temporal lobes of the brain
 Middle Cranial Fossa: Borders
• The anterior cranial
fossa consists of
three bones:
two temporal bone
and sphenoid bone.
 Middle Cranial Fossa: Borders
• Anteriorly and laterally it is bounded by the lesser wings of
the sphenoid bone. These are two triangular projections of bone that
arise from the central sphenoid body.
• Anteriorly and medially it is bounded by the limbus of the sphenoid
bone. The limbus is a bony ridge that forms the anterior border of
the chiasmatic sulcus (a groove running between the right and left
optic canals).
• Posteriorly and laterally it is bounded by the superior border of the
petrous part of the temporal bone.
• Posteriorly and medially it is bounded by the dorsum sellae of the
sphenoid bone. This is a large superior projection of bone that arises
from the sphenoidal body.
• The floor is formed by the body and greater wing of the sphenoid,
and the squamous and petrous parts of the temporal bone.
 Contents
• The middle cranial fossa consists of
1. Central portion, which contains the pituitary gland, and
2. Two lateral portions, which accommodate the temporal
lobes of the brain.
 Central part of the middle cranial
fossa
• The central part of the middle
cranial fossa is formed by the
body of the sphenoid bone.
• It contains the sella turcica,
which is a saddle-shaped bony
prominence.
• It acts to hold and support the
pituitary gland, and consists of
three parts:
• Tuberculum sellae
• Hypophysial fossa or pituitary
fossa
• Dorsum sellae
 Lateral Parts of the middle cranial
fossa
• The depressed lateral parts of the middle cranial fossa are
formed by the greater wings of the sphenoid bone,
and the squamous and petrous parts of the temporal bones.
• They support the temporal lobes of the brain.
• It is the site of many foramina – small holes by which
vessels and nerves enter and leave the cranial cavity.
 Middle cranial fossa: Foramina
• There are many foramina that
transmit vessels and nerves into
and out of the middle cranial
fossa.
Foramina of the Sphenoid Bone
• The optic canals are situated
anteriorly in the middle cranial
fossa.
• They transmit the optic
nerves (CN II) and ophthalmic
arteries into the orbital cavities.
• Immediately lateral to the
central part of the middle cranial
fossa are four foramina:
 Middle cranial fossa: Foramina
• Superior orbital fissure opens anteriorly into the orbit. It
transmits the oculomotor nerve (CN III), trochlear nerve (CN
IV), ophthalmic branch of the trigeminal nerve (CN V1), abducens
nerve (CN VI), opthalmic veins and sympathetic fibres.
• Foramen rotundum opens into the pterygopalatine fossa and
transmits the maxillary branch of the trigeminal nerve (CN V2).
• Foramen ovale opens into the infratemporal fossa, transmitting
the mandibular branch of the trigeminal nerve (CN V3) and
accessory meningeal artery.
• Foramen spinosum also opens into the infratemporal fossa. It
transmits the middle meningeal artery, middle meningeal vein and
a meningeal branch of CN V3.
 Middle cranial fossa: Foramina
Foramina of the Temporal Bone
The temporal bone is marked by three major foramina:
• Hiatus of the greater petrosal nerve – transmits the greater
petrosal nerve (a branch of the facial nerve), and the petrosal branch
of the middle meningeal artery.
• Hiatus of the lesser petrosal nerve – transmits the lesser petrosal
nerve (a branch of the glossopharyngeal nerve).
• Carotid canal – located posteriorly and medially to the foramen ovale.
This is traversed by the internal carotid artery, which ascends into
the cranium to supply the brain with blood. The deep petrosal nerve
also passes through this canal.
• At the junction of the sphenoid, temporal and occipital bones is
the foramen lacerum. In life, this foramen is filled with cartilage,
which is pierced only by small blood vessels.
 Posterior cranial fossa
• The posterior cranial
fossa is the most posterior
and deep of the three
cranial fossae.
• It accommodates the
brainstem and cerebellum.
 Borders
• The posterior cranial fossa is comprised of three bones: the
occipital bone and the two temporal bones. It is bounded as
follows:
• Anteromedial – dorsum sellae of the sphenoid bone (large
projection of bone superiorly that arises from the body of the
sphenoid).
• Anterolateral – superior border of the petrous part of
the temporal bone.
• Posterior – internal surface of the squamous part of the occipital
bone.
• Floor – mastoid part of the temporal bone and the squamous,
condylar and basilar parts of the occipital bone.
 Posterior Cranial Fossa: Contents
• The posterior cranial fossa houses the brainstem
and cerebellum.
• The brainstem is comprised of the medulla oblogata, pons
and midbrain and continues down through the foramen
magnum to become the spinal cord.
• The cerebellum has an important role in co-ordination and
fine motor control
 Posterior cranial Fossa: Foramina
• Foramina present in the posterior
cranial fossa allows the passage of
blood vessel or nerve.
Temporal Bone
• The internal acoustic meatus is an
oval opening in the posterior aspect
of the petrous part of the temporal
bone.
• It transmits the facial nerve (CN
VII), vestibulocochlear nerve (CN
VIII) and labyrinthine artery.
 Posterior cranial Fossa: Foramina
Occipital Bone
• A large opening, the foramen
magnum, lies centrally in the floor of
the posterior cranial fossa.
• It is the largest foramen in the skull.
• It transmits the medulla of the
brain, meninges, vertebral
arteries, spinal accessory
nerve (ascending), dural veins and
anterior and posterior spinal
arteries.
• Anteriorly an incline, known as
the clivus, connects the foramen
magnum with the dorsum sellae.
 Posterior cranial Fossa: Foramina
• The jugular foramina are situated either side of the foramen
magnum.
• Each transmits the glossopharyngeal nerve, vagus nerve, spinal
accessory nerve (descending), internal jugular vein, inferior
petrosal sinus, sigmoid sinus and meningeal branches of the
ascending pharyngeal and occipital arteries.
• Immediately superior to the anterolateral margin of the foramen
magnum is the hypoglossal canal. It transmits the hypoglossal
nerve through the occipital bone.
• Posterolaterally to the foramen magnum lies the cerebellar
fossae. These are bilateral depressions that house
the cerebellum. They are divided medially by a ridge of bone,
the internal occipital crest.
 The brain
• The brain consists of the
cerebrum, diencephalon,
midbrain, pons, cerebellum
and medulla oblongata.
• The midbrain, pons, and
medulla oblongata together
form the brainstem.
• The medulla oblongata is
continuous below with the
spinal cord
 MENINGES
• The brain and the spinal
cord are covered by three
layers of meninges; the
outermost toughest layer is
known as dura mater, the
next layer is known as
arachnoid mater and the
innermost thin layer is
known as pia mater.
 MENINGES: Dura Mater
• The Dura mater, derived from mesoderm, is made up of dense
fibrous tissue and hence it is also known as pachymeninx.
• The dura mater is the outermost layer of the meninges and is
located directly underneath the bones of the skull and vertebral
column.
• It is thick, tough, and inextensible.
• The dura mater consists of two layered sheets of connective
tissue:
• Periosteal layer – lines the inner surface of the bones of the
cranium.
• Meningeal layer – located deep to the periosteal layer. It is
continuous with the dura mater of the spinal cord.
 MENINGES: Dura Mater
• The dural venous sinuses are located between the two
periosteal and meningeal layers of dura mater. The dural
venous sinueses are responsible for the venous drainage of
the cranium and empty into the internal jugular veins.
• The dura mater receives its own vascular supply – primarily
from the middle meningeal artery and vein.
• It is innervated by the trigeminal nerve (V1, V2 and V3).
MENINGES: Arachnoid Mater
• The Arachnoid mater and the Pia mater are derived from
neural crest cells and are quite thin. Hence, these two inner
layers are known as leptomeninges.
• The arachnoid mater is the middle layer of the meninges, lying
directly underneath the dura mater.
• It consists of layers of connective tissue, is avascular, and does
not receive any innervation.
• Underneath the arachnoid is a space known as the sub-arachnoid
space. It contains cerebrospinal fluid, which acts to cushion the
brain.
• Small projections of arachnoid mater into the dura (known
as arachnoid granulations) allow CSF to re-enter the circulation
via the dural venous sinuses.
An arachnoid granulation is visible in the centre
 MENINGES: Pia mater
• The pia mater is located underneath the sub-arachnoid
space.
• It is very thin, and tightly adhered to the surface of the
brain and spinal cord.
• It is the only covering to follow the contours of the brain
(the gyri and fissures).
• Like the dura mater, it is highly vascularised, with blood
vessels perforating through the membrane to supply the
underlying neural tissue.
 MENINGES: Spaces
• The space between the dura mater and the endosteum of
the bone covering it is known as epidural or extradural
space.
• The space between the dura mater and the arachnoid mater
is known as the subdural space.
• The space between the arachnoid mater and the pia mater is
known as the subarachnoid space and the space between
the pia mater and the brain is known as the subpial space
 MENINGES: Functions
These coverings have two major functions:
• Provide a supportive framework for the cerebral and cranial
vasculature.
• Acting with cerebrospinal fluid to protect the CNS from
mechanical damage.
• The meninges are often involved cerebral pathology, as a
common site of infection (meningitis), and intracranial
bleeds.
 Clinical Relevance: Meningitis
• Meningitis refers to inflammation of the meninges. It is usually
caused by pathogens, but can be drug induced.
• Bacteria are the most common infective cause. The most common
organisms are Neisseria meningitidis and Streptococcus pneumoniae.
• The immune response to the infection causes cerebral oedema,
consequently raising intra-cranial pressure.
This has two main effects:
• Part of the brain can be forced out of the cranial cavity – this is
known as cranial herniation.
• In combination with systemic hypotension, raised intracranial
pressure reduces cerebral perfusion.
• Both complications can rapidly result in death.
 Ventricular system
• The ventricular system is a set of
communicating cavities within the
brain
• These structures are responsible for
the production, transport and
removal of cerebrospinal
fluid, which bathes the central
nervous system
• The ventricles are lined
by ependymal cells, which form a
structure called the choroid plexus.
• It is within the choroid plexus that
CSF is produced.
 Functions of Cerebrospinal Fluid
• Cerebrospinal fluid is an ultrafiltrate of plasma that surrounds
the brain and spinal cord.
It serves three main functions:
• Protection – acts as a cushion for the brain, limiting neural
damage in cranial injuries.
• Buoyancy – by being immersed in CSF, the net weight of the
brain is reduced to approximately 25 grams. This prevents
excessive pressure on the base of the brain.
• Chemical stability – the CSF creates an environment to allow for
proper functioning of the brain, e.g. maintaining low extracellular
K+ for synaptic transmission.
 Ventricles of the Brain
• Embryologically, the
ventricular system is
derived from the lumen of
the neural tube.
• In total, there are four
ventricles;
• Right and left lateral
ventricles,
• Third ventricle and
• Fourth ventricle.
 Lateral Ventricles
• The left and right lateral
ventricles are located within
their respective
hemispheres of the
cerebrum.
• They have ‘horns’ which
project into the frontal,
occipital and temporal lobes.
• The volume of the lateral
ventricles increases with
age.
 Third Ventricle
• The lateral ventricles are
connected to the third
ventricle by the foramen of
Monro.
• The third ventricle is situated in
between the right and the left
thalamus.
• The anterior surface of the
ventricle contains two
protrusions:
• Supra-optic recess – located
above the optic chiasm.
• Infundibular recess – located
above the optic stalk.
 Fourth Ventricle
• The fourth ventricle is the last in the
system – it receives CSF from the third
ventricle via the cerebral aqueduct.
• It lies within the brainstem, at the
junction between the pons and medulla
oblongata.
• From the 4th ventricle, the fluid drains
into two places:
• Central spinal canal – bathes the spinal
cord
• Subarachnoid cisterns – bathes the
brain, between arachnoid mater and pia
mater.
• Here the CSF is reabsorbed back into
the circulation.
 Production and Reabsorption of
Cerebrospinal Fluid
• Cerebrospinal fluid is produced by the choroid plexus, located in
the lining of the ventricles.
• It consists of capillaries and loose connective tissue, surrounded
by cuboidal epithelial cells.
• Plasma is filtered from the blood by the epithelial cells to
produce CSF. In this way, the exact chemical composition of the
fluid can be controlled.
• Drainage of the CSF occurs in the subarachnoid cisterns (or
space). Small projections of arachnoid mater (arachnoid
granulations) protrude into the dura mater.
• They allow the fluid to drain into the dural venous sinuses.