The Cranial Meninges

When plasma fluid- which is a clear colorless fluid -perforates from the blood and enters the cavity in the subarachnoid space its name becomes (Cerebrospinal Fluid). So the CSF is the same as the plasma fluid of the blood..

So ,the cranial meninges enclose a fluid filled cavity which contains the CSF,This cavity is located in the Sub arachnoid space.. it functions as a shock absorber, so its absence would cause a serious brain concussion) ( if the person is subjected to a trauma, and the skull would be cracked or broken instantly..in other words it acts like a pillow which absorbs the severity of the shock and protects the skull and the brain.

The meninges: Its composed of three layers which are..

1-the Dura mater:
It's the toughest layer, and is classified into two layers: 1)the inside of the periosteum of the calvarian bones 2)meningeal tough fibrous membrane

2- the Arachnoid matter:

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Its named like this because it sends out fibrous trabiculae, which are joined together to form a shape of a network. These fibers extend from the arachnoid all the way to the pia mater.

3- the Pia mater: Its highly vascularized,** the arteries are of 2 types: Cerebral and Meningeal. ** but for the veins, the cerebral veins when they drain,they go all the way and drain in the meningeal veins.So, these large veins which are now called venous sinuses-(large vein=sinus) drain both:meningeal and cerebral blood,,because in the end the cerebral veins will drain in them. (So these are what we refer to as the venous sinuses of the skull,,they are large veins of meningeal origin,but because they drain from both cerebral and meningeal blood they become very large and we refer to them as venous sinuses)
These venous sinuses are located within the dura mater between two layers the periosteal and the meningeal layer of the dura mater.

4-The Dura mater :

The most external part of the meninges ,and it consists of two layers: 1-preiosteum layer : very tough layer and is attached to the periosteal part of the calvarian bone, but we consider it as outer layer of the Dura . 2-meningeal layer: it's the main part of dura & we call it dura mater proper , it's tough, thick and fibrous .And it continues at the foramen magnum to cover also the spinal cord along with the archnoid and pia mater.
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So, the meninges cover the brain and the spinal cord. also the CSF is within the brain, and in the vertebral column surrounding the spinal cord. Once again as we said, the brain venous sinuses - which drain blood from the brain,the meninges and the bones- are located between the periosteal and the meningeal layers of the dura mater.

Dural reflections:
Reflection means folding .The dura is not always straight sometimes it folds to fill the spaces between the brain and the skull, in order to fix the brain in it's position .So these are foldings of the internal meningeal layer between the brain compartments . You know the brain is composed of two halves right and left and there is a space between them so the meningeal layer enters into this space this is a reflection or a folding of the dura . for example when you look here this is the right hemisphere and this is the left hemisphere ,Now in between them there is a space, the dural meningeal layer (the brown layer) is folding down and returning back up, this is what we mean by reflection of the dura. The importance of dural reflection: They restrict auditory displacements .So they hold the brain fixed in its place by limiting the space between the brain and the skull bones and preventing dislocation of the brain .So these reflections when they come between the two hemispheres of the brain they prevent for example the lateral movement of the brain. There is another one located horizontally between the cerebrum and cerebellum and it prevents the vertical movement of the brain. So they restrict the movement of the brain within the skull.

The main reflections of Dural mater:

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We have four Dural reflection : 1-Falx cerebri . 2-Falx cerebelli. 3-Tentoriunm cerebelli. 4-Sellardiaphragm. Falx cerebri: Falx means that its shape is Sickle shape . and cerebri because it's located between the two cerebral hemisphers. **The most major parts of the brain are the cerebrum and the cerebellum. Falx cerebelli: Its located below the falx cerebri and is smaller than it .its located between the two cerebellar hemisphers ( ) Tentorium cerebelli Its located in the space between cerebrum and cerebellum and separates them from each other . Tentorium from tent because it covers the cerebellum. Sellar diaphragm: The smallest one ,covers the sella turcica and forms the sheet over the pituitary gland which is situated in sella turcica. You can imagine the sella turcica as a bed and the pituitary gland lying in this bed and the sellar diaphragm forms its cover. it separates and fixes the pituitary gland in its place, so its more related to pituitary gland . ** Please remember each reflection separates between which structures.

Arachnoid mater:
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Its an intermediate layer and its attached to the pia mater throw a web glide ( web glide arachnoid trabiculae).its avascular (there is no blood supply) .remember that blood supply to the pia is from cerebral a. and to the Dura is from meningeal a. .And since the arachnoid is avascular it receives nutrients and oxygen from the CSF which is located below the arachnoid layer by diffusion ,the nutrients will diffuse from the CSF into the arachnoid . The arachnoid mater is held against the Dura by the pressure of the CSF ,So when the quantity of the CSF decreases the pressure of the CSF will decrease as well ,and as a result the arachnoid will detach and descend from the Dura. So, technically the dura and the arachnoid layers are not attached but the presence of the CSF under the arachnoid layer presses it upward, and causes the two layers to seem attached together ,So if this fluid was removed the cavity or the space will be removed. *The sub arachnoid space: is the space between the arachnoid and pia mater,it contains arachnoid trabeculae , CSF and cerebral arteries and veins.

The pia mater:

Its very thin and delicate membrane that is highly vascularized and it's very hard to distinguish .it adheres to brain surface and follows its contours .Because the brain cortex is folded, (composed of elevations which are called gyri and depressions which are called sulci), the pia mater follows these foldings. *The brain cortex is folded in order to increase its surface area And as a result increase the number of brain cells (the neurons) *this folded cortex has the ability to contain neurons three times more than if it was straight. The meningeal spaces : They are three spaces :
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1-Epidural space . -2- sub Dural space -3- sub arachnoid space . ** the 1st and 2nd one are not present normally we only see them in abnormal situations like injuries to a blood vessel .So, only we can see the sub arachnoid space in normal situations. the sub arachnoid space : Its located between the arachnoid and the pia mater and it contains the CSF ,So if the CSF is reduced this space will be lost. The epidural space: Epi means above the Dura, between the dura and the bone .its not present normally but it will be present in case of hemorrhage to a vein or artery there .The most important example is the injury to middle meningeal artery, it causes Epidural hemorrhage .So when the hemorrhage happens we will see this space . The subdural space : Sub means under the Dura, between the dura and the arachnoid .we can see it also just in case of hemorrhage like injury to cerebral v., because cerebral veins drain into this area any injury to one of them will cause bleeding in this space .

Blood supply to the meninges :

Meninges cover the whole brain , remember that we have ant. ,middle and post. Cranial fossa .In the ant. Fossa we have the ant. Meningeal a. ,in the middle we have the middle meningeal a. and in the post. Fossa we have the post. Meningeal a. and these arteries supply the Dura mater only and the calvarian bones from inside . The middle meningeal a. is the largest one and has two divisions( ant. And post. ), Along with this artery there is another smaller artery passing ant. to it,which is the accessory meningeal a., again they are both in the middle cranial fossa and they arise from the maxillary
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artery, which is the largest terminal branch of the external carotid artery.( ECA terminates behind the neck of the mandible into two baranches which are: 1-the superficial temporal artery2-the maxillary artery . As the maxillary artery passes behind the neck of the mandible towards the maxilla it sends two arteries the largest one is 1the middle meningeal a. which goes through foreman spinosum .while,2- the accessory meningeal a. which is ant. To it passes through the foramen ovali . **So remember that we have two structures passing through foramen ovali, the 1st one is mandibular trigeminal nerve which is leaving the foramen the 2nd is entering the foramen which is the accessory meningeal a.

The anterior meningeal arteries

They are two arteries, Ant. Meningeal arteries come from the ethmoidal artery which also come from the opthalmic a. which is a branch from ICC. Posterior Meningeal arteries: * they are four in number* - Two from ascending pharyngeal a. (which is the only medial branch of external carotid), it ascends along the walls of the pharynx and supplies it, then at the base of the skull it terminates by giving two branches which pass through two foramina , one passes through 1.hypoglossal canal and the other through the 2.jugular (at the lower part of petrous part of temporal bone). - Another one from the vertebral a. passes through 3.foramen magnum, and the fourth post meningeal a. comes from the occipital a. which passes through the 4.mastoid foramen.

Epidural Hemorrhage

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Hemorrhage due to injury to a meningeal artery. It is the most common injury of the middle meningeal a. which is the largest one. The blood collects between dura and bone, as the blood collects there it will produce local pressure , this pressure will compress the brain , so the patient will lose his consciousness and get in to coma, few hours later it may lead to death Treatment : draining the blood and closure of the artery (by ligation : heating the artery/ )

Dural Venous Sinuses They are blood filled spaces within Dura matter that are lined with endothelium and drain all blood from brain , meninges and from the bones . *Location: Between the periosteal and Meningeal layers of Dura, where Dural infoldings attach. (the area of reflection)

*(you have to know their names and draining ) - Sup. Sagittal sinus: at the upper margin of falx cerebri passing sagitally from ant. all the way to the post. aspect to become the right transverse sinus. - Inf. Sagittal sinus: at the lower margin of falx cerebri,when it terminates it continues posteriorly within the reflection between falx cereblli and tentorium cerebelli,to become the straight sinus. The straight sinus when it goes posteriorly it becomes the left transverse sinus. - Two transverse sinuses : 1. On the right as a continuation of the sup. sinus. 2. On the left as a continuation of the straight sinus which is from the inf. sinus .

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- The transverse sinuses, as they go posteriorly,they become the Sigmoid sinuses because they fold and make a letter S shape which become IJV at the borders of jugular foremen. So the IJV is the continuation of the sigmoid sinus at the jugular foramen ! - Cavernous sinus (like a cave) is a venous plexus , they are actually two, one on the right and one on the left. lateral to sella turcica. It receives the sup. & inf. Ophthalmic v. (which drain from facial veins ) , So they provide a root for the spread of infection from outside all the way to the brain inside. *So if you hear of cavernous sinus thrombosis, it indicates inflammation within the cavernous sinus, because its communicated to the outside, So the most common problems with these venous sinuses occur within the cavernous sinuses because they are communicating with veins from outside the skull.

NOTE : you have to read your text for more details, you have to know the location and where they drain ! The End Wish you all the best of luck Done by: Hadeel sumrain & abeer derawi

Revised and corrected by Nagham Rabi Good luck all

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