27.

THE FOURTH VENTRICLE

Fourth ventricle is the last and lowest ventricle of the cerebrum. Its tent-shaped roof makes it
more spacious. Its roof contains three apertures for the release of closely guarded CSF into
the subarachnoid space for absorption into the superior sagittal sinus.
The cavity of the hindbrain is called the fourth ventricle. It is a tent-shaped space situated
between the pons and the medulla in front, and the cerebellum behind.

Communications
1. Superiorly, it communicated with the third ventricle through the cerebral aqueduct.
2. Inferiorly, it is continuous with the central canal of the medulla, and of the spinal cord.
3. Dorsally, in lower part of the roof there is a median aperture (foramen of Magendi).
Through this aperture the ventricle communicates with the subarachnoid space
(cistern magna).
4. On either side, again it communicates with the subarachnoid space through two lateral
apertures (foramina of Luschka)

Recesses of the Fourth Ventricle

1. A median dorsal recess, extends into the white core of the cerebellum, above the
nodule.
2. Two lateral dorsal recesses, one on each side, extend backwards, lying above the
inferior medullary velum and below the cerebellar nuclei.
3. Two lateral recesses, one on each side, extend laterally between the inferior cerebellar
peduncle (in front) and the stem of the flocculus (behind). They reach up to the
flocculus itself. Each recess opens at its lateral end through the foramen of Luschka.

Lateral Boundaries
On each side, the fourth ventricle is bounded: (a) Inferolaterally, by the gracile tubercle, the
fasciulus cuneatus, the cuneate tubercle, and the inferior cerebellar peduncle; and (b)
superolaterally, by the superior cerebellar peduncle.

Roof of Fourth Ventricle

The roof is tent-shaped, projecting into the cerebellum. It is formed by :

(1)
(2)
(3)
(4)
(5)

The superior cerebellar peduncles;

The superior medullary velum;

The inferior medullary velum;
The tela choroidea of the fourth ventricle, containing the choroid plexus;
&
The tainiae with the obex. The taenia are white ependymal ridges
covered with tela choroidea lying along the inferolateral margins of the
roof. The two taeniae are continuous below with the obex which covers
the ventricle and is lined with ependyma both in front and behind.

The choroid plexus of the fourth ventricle is supplied bya branch from the
posterior inferior cerebellar artery. It lies within the tela choroidea of the fourth
ventricle. The entire plexus is T-shaped, the vertical limb of the T being double.
The foramen of magendie lies between the two limbs. The horizontal limbs
extend into the lateral recesses and protrude through the foramina of Luschka
into the subarachnoid space.

Floor of Fourth Ventricle

It is also called the rhomboid fossa because It is rhomboidal in shape.
The floor is formed by :
(a)
(b)

The posterior surface of the pons; and

The posterior surface of the open part of the medulla.

Deep to the floor there is a layer of grey matter containing various cranial nerver
nuclei. The floor is lined by ependyma. The following features are seen in the
floor.
1. A median sulcus divides the floor into right and left halves.
2. On either side of the midline, there is an elevation called the median
eminence. This eminence is bounded, laterally, by the sulcus limitans.
3. The following are seen in relation to the sulcus limitans.

(a)

4.

5.

6.

7.

A bluish coloured area called the locus coeruleus, deep to which there
is the substantia ferruginea.
(b) A depression, the superior fovea, which lies just lateral to the facial
colliculus.
(c) Another depression, the inferior fovea, that lies just above the vagal
triangle (see below).
The following features are seen in relation to the median eminence.
(a) The facial colliculus is an elevation over the upper part of the
eminence. It lies opposite the superior fovea. It is produced by the
underlying abducent nucleus, and the fibers of the facial nerve and
they wind around the nucleus.
(b) The lower part of the eminence is occupied by the hypoglossal
triangle.
The vestibular area lies lateral to the fovea. Part of ot extends into the
lateral recess, and forms an elevation called the auditory tubercle. The
tubercle overlies the dorsal cochlear nucleus and the cochlear nerve.
The striae medullares are transverse lines running across the floor. They
represent fibers passing from the arcuate nucleus to the opposite half of the
cerebellum.
The vagal triangle lies below the inferior fovia and between the
hypoglossal triangle and the vestibular area. It overlies the dorsal nucleus
of the vagus nerve.

Development
Fourth ventricle is the cavity of rhombencephalon. Roof plate here becomes thin
and forms the roof of the fourth ventricle. The floor plate becomes thick due to
migration of alar lamina lateral to basal lamina. It forms the floor of the fourth
ventricle. Floor is formed by caudal part of pons and cranial part of medulla
oblongata.
CLINICLE ANATOMY
1. Vital centres are situated in the vicinity of the vagal triangle. An injury to
this area is therefore, fatal.

2. Infratentorial brain tumours block the median and lateral foramina situated
in the roof of the ventricle. This results in a marked and early rise of
intracranial pressure.

DISSECTION
1. Give a median sagittal incision into the vermis of the cerebellium. Separate
the two halves of cerebellum. About midway between the superior and inferior
margins one would be able to visualise the cerebellar recess or median dorsal
recess of the fourth ventricle.
2. Carefully lift the right tonsil situated on the inferior surface of cerebellum out
of its bed. The thin layer of white matter forming its bed is the inferior
medullary velum. Identify the lateral aperature of fourth ventricle inferolateral
to this velum. Identify lateral dorsal recess above inferior medullary velum
and lateral recess situated between inferior cerebellar peduncle and the
flocculus.
3. Identify the structures in the tegmentum of the lower half of pons and dorsal
aspect of open part of medulla oblongata.