The Cranial Meninges The plasma fluid from the blood, and enters into this space and

it's named (CSF). The CSF spinal fluid is the same as the plasma fluid. This cavity is located in the Sub arachnoid space.. it functions as a shock absorber, or a brain's pillow to absorb shocks. so the lack of it would cause a serious brain concussion if subjected to a trauma, and the skull would be cracked or broken instantly.

The meninges:
One, the Dura mater:
It's the toughest layer . and includes two layers: periosteum of the bone from inside.

Two, the Arachnoid matter:

Its name is derived from it sending out fibers trabicually, and is intertwined like a web. These fibers go from the arachnoid all the way to the pia mater.

Three, the pia mater: It includes arteries. And there are 2 types: Cerebral and Meningeal. The cerebral veins:
go all the way from arachnoid to pia mater, and drain into the meningeal veins and are also called venous sinuses these venous sinuses within the skull drain booth cerebral and meningeal a. and they are very large veins that drain blood from meninges, pons and from the brain itself .they are
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located within the dura mater between two layers the periosteum and the meningeal.

The Dura mater :

The most external part and it consist of two layer : 1-preiosteum layer : tough and attach to the bone ,and it's originally from the 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 continue at the foramen magnum to cover also the spinal cord along with the archnoid and pia mater. So once again the venous sinuses drains between these two layer.

Dural reflection:
Reflection mean folding .The dura is not straight layer but it has folding to fill the spaces between the brain and the skull in order to fix the brain in it's position .So these are folding of the internal meningeal layer between the brain compartments . You know the brain is composed of two half right and left and there is a space between them so the meningeal layer inter into this space this is a reflection or folding of the dura .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 folding , is folding down and returning back up this is what we mean by reflection of the dura.

The importance of dural reflection:

They are strict auditory displacements .So they hold the brain fixed in its places limiting the space between the brain and the skull bones and preventing dislocation of brain .So these reflection when they come between the two hemisphere of brain they prevent the lateral movement of the brain. There is another one located horizontally between the cerebrum and

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cerebella and it prevent the vertical movement of the brain. So they restrict the movement of the brain within the skull.

The main reflections of Dural mater:

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 cerebra and cerebella . Tentorium from tent because it cover the cerebellum. Sellardiaphragm: The smallest one ,cover the sella turcica and its forming the sheet over the pituitary gland which are situated in sella turcica .if you imagine the sella turcica is like a bed and then we have the pituitary gland and the sellar diaphragm like a cover.it separate and fix the pituitary gland in its space so its more related to this gland .

Arachnoid mater:
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 .

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The arachnoid mater is held against the Dura by the pressure of the CSF so when the quantity of the CSF is less than the pressure of the CSF will be less as will ,and as result the arachnoid will detaches and descend from the Dura and technically these both layer are not attached still the presence of the CSF causes the two layer to seems attach 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 and contain arachnoid trabecular , CSF and cerebrl a. & v .

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 ,highs and lows and the elevation in the cortex are called gyrus and the lows are called sulcus. The brain cortex is folded in order to increase its surface area to increase the number of brain cells the neurons and it can reach more than three time the number from having a straight brain cortex.

The meningeal spaces :

They are three spaces : 1-Epidural space . -2- sub Dural space -3- sub arachnoid space . the 1st and 2nd one are not present normally so only normally we can see the sub arachnoid space . -the sub arachnoid space : Its located between the arachnoid and the pia mater and it contain the CSF ,So if the CSF is reduced this space will be lost . -the epidural and the sub dural spaces : we can find them in abnormal situation like injury to blood vessels a. or v. -The epidural space: Epi means above the Dura between the dura and the bone .its not present normally but it will be in the case of hemorrhage to
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vein or artery there .The most important example is the injury to middle meningeal artery it cause Epidural hemorrhage .So when the hemorrhage happen we will see the space . -The subdural space : Sub means under the Dura between the dura and the arachnoid .we can see it also just in the case of hemorrhage like injury to cerebral v. because they drain into this area so if any one of them get injured will cause bleeding in this space .

Blood supply to the meninges :

Meninges cover the hole 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 artery supply the Dura mater only and the calvarian bones from inside .

The middle meningeal a. is the largest one and have two

division ant. And post. Along with this artery there is another smaller artery passing ant. to it, is the accessory meningeal a. again they are both in the middle cranial fossa and they arising from the maxillary artery which is the largest terminal branch of the ECC a. the other branch of ECC is the superfacial temporal artery .As the maxillary artery pass behind the neck of the mandible toward the maxilla it sends two artery the largest one is the middle meningeal a. which go throw foreman spianosom .while the accessory meningeal a. pass throw the foramen ovali ,So remember that we have two structures pass in foramen ovali the 1st one is mandibular trigeminal nerve its leaving the foramen the 2nd is entering the foramen which is the accessory meningeal a.

The anterior meningeal a.

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

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

Dural Venous Sinuses Blood filled spaces within dura matter that 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) Main : (you have to know name and draining )

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- Sup. Sgittal sinus: at the upper margine of falx cerebri passing sagitally from ant. all the way to post then become right transverse sinus. - Inf. Sagittal sinus: at the lower margin of falx cerebri, drains to Straight sinus (at the junction between falx cerebri and tentorium cerebella ) which goes posteriorly to become left transverse. - Two transverse sinus : 1. On the right as a continuation of the sup. sinus. 2. On the left as a continuation of the inf. sinus . - The transverse become Sigmoid sinus (2) shape like S which become IJV at the border of jugular foremen. So the IJV is the continuation of the sigmoid sinus at the jugular foramen ! - Cavernous sinus (like a cave) is venous plexus , it is actually two one on the right and one on the left lat. to sella turcica. It receives the sup. & inf. Ophthalmic v. (which drain from veins facial veins ) , So they provide a root of infection from outside because they communicate 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

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