Today we will continue with the ventricular system and the vasculature of the brain ..

also the cranial nerve ( the material that is required for the cranial nerve is the table that is in the book ) ..( you must know the Latin number of each nerve , the name of each nerve , from which foramen does it pass and the main function ) Today we will move inside the brain . * in the brain we have champers we refer to them as ( ventricular system of the brain ) * The champers are 4 in number and we call them .>>> ventricles * they are very important because they form the area of production of the csf (cerebrospinal fluid )

** We have two large champers that are inside the cerebrum at both sides of the cerebrum in the right and left hemispheres we call them the lateral ventricles (they are the first and the second ventricles) ** then there is a smaller one in the middle in the level of the diencephalons between the two masses of the thalamus we refer to it the third ventricle ** the last one and the smallest that located down of the mid brain ( because it`s so small and we can`t put a champer there ) , in the hind brain between the pons and medulla oblongata anteriorly and cerebellum posteriorly , we refer to it the fourth ventricle * Within these champers the csf is produced from what we call it the choroid plexus So what is the coroid plexus ?? - plexus is a capillary network - Choroid oid means like its a greek word that means like coroin you remember the coroin from the previous semester coroin means skin so it`s like a skin because there are cells .
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Contributing to this plexus those are similar to the cells forming the skin which are the epithelial cells so there is a epithelial coroid cells we call them epindymal cells So the choroid plexus is formed by 1- the capillary network 2- pia matter 3- last layer is the epithelial cells ( epindemal cells )

**So what is happening there that we have a cerebrul artery that is found in the subarachnoid space between the archnoid and the pia matter now when the cerebral artery send a branch inside the brain the branch will continue all the way to the champers ( to one of the champers ) there the artery will start providing blood capillaries So the blood capillary from the inside layer ** from out side there is the pia matter ( it pull it with it when it enters ) ** and the last layer is the epindymal layer ( covering the inner surface of the champer ) So once the blood capillary there the plasma fluid start to filtrate from the blood capillary through pia matter then through the epindymal cell to inside that champer So the filter are those three layers 1- the wall of the blood capillary 2- pia matter 3- epindymal cells

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so these layers will prevent any blood to pass through them ( no platlets , red blood cell or whithe blood cell can pass ) so the only thing that can pass is the clear colourless fluid which is the plasma fluid once the fluid filtrate through these filters , it will enter into the ventricle , its there the plasma fluid is called the cerebrospinal fluid ** so what is the coroid plexus ? its form from there layers 1- the wall of the blood capillary 2- pia matter 3- epindymal cells ** what`s happening there ?? the arteriole gets inside the champer and take with it the pia matter to inside the champer ** what is the function of the coroid plexus ? production of the csf

The lateral ventricles locate within the cerebrum, and they are 2 large cavities that are filled with the CSF and they usually communicate with the third ventricle. There is membrane separates these 2 lateral ventricles from each other, and if you look to this membrane (from above), you will find that this membrane is transparent membrane, so that is why they called it SEPTUM PELLUCIDUM. When you look to the brain medially ,you will find that the left &right hemisphere of the cerebrum ,and the longitudinal fissure end in white matter (that is mean : mylinated axons) ,this is what we call it CORPUS CALLOSUM : *Corpus: body *callosum : hard so it is very hard body formed by mylinated axons that make interconnection between the right and left cerebrum together
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 below it immediately we have what it is called septum pellucidum. (Septum: means wall ,pellucidum: means transparent .) Inferiorly, the 2 lateral ventricles will drain their CSF through small formin to the third ventricle (which is located at the midline below septum pellucidum). The 2 lateral ventricles have a small opening to drain the CSF into third ventricle, this opening called: interventricular foramina (2 in number). So interventricuar foramina communicate the 2 lateral ventricles with the third ventricle. NOW WE REACH THE THIRD VENTRICLE it is locates within diencephalon below the septum pellucidum, in the midline between 2 masses of thalamus. When you look to this chamber, you will see that it is penetrated in the center by brain tissue which is connect 2 masses of thalamus (right &left), this is what we call it INTERTHALAMIC CONNECTION. The thalamus consider one unit of brain tissue, but it has to halves (right&left), in 70%, both halves connect with each other by interthalmic connection (which passes through the third ventricle). Border of third ventricle : **lateral wall << 2 masses of thalamus **the floor <<hypothalamus In the third ventricle also there is a choroid plexus that produce CSF , so CSF from lateral ventricle, and in addition to that we also have CSF from third ventricle itself, ALL these CSF will drain through a duct that passes through midbrain <<< cerebral aqueduct . **cerebral: CSF **aque: aqueous fluid **duct: tube because aqueous fluid will pass through this duct and go to fourth ventricle .

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NOW, THE FORTH VENTRICLE it is the smallest chamber that is located in the hindbrain between brain stem <anteriorly, cerebellum <posteriorly In the roof of the forth ventricle there is 3 foramina: 1- 2 laterally (foramen of Luschka) 2- one in the center ( foramen of Magendie) Those 3 foramina open the fourth ventricle into subarachnoid space (which is the space between arachnoids and pia mattar) WHY??? To drain the CSF from inside the brain into subarachnoid space between the meninges, so this is the way how the CSF goes from the brain to the meninges. HERE, the DR show us video to explain the circulation of CSF. SO, as I told you first the CSF produced by lateral ventricles, then drain into third ventricle which is located below them, then forth ventricle, then it starts to pass to subarachnoid space. There is a superior sagittal sinus, which is one of the dural sinuses, (they draining the blood from the brain and the meninges venous sinuses, superior sagittal, inferior sagittal, straight sinus, transverse sinus, sigmoid sinus). NOW, the CSF filled the subarachnoid space and it continuously will be released (as the blood go to the brain). SO, if the CSF continue to produced, it gonna filled the brain totally so it will make some problem. Because we have part of CSF produced, we should have another part to be secreted or absorbed also to return back to the circulation TO KEEP THE BALANCE FOR THE AMOUNT &PRUSSURE OF CSF WITHIN THE BLOOD AND BRAIN.

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For the amount and the pressure of CSF within the meninges and the brain so : How it return back to the circulation? By arachnoids granulations ( extension from arachnoid they exit from the arachnoids to go over the meningeal layer of dura Now Between dura and bone there is a vein (superior sagittal sinus) arachnoids extend and go to the sagittal sinus. now when it is there the CSF start to filtrate from inside to outside (from subarachnoid space back to the veins (sinuses) this is what we call it: (arachnoids granulations): villi; which is an extension of arachnoid matter all the way towards the sagittal sinuses then they extend to go to the veins and then the CSF pass through these spaces within into go to the vein, from here it will filtrate back into the venous circulation. so CSF produced here, but the CSF enter the sagittal sinus its reabsorbed back into the venous circulation again so this is how it going. They filtrate with in the ventricles to the subarachnoid space >> then they filtrate back to the sagittal sinuses >> to the Internal jugular vein to the venous circulation ( CSF circulation or arachnoid circulation).

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Avery important condition (hydrocephalus)

(Hydro: water, Cephalus: head) Excess CSF in the ventricles leading enlargement of the head

Causes: 1. overproduction 2. obstruction of CSF flow 3. interference with CSF absorption

Results in infants: the head in size

If the circulation of the CSF has some problems (e.g.: over production of the CSF will lead to increase amount of CSF and increase the intracranial pressure.) The foramen in the fourth ventricle that connect the CSF within the Brain into the subarachnoid space (foramen of luschka , magendie ) >> they may be block so the CSF will accumulate inside the brain. Or the excretion (the arachnoid granulation damaged) there is no filtration from subarchnoid space into the vinous sinuses

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So there is excess of the CSF in the ventricles, that will lead to enlargement of the head in small children; because in the children there are no complete calcification of the bone (soft tissue).

In the adult the skull and the sutures already closed so there is no enlargement in the head instead there is severe pain and damage of the tissue of the brain in the adults. "which may lead to death if not treated "

Another case >> small baby that has fall down from her bed to the ground >> her head is injured and there was an occlusion due to inflammation inside the brain, The foramina will close in the fourth ventricles so the fluid start to accumulate and the head start to enlarge.

Artery in the brain:

The blood supply in the brain is very important:

[A] 2 ICA [B] 2 Vertebral a.

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1- ICA:

Continuation of the CCA in the carotid sheath (providing blood supply to all anterior superior part of the brain).

2- Vertebral A:

A branch from the first part of the subcalvian (providing blood supply to the inferior posterior part of the brain).

*The ICA when it enters by the Carotid canal to inside the skull and they usually will provide 5 arteries:

1- ophthalmic artery: ( it will go to the orbit) through optic canal with optic nerve, then it enters and it will provide blood supply to the most structure within the orbit to give supraorbital and supratrocheolar artery, that provide blood supply to the forehead . (This artery not much related to the brain)

But the remaining ones related to the brain:

2- anterior cerebral artery : (the most anterior one )

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It usually will go and run inside the longitudinal fissure, then they loop around the corpus callosum to provide blood supply to the most medial surface of the frontal and parietal bone. So they run in the longitudinal fissure: to provide blood supply to the medial surface of the cerebrum until parieto-occipital sulcus, and at the level of this sulcus they will terminate .

3- the other one is the middle cerebral artery : because it is situated in the middle part of the brain and it is the largest branch of the ICA >> it will run in the lateral sulcus ( they separate the temporal from the parietal and frontal lobe ); so it will go laterally then it will go posteriorly with in the lateral sulcus to provide blood supply to the most of the lateral aspect of the brain. There is posteriorly communicated branches they are small one coming from the ICA to communicate to the posterior cerebral artery . and there is a coriadel Artery ,, they will penetrate the brain tissue to the ventircls to form coride pleux . Vertebral Artery : arise from the subclavian artery and they enter the skull through what we call if Foramen Magnum , after that they will be pass over the Medulla Oblengata lowest part of the brain at the junction btw the Medulla and the pons at the junction the 2 vertebral artery from both side will join together form a larger artery what we call it basilar artery so this artery is a large branch by the union of vertebral
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artery start from junction btw the medulla oblongata and the poins terminate to posterior cerebral artery . Ones it is arise there it will go posteriorly over the middle surface of the brain provide blood supply to the mideal surface of the temporal and occipital lope . the vertebral artery again when they get in the foramen magnum they get to provide several branches : 1. Pos . meningeal artery : dura mater 2. Ant and pos spinal artery : spinal cord 3. Inf.cerebal artery : cerbulum 4. Medullary artery : medulla oblongata * Basilar artery * over the bones first of all it will give us a very important branch ant, inf , cerebral artery and then what we call lapyrinthine artery go all the way to the inner ear ,, cerebellum artery to the cerebellum

pontine artery : go to the pons pos cerebral artery : turns back ward of midbrain supply : 1. Occipital lobe 2. Inf. Part of temporal lobe 3. Middle part of the temporal lobe all of these artery because of the importance of the blood supply the brain tissue contribute to the 2.5% of the tissue mass in the body BUT 20% of O2 in the body supply only the brain .

Lapyrinthine Artery : 15% of it from basilar artery and 85% from anterior inferior cerebellar artery . Importance : go to the lapyrinth all the with the facial and 11 | P a g e vesteblococcya check the spilling nerves to the internal acoustic meatus supply the inner ear .

Circulus Arteriosus Circle of Willis Why ?! if one of the arterys that supply the brain is occluded either the basilar or the ICA with the prncess of this circle the blood supply to the brain continue . Anastomosis between branches of 2 ICA & 2 vertebral artery Within the brain , consist anteriorly with anterior communicating artery which the 2 anterior cerebral artery . ant. Cerebral a. ICA Post. Communicating a post. Cerebral a. basilar a. the only artery that dont contribute to the circle is middle cerebral artery and vertebral artery . regard to the cranial nerves you should just distinguished in the lab you have to know the origin and the skull foramina of each cranial nerve and the main function the are 12 pairs not all of them arise from the brain accessory nerve arise from the spinal cord go all the way to the foramen magnum and the jugular foramina , they are part of the PNS

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Done by : Heba saleh Radiadeh , Haya Momani , Weam Rahamneh , Sondos Harbieh

forgive us if you find any Mistakes :)

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