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Week 13- SHANE > Cranial Cavity > Flashcards

Cranial Cavity Flashcards

1
Q

Are emissary veins located inside or outside the skull?

A

outside but they pass through at points to empty into dural venous sinuses

In a more general sense, emissary veins comprises a larger set of veins that connect the intracranial venous sinuses with veins outside the cranium

There are parietal, mastoid, occipital and condylar emissary veins

NOTE: this is a potential routes for spread of infection from scalp into cranial vault

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2
Q

What are the layers of the skull?

A

bi-layered:
(1) outer dense layer

(2) inner spongy layer

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3
Q

What is contained in the inner spongy layer of the skull?

A

diploic veins & red bone marrow

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4
Q

Where do diploid veins drain?

A

they also drain into dural sinuses. Emissary and diploic veins communicate with each other

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5
Q

What are the meninges of the brain?

A

(1) an outer tough protective membrane, the dura mater
(2) an inner, more delicate, fibrous membrane, the pia mater which carries blood vessels to the brain and cord, and
(3) an intermediate structure configured like a spider’s web–the arachnoid mater, which, together with cerebrospinal fluid, fills in the space between the dura and pia.

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6
Q

The dura mater is aka?

A

Pachymeninx (thick membrane)

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7
Q

What are the layers of the dura mater?

A

The dura is a dual structure with an inner meningeal layer and an outer periosteal layer (endocranium) which is intimately applied to the inner surface of the cranial bones (serving as a periosteum) and which becomes continuous with the pericranium (periosteum of the skull surface) at the various foraminae (Latin=windows) of the skull.

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8
Q

At certain locations, the two layers of the dura mater separate to form what?

A

dural venous sinuses. These are typically triangular in coronal section and usually associated with bone.

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9
Q

How many dural partitions are there?

A

4

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10
Q

Where does the Falx cerebri run?

A

It is a strong membrane extending down into the longitudinal fissure between the two cerebral hemispheres

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11
Q

What are the attachments of the Falx cerebri?

A

crista galli, midline of calvaria, internal occipital protuberance

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12
Q

The superior attachment of the Falx cerebri contains what?

A

superior attachment contains the superior sagittal sinus; free margin contains the inferior sagittal sinus

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13
Q

How are the superior and inferior sagittal sinuses attached?

A

the straight sinus, which runs along the inferior/posterior border of the falx cerebri along its connection to the tentorium cerebelli

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14
Q

What is the Tentorium cerebelli?

A

a transverse shelf of dura separating cerebellum from the occipital poles of the cerebral hemispheres

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15
Q

What are the attachments of the tentorium cerebelli?

A

attached laterally and posteriorly to the transverse sinuses; attached anteriorly to the superior border of the petrous temporal bone and the posterior clinoid processes. It’s free border extends anteriorly to the anterior clinoid processes

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16
Q

What does the tentorium cerebelli meet up with in the midline?

A

becomes continuous with the falx cerebri along the midline where the two meet at right angles to form the straight sinus

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17
Q

The transverse sinus runs in which dura partition?

A

the tentorium cerebelli (at posterior margin)

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18
Q

Where is the confluence of sinuses?

A

at the junction of the transverse, superior sagittal, and straight sinuses

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19
Q

Where does the Falx cerebelli run?

A

single midline, vertically- oriented partition, extending inferiorly between & separating the 2 cerebellar hemispheres

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20
Q

What bone is the falx cerebelli attached to?

A

triangular process attached to the inner surface of the occipital bone; projects into the posterior cerebellar notch between the two cerebellar hemispheres

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21
Q

What is the Diaphragma sellae?

A

a roof of dura covering the pituitary; this roof is incomplete to allow the stalk of the hypophysis to reach the hypothalamus

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22
Q

What is/are the attachments of the diaphragm sellae?

A

hypophyseal fossa

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23
Q

What is the route of Dural Venous Drainage?

A

-sup. sagittal sinus to confluence of sinuses; inf. sagittal sinus to straight sinus to confluence of
sinuses

  • confluence of sinuses to transverse sinus to sigmoid sinus to internal jugular vein
  • cavernous sinus to sigmoid sinus via superior and inferior petrosal sinuses
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24
Q

What does the superior petrosal sinus do?

A

drains blood from inter cavernous sinus and cavernous sinus to the junction of the transverse and sigmoid sinuses

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25
Q

What does the inferior petrosal sinus do?

A

drains blood from inter cavernous sinus and cavernous sinus to the junction of the sigmoid sinus and the internal jugular vein

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26
Q

The dural sinuses drain the majority of the blood of the cranial vault. What is the main source of blood for the dural venous sinuses?

A

various cerebral and cerebellar veins which drain the brain substance. These veins communicate with the dural sinuses at various points. Blood and CSF drained by the dural sinuses ultimately leaves the cranium via the internal jugular veins.

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27
Q

What dura venous sinus communicates with the emissary and diploic veins?

A

the superior sagittal sinus

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28
Q

How can meningitis occur?

A

The superior sagittal sinus communicates with diploic veins and emissary veins from the scalp–these can serve as pathways for entry of bacteria from the scalp into the superior sagittal sinus resulting in a meningitis (an infection of the meninges)

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29
Q

Which emissary veins communicate with the sigmoid sinuses?

A

mastoid and condyloid emissary veins

these can also serve as a route of infection

30
Q

Where are the cavernous sinuses located?

A

located on either side of the body of the sphenoid bone. They communicate with each other via the intercavernous sinuses

31
Q

What veins drain to the cavernous sinuses?

A

the ophthalmic veins, the veins of the deep face (pterygoid plexus), and the superior and inferior petrosal sinuses

These cavernous sinuses thus serve as a focal point for the spread of infections from the surface of the cranium or face to sinuses throughout the cranium.

32
Q

The dura receives most of its blood supply from what?

A

the middle meningeal arteries which are branches of the maxillary artery off the external carotid

33
Q

Where does the middle meningeal artery branch from the maxillary artery?

A

via foramen spinosum. The middle meningeals ascend through the foramen spinosum on either side and course outside the periosteal layer of dura forming a groove in the skull; they supply the skull as well as the dura and are frequently injured in skull fractures.

34
Q

Sensory innervation to the dura is by what?

A

CN 5 (trigeminal). Each of its 3 divisions (V1-V3) gives off a sensory branch to the dura. A significant meningeal branch arises from the 3rd division of the trigeminal nerve, the mandibular division. It travels through foramen spinosum along with the middle meningeal artery.

35
Q

What are some causes of headaches in relation to dura?

A

following meningeal infection or inflammation, blood vessel caliber, intracranial pressure, lumbar punctures there is either increased or decreased pressure on the sensory fibers in the dura layer and that causes headache

36
Q

Together, the Pia and Arachnoid Mater are known as what?

A

the Leptomeninges

37
Q

Describe the pia mater of the brain?

A

delicate, transparent membrane closely applied to to the brain, carrying extensive network of blood vessels supplying brain. Follows folds & fissures (sulci of brain tissue.) Innermost of 3 layers.

38
Q

Is the arachnoid mater avascular?

A

yes

39
Q

Is the arachnoid mater in closer association with the pia or dura mater?

A

the dura mater. It is separated from the pia by the subarachnoid space containing CSF. The arachnoid is closely applied to the dura over the brain but is separated from it by a thin film of fluid.

40
Q

Does the arachnoid mater dip into fissures or sulci like the pia mater?

A

No

41
Q

How is the inner arachnoid membrane connected with the pia mater?

A

by delicate fibrous threads, the arachnoid trabeculae (gives it a spider-web looking appearance)

42
Q

CSF synthesized in the choroid plexus circulates through the brain ventricular system and finally enters to the subarachnoid space by openings in which ventricle?

A

the IVth.

The subarachnoid space is narrow on the surface of the hemispheres but leaves wide intervals at the base of the brain, the subarachnoid cisternae.

After circulating through the subarachnoid space, all CSF eventually reaches the superior aspect of the brain.

43
Q

How does CSF enter venous circulation?

A

CSF enters the subarachnoid space lying deep to the superior sagittal sinus or lateral extensions of this sinus. Berry-like tufts of arachnoid (arachnoid villi) bunch together to form structures called arachnoid granulations, which punch their way through the dura, allowing CSF to drain through the arachnoid membrane into the venous blood in the superior sagittal sinus.

44
Q

Is CSF produced in the subarachnoid space?

A

NOOO. It is made in the ventricular system of the brain and spinal cord and then circulated into the subarachnoid space

45
Q

T or F. Brain hemorrhages can occur in the epidural space (between the skull and the periosteal layer of dura), in the subdural space (between the dura and the arachnoid) and in the subarachnoid space

A

T. These hemorrhages can be life- threatening as they increase intracranial pressure, compress the brain and cause various herniations

NOTE: the subdural ‘space’ is only a potential space but can become inflammed

46
Q

Each type of brain hemorrhage can be recognized by various clinical tests. A procedure to differentiate a subarachnoid hemorrhage from other hemorrhages is a lumbar puncture–why?

A

because blood in the subarachnoid space will be continuous with CSF sampled via a lumbar puncture

47
Q

What is an Extradural (epidural) hematoma?

A

between skull and periosteal dura; e.g., following skull fractures that damage meningeal arteries.

48
Q

Do epidural hematomas fill the enter space between the dura and skull or isolated pockets? Why for either answer?

A

isolated pockets because of the tight adherence of the periosteal dura. This causes pressure to build up on the underlying brain tissue

49
Q

What is a clinical sign of an epidural hematoma?

A

Typically presents with a brief period of unconsciousness, followed by a lucid phase and then rapid deterioration, often into coma

50
Q

What is a subdural hematoma and what causes it?

A

between dura and arachnoid; e.g., following trauma that jerks brain inside the skull, tearing cerebral veins (“bridging” veins) as they enter venous sinuses.

Chronic subdural hematomas may take days or weeks to become symptomatic.

51
Q

What is a subarachnoid hemorrhage and what causes it?

A

bleeding in the subarachnoid space; e.g., following cerebral lacerations, tearing cerebral arteries, or via spontaneous (nontraumatic) aneurysm.

Typically sudden in symptomology onset, often with an excruciating headache.

Clinical diagnostic: ?

52
Q

CT appearance of Extradural (epidural) hematoma

A

lens-shaped (lenticular) biconvex hematoma. Note localized “short and thick” appearance, midline herniation and compression of lateral ventricle

53
Q

CT appearance of Subdural hematoma

A

typically crescent-shaped. Note “thinner” appearance and more elongated spread than epidural hematoma.

Acute stage: hyperdense in radiology due to acute bleed.

Chronic stage: after several weeks, blood may begin to liquefy and appear isodense or hypodense.

54
Q

CT appearance of Subarachnoid hemorrhage

A

Note bleeding within the cerebral sulci (subarachnoid space) and cortical tissue, as well as in the posterior horn of the lateral ventricle.

55
Q

What are the main contents of the anterior fossa of the brain?

A

frontal lobes of the brain.

has raised posterior ridge, formed by lesser wing of the sphenoid bone

56
Q

What are the main contents of the middle fossa of the brain?

A

The temporal lobes and the pituitary gland occupy the middle cranial fossa.

has raised posterior ridge, formed by petrous crest of temporal bone

57
Q

What are the main contents of the posterior fossa of the brain?

A

The occipital lobes, cerebellum and brainstem occupy the posterior cranial fossa.

58
Q

What are the main bones of the anterior fossa?

A
  • cribriform plate and crista galli of the ethmoid bone
  • orbital part of the frontal bones
  • lesser wings and anterior part of the body of the sphenoid bone
59
Q

What CN passes through the foramen of the cribriform plate of the ethmoid bone?

A

CN 1 (olfactory)- only CN in the anterior fossa

60
Q

What passes through the optic canal?

A

C.N. II (optic) and ophthalmic artery

61
Q

What structures pass through the superior orbital fissure?

A

used by 4 cranial nerves to exit skull in order to reach the orbit: C.N. III (oculomotor), C.N. IV (trochlear), C.N. V1 (ophthalmic division of
trigeminal), and C.N. VI (abducens); also ophthalmic veins

62
Q

What structures pass through the foramen rotundum?

A

C.N. V2 (maxillary division of trigeminal )

63
Q

What structures pass through the foramen ovale?

A

C.N. V3 (mandibular division of trigeminal)

64
Q

What structures pass through the foramen spinosum?

A

Middle meningeal artery and nerve

65
Q

What structures pass through the foramen lacerum?

A

Internal carotid a. passes over f. lacerum as it enters the cranial vault (via the CAROTID CANAL) and the greater petrosal nerve (VII) heading forwards to the pterygoid canal.

Note that neither pass through f. lacerum as it is closed to the exterior by cartilage.

66
Q

What structures pass through the internal auditory meatus?

A

used by 2 cranial nerves, C.N. VII (facial) including the nervus intermedius of VII (special sensory [chorda tympani n] + parasympathetic
[greater petrosal n] portions) and C.N. VIII (vestibulcochlear)

67
Q

What structures pass through the jugular foramen?

A

used by 3 cranial nerves- C.N. IX (glossopharyngeal), C.N. X (vagus)
and C.N. XI (accessory);

also contains the internal jugular vein

68
Q

What structures pass through the hypoglossal canal?

A

C.N. XII (hypoglossal)

69
Q

What structures pass through the foramen magnum?

A

(UNPAIRED) medulla oblongata becomes continuous with the spinal cord; also vertebral arteries and C.N. XI (accessory) enter the cranial cavity

70
Q

Describe the course of the Internal Carotid artery in relation to the Cavernous Sinus

A

the internal carotid artery enters base of skull via carotid canal

  • travels anteriorly and horizontally within the carotid canal
  • enters interior of cranial vault via intracranial opening of carotid canal
  • then proceeds superiorly, traveling through the cavernous sinus, forming s-shaped bend as it courses through sinus

Week 13- SHANE (12 decks)

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