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Neuroanatomy > The Meninges and the Cavernous Sinus > Flashcards

The Meninges and the Cavernous Sinus Flashcards

1
Q

List the Brain Meninges.

A
  1. Pia Mater
  2. Arachnoid Mater
  3. Dura Mater
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2
Q

List the meningeal layers and spaces from superficial to deep.

A
  1. Dura mater
  2. Subdural space
  3. Arachnoid mater
  4. Subarachnoid mater
  5. Pia mater
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3
Q

What is the Pia Mater?

A

Vascular membrane covered by flattened mesothelial cells

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4
Q

List the features of the Pia Mater.

A
  1. Closely cover the brain and spinal cord
  2. Closely inverts CNS to depths of deepest fissures and sulci
  3. Prolonged out over cranial nerves and spinal nerves to fuse with their epineurium
  4. Invaginated into the brain substance with cerebral arteries which enter the brain; these arteries are loosely arranged in perivascular space containing CSF.
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5
Q

What is the Arachnoid Mater

A

A Delicate, impermeable, avascular membrane.

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6
Q

Features of the Arachnoid Mater

A

Inner, and outer surfaces are covered by flattened mesothelial cells
Vessels and nerves pierce the dura and arachnoid mater both at the same place.
Fused with epineurium of the nerves.

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7
Q

Clinical Significance of the Arachnoid Mater with relation to the optic nerve.

A

In the optic nerve, the arachnoid forms a sheath for the nerve → Extends into the orbital cavity through the optic canal →
Fuse with the sclera of the eyeball.
Increased intracranial pressure results in ophthalmoplegia

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8
Q

Functions of the Arachnoid Mater.

A
  1. Connect dura to pia
  2. Help to keep the brain in place in the skull
  3. Help to maintain CFS metabolism
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9
Q

What is the Arachnoid Villi?

A

In certain areas arachnoid mater herniates through holes in the dura mater – into Dural venous sinuses.

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10
Q

Changes in Arachnoid Villi with age.

A
  • Separate villi present in children
  • With age, Aggregates into visible clumps
  • Known as Arachnoid Granulations.
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11
Q

Where is the Arachnoid villi most numerous

A

in superior sagittal sinus and its laterally projecting blood lakes

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12
Q

Explain Subarachnoid cisterns

A

Large spaces exist as a result of incompatibilities in the contours of bone and brain
The arachnoid bridges over the sulci on the surface of the brain.
Sometimes arachnoid and pia maters are widely separated; make cisterns.

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13
Q

List the Arachnoid Cisterns.

A

Cerebellomedullary cistern
Pontine cistern
Interpeduncular cistern
Chiasmatic cistern

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14
Q

2 Layers of the Dura Mater

A

1) Outer endosteal layer
2) Inner meningeal layer

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15
Q

Describe the Outer Endosteal Layer.

A

Is the periosteum which invests the surface of any bone, and blood vessels pass through it to supply the bone.
At the margins of every foramen in the skull, it continues with the periosteum on the outer surface of cranial bones.
At sutures continue with sutural ligaments
Most strongly adherent to bones over the base of the skull.

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16
Q

Describe the Inner Meningeal Layer

A

Dura mater proper
Dense, strong, fibrous membrane

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17
Q

Layers of the Inner Meningeal Layer

A

Inner and outer layers to a single layer.
(Theoretically) structures such as middle meningeal vessels lie between 2 layers. (Snell) → But they appear on the outer surface of fused single-sheet extradural

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18
Q

Explain “Extradural haemorrhage”

A

Hemorrhage from these vessels
In the inner layer
of the inner meningeal layer
of the Dura Mater

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19
Q

List the 4 septa of the meningeal layers.

A
  1. Tentorium cerebelli
  2. Falx cerebri
  3. Falx cerebelli
  4. Diaphragm sellae
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20
Q

Function of the 4 meningeal Septa

A

Restrict the displacement of the brain associated with acceleration and deceleration when head is moved.

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21
Q

What is the Tentorium Cerebelli?

A

Crescent shaped fold of dura mater that roofs over the posterior cranial fossa.

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22
Q

What is the Falx cerebri?

A

Sickle shaped flange of inner layer in midline

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23
Q

What is the Falx Cerebella?

A

Small sickle shaped fold of dura

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24
Q

What is the Diaphragm sellae?

A

A Small circular fold of dura mater
From the roof of the pituitary fossa
A small opening in its center allows passage of the hypophysis cerebri (Pituitary stalk)

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25
Q

Distribution of Blood Supply of the Dura Mater

A

Inner layer – little blood supply
Outer layer – rich blood supply

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26
Q

Name the artery supplying the Supratentorial part of the Dura Mater.

A

Middle meningeal artery

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27
Q

Blood Supply of the Dura in the Anterior Cranial Fossa

A

Meningeal beanch of ophthalmic artery
Meningeal branch of anterior and posterior ethmoidal artery
Branch of middle meningeal artery

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28
Q

Blood Supply of the Dura in the Middle Cranial Fossa

A

Middle meningeal artery
Accessory meningeal artery
Ascending pharyngeal artery

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29
Q

Blood Supply of the Dura in the Posterior cranial fossa

A

Meningeal branches of vertebral artery

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30
Q

What is the Middle Meningeal artery?

A

● Branch of maxillary artery
● Arise in infratemporal fossa
● Enter foramen spinosum – Middle cranial fossa

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31
Q

What does the Middle Meningeal Artery Supply?

A

Middle meningeal artery supply bones of the vault of skull. Doesn’t supply the brain

32
Q

the 2 branches of the middle meningeal artery.

A

Anterior (Frontal)
- Course towards pterion
Posterior (Parietal)

33
Q

Hemorrhage of the anterior branch of the middle meningeal artery.

A

lying over precentral gyrus → Haemorrhage → Pressure in motor area

34
Q

Hemorrhage of the Posterior branch of the middle meningeal artery

A

lying over the supra temporal gyrus → Haemorrhage → Contralateral impairment of hearing

35
Q

Venous Drainage of the Dura Mater

A

Diploic veins
Middle meningeal veins

36
Q

Innervation of dura mater

A

branches of:
- Trigeminal nerve
- Vagus nerve
- C1, C2, C3, cervical spinal nerves

37
Q

Clinical Significance of the innervation of the dura mater.

A

Dura has numerous sensory nerve endings
sensitive to stretching
produce the sensation of headache
Pain sensation of dura mater is reffered to same side of the head, back of the neck and back of the scalp.

38
Q

Importance of Dural Venous Sinuses.

A

Sinuses between inner and outer layers of dura mater. So, they receive blood from the brain and also bones.
Sinuses between meningeal layers of dura mater. So, they receive blood only from the brain.

39
Q

Blood Flow in the Dural Venous Sinuses

A

Venous sinuses are valve less. So, blood flows either direction.

39
Q

List the Important Dural Venous Sinuses

A
  1. Superior sagittal sinus
  2. Transverse sinus
  3. Sigmoid sinus
  4. Superior petrosal sinus
  5. Inferior petrosal sinus
  6. Sphenoparietal sinus
  7. Occipital sinus
  8. Cavernous sinus
  9. Intercavernous sinus
  10. Inferior sagittal sinus
  11. Straight sinus
40
Q

Lining of Dural Venous Sinuses

A

Venous sinuses are lined by endothelium.

41
Q

Importance of the Vertebral Vein

A

No veins accompany the vertebral and Basilar arteries. Vertebral veins commence outside the skull below the occipital bone.

42
Q

Extent of the cavernous sinus

A

It extends from apex of the orbit to apex of the petrous part of the temporal bone.

43
Q

Attachment of the Cavernous Sinus

A

Front attachment of the sinus is anterior & middle clinoid precesses of the splendid bone.

44
Q

Blood flow into the cavernous Sinus.

A
  1. Orbit
  2. Vault
  3. Cerebral hemispheres
45
Q

Roof of the Cavernous Sinus

A

Formed by meningeal layer of dura mater

46
Q

Floor of the Cavernous Sinus

A

Formed by endosteal layer of dura mater

47
Q

Lateral Wall of the Cavernous Sinus.

A

Formed by meningeal layer of dura mater

48
Q

medial wall of the cavernous sinus.

A

The upper part is formed by the meningeal layer of dura mater
The lower part is formed by the endosteal layer which covers the body of the sphenoid bone.

49
Q

Content of the cavernous sinus within the sinus.

A

Internal carotid artery
Abducent nerve
Sympathetic nervous plexus

50
Q

Content of the cavernous sinus within the lateral wall.

A

Occulomotor nerve
Trochlear nerve
Ophthalmic branch of trigeminal nerve
Maxillary branch of trigeminal nerve

51
Q

the course of the internal carotid artery within the cavernous sinus

A

Internal carotid artery curves upwards from the foramen lecerum to enter the posterior part of the sinus and runs forwards within the sinus.

52
Q

How does the abducens nerve enter the cavernous sinus

A

Abducens nerve enters the back of the cavernous sinus.

53
Q

Course of the abducens nerve within the cavernous sinus

A

Abducens nerve (6 thCN) – It is in entering to cavernous sinus via may be through inferior petrosal sinus.
Within sinus abducens nerve runs forward on the inferolateral side of the internal carotid artery.

54
Q

Relation of the internal carotid artery within the cavernous sinus

A

The internal carotid artery accompanies the plexus of postganglionic sympathetic fibers from the superior cervical ganglion.
6th CN is inferomedial to the internal carotid aretry.

55
Q

3rd CN in the lateral wall of the cavernous sinus

A

It pierce anterior part of the roof of the cavernous sinus and then enters in to lateral wall. It is the most medial nerve in the lateral wall at the anterior end of the sinus.

56
Q

4th CN in the Lateral wall of the cavernous sinus.

A

It pierce the roof, posterior to the 3 rdCN and then comes to lateral wall which is lateral to the 3 rd CN.

57
Q

5th CN in the lateral wall of the cavernous sinus

A

Ophthalmic branch → It goes along the lateral wall and then enters in to the superior orbital fissure.
Maxillary branch → Goes within the lateral wall then it enters in to the foramen rotundum.

58
Q

Course of CN3 in the cavernous sinus

A

Occulomotor nerve CN3 inclines downwards medial to the other nerves, namely trochlear nerve and the branches of the ophthalmic nerve.

59
Q

Course of the 5th CN in the cavernous sinus

A

Maxillary division of trigeminal nerve runs horizontally forwards in lateral wall.

60
Q

Anterior relation of the cavernous sinus

A

The anterior part of the roof of the sinus is pierced by ICA.
Apex of the orbit.

61
Q

Posterior relation of the cavernous sinus

A

Tentorium cerebelli, crus cerebri of the mid brain, petrous part of the temporal bone.

62
Q

Lateral Relation of the cavernous sinus

A

Medial surface of the temporal lobe, Meckel’s cave.

63
Q

Posteroinferior reaction of the cavernous sinus

A

Rest of the Meckel’s curve & trigeminal ganglion.

64
Q

Medial Relation of the caevernous sinus

A

Pituitary fossa, body of the splendid bone and air sinus.

65
Q

Superior relation of the cavernous sinus

A

ICA, optic tract, olfactory tract, anterior perforating substances

66
Q

Inferior relation of the cavernous sinus

A

Inferior to the sinus → Foramen lacerum

67
Q

Anterior wall tributary of the cavernous sinus

A

superior ophthalmic vein through Superior orbital fissure
Inferior ophthalmic

68
Q

Tributary to the roof of the cavernous sinus

A

superficial middle cerebral vein
Inferior cerebral vein
Saphenoparietal sinus

69
Q

Posterior wall drainage of the cavernous sinus

A

Superior petrosal sinus
Inferior petrosal sinus

70
Q

Inferior ophthalmic vein drainage into the cavernous sinus

A

Inferior ophthalmic vein drains into both the pterigoid plexus and the cavernous sinus.

71
Q

Communication of cavernous sinus

A

Pterygoid plexus with cavernous sinus by emissary veins through foramen ovale, foramen lecerum, venous foramen

72
Q

Infection of the skin can spread to the cavernous sinus by:

A

Angular vein of the face → Superior ophthalmic vein → to the cavernous sinus
Deep facial vein of the face → Pterygoid plexus → Cavernous sinus.

73
Q

Clinical consequence of the infection of the face spreading to cavernous sinus.

A

thrombosis within cavernous sinus
thrombosis within cavernous sinus

74
Q

Rupture of the base of skull (cavernous sinus)

A

Rupture of the base of the skull – Damage ICA within the cavernous sinus praduces pulsation exophthalmas.

Neuroanatomy (6 decks)

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