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StatPearls . Sweetheart Island (FL): StatPearls Publishing; 2021 Jan-.


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Introduction

Three layers referred to as the meninges encase the brain and spinal cord. Native superficial come deep, this layers are the dura mater, arachnoid mater, and pia mater. The dura mater is a dense connective tissue layer that is adherent come the inner surface of the skull. Following is the arachnoid mater that is a thin impermeable layer, and the innermost is the pia mater, i m sorry is a vascular class that closely invests end the brain and spinal cord.<1> These membranes define three potential clinically significant spaces: the epidural space, i beg your pardon exists between the skull and also the dura mater; the subdural space, found in between the dura mater and also arachnoid mater; and the subarachnoid space, i m sorry is in between the arachnoid mater and also pia mater. The epidural space in the skull is a potential space, while the is actually current in the spinal cord. The subarachnoid room consists the the cerebrospinal liquid (CSF), major blood vessels, and cisterns. The cisterns are enlarged pockets that CSF developed due to the separation of the arachnoid mater native the pia mater based on the anatomy of the brain and spinal cord surface. The cisterns are developed due to the close and also firm follow of the pia mater come the mind and spinal cord surface ar while fairly loosely come the arachnoid mater.


Structure and also Function

Anatomically, the subarachnoid an are exists between the arachnoid mater externally and also pia mater internally. A network that fine fragile connective tissue called trabeculae connect these 2 layers and gives this an are its properties spider web appearance. The subarachnoid trabeculae act as supportive pillars between the pia mater and arachnoid mater, and due to the curtain-like structure with holes, it enables the circulation of CSF.<2> Besides trabeculae, over there are significant cerebral blood ship that permeate the nervous tissue within this space.

The subarachnoid an are does not have actually a uniform depth across the central nervous system and also forms extensions about the neurovascular structures, spaces, and cisterns. It develops sleeve-like extensions about the cranial and spinal nerves and terminates where the pia mater and also the arachnoid mater fuses v the perineum of this nerves. Besides, this an are surrounds the arteries and veins that the main nervous system up to the allude where they penetrate the nervous tissue and divide right into arterioles and also venules. When the pia mater very closely adheres come the surface ar of the mind and complies with the contours of cortical sulci and also gyri, the arachnoid mater just bridges over the sulci, leading to the development of CSF filled triangle spaces. Also, at some areas where the mind draws away from the skull since of its natural variation in shape, the arachnoid mater and also the pia mater space not in close approximation. This results in normally enlarged CSF filled expansions referred to as the subarachnoid cisterns. These expansions transmit intracranial vessels together with cranial nerves and also hold far-reaching clinical relevance.<3> Although theses cisterns are commonly described as separate compartments, they room not important anatomically separate. They room in cost-free communication with each other and with the rest of the subarachnoid space. Some major cisterns include<4>:

1) Cistern of the lamina terminalis:

It is situated anterior to the third ventricle and contains the anterior cerebral arteries, the anterior communicating artery, the hypothalamic artery, Heubner"s artery, and the origin of the fronto-orbital arteries.

2) Sylvian cistern:

Also known as the insular cistern, is found in the fissure in between the temporal and also frontal lobes. It contains the middle cerebral artery and also vein and also the fronto-orbital veins. 

3) Suprasellar cistern:

Also recognized as the chiasmatic cistern contains the anterior element of the optic chiasm, optic nerves (cranial nerve II), the hypophyseal stalk, and the origin of the anterior cerebral artery.

4) Interpeduncular cistern

Located between the two cerebral peduncles the the midbrain. It communicates inferiorly with the pontine cistern and superiorly through the chiasmatic cistern and contains the bifurcation the the basilar artery, peduncular part of the posterior cerebral artery and superior cerebellar artery, the posterior connecting arteries that connect with the peduncular segment of the posterior cerebral arteries, the basal vein and the oculomotor nerve (cranial nerve III).

5) Superior cistern

Located posterolateral to the midbrain. Its lateral extensions attach it to the interpeduncular cistern. The contains the great cerebral vein, the third part of the posterior cerebral arteries and the superior cerebellar arteries. The infratentorial section contains the trochlear nerve (cranial nerve IV).

6) Pontine cistern:

It is located anterior come the pons and also receives CSF native the paired foramen the Luschka (lateral aperture) of the fourth ventricle. It consists of the basilar artery, the beginning of the anterior worse cerebellar artery, the beginning of the exceptional cerebellar artery, and also the abducens nerve (cranial nerve VI).

7) Cerebellopontine cistern:

Situated in the lateral angle between the pons and the cerebellum. It has the face nerve (cranial nerve VII), the vestibulocochlear nerve (cranial nerve VIII), the trigeminal nerve (cranial nerve V), and the anterior worse cerebellar artery.

8) Cerebellomedullary cistern:

Also known as the cisterna magna is the largest subarachnoid cistern. It is located in between the medulla oblongata and the cerebellum. It receives CSF indigenous the 4th ventricle through foramen the Magendie (median aperture). It has the vertebral artery, the beginning of the posterior worse cerebellar artery, the glossopharyngeal nerve (cranial nerve IX), vagus nerve (cranial nerve X), accessory nerve (cranial nerve XI) and also hypoglossal nerve (cranial nerve XII). 

9) Lumbar cistern:

It is situated at the lower lumbar spinal canal. It extends native the conus medullaris around the level of the an initial and second lumbar vertebrae to the level that the 2nd sacral vertebra. It includes the filum terminale and the cauda equina. Throughout lumbar puncture, the clinician paint, etc CSF indigenous this cistern.

Functionally, the CSF operation within the subarachnoid room and the ventricular system. The choroid plexus mainly secretes the cerebrospinal fluid at a price of 0.3 ml/min, and also there are about 150 ml that CSF turn around at any kind of given time.<5> While the ventricular system contains 25 mL, the rest is existing within the subarachnoid space. A smaller amount the CSF is additionally secreted through the ependymal lining that the ventricles and also the dura mater that the nerve root sleeves in the spinal canal.<3> After production, CSF operation from the lateral ventricles v the left and also right foramen of Monro and also enters the third ventricle. Next, it flows into the 4th ventricle with the cerebral aqueduct. ~ that, CSF flows right into the subarachnoid space through the foramen the Lushka laterally and foramen the Magendie medially. It flows superiorly and also inferiorly overlying the cerebral cortex and also spinal cord.

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<6> Eventually, that reaches the arachnoid granulations that space projections of the arachnoid mater into the remarkable sagittal sinus and act as an avenue because that reabsorption that CSF into the blood with a pressure-dependent gradient.