VENTRICULAR SYSTEM OF THE BRAIN

The human brain is so vital and delicate that it is fully enclosed

in a bony vault in order to protect it from damage. To add even more
protection, the brain is wrapped in three meningeal layers – Dura
mater, arachnoid mater and pia mater. However, even with all those
layers, there is still space surrounding the brain that makes it
vulnerable to injury.

This space is therefore occupied by a clear fluid that suspends

the brain within the cranial vault. The CSF is produced in the
ventricular system of the brain. There are four (4) such hollow spaces
in the brain that house CSF; two (2) lateral ventricles, a 3rd ventricle
and a 4th ventricle.

Lateral ventricles: Body, anterior horn, posterior horn & inferior

temporal horn

Third (3rd) ventricle: is located in the supraoptic recess (superior to

the optic chiasm), infundibular recess (superior to the pituitary
infundibulum), suprapineal recess (superior to the pineal gland), and
pineal recess.

Fourth ventricle: is located in the brainstem. Floor – located in the

rhomboid fossa, roof – superior and inferior medullary velum of the
cerebellum.

Cisterns: suprasellar (chiasmatic cistern of the corpus callosum).

Foramina:

Interventricular foramina (Monro): Lateral → 3rd ventricle

Cerebral aqueduct of Sylvius: 3rd ventricle → 4th ventricle

Median aperture (Magendie): 4th ventricle → subarachnoid space

Right and left apertures (Luschka): 4th ventricle → subarachnoid
space

CLINICAL RELATION

 Hydrocephalous
 Coup/counter coup
 CSF inhibition
 ICP (increased intracranial pressure)

Each ventricle is home to a choroid plexus; a vascular part of the pia

mater, which is called the tela choroidea folds into the cavity of the
ventricle and is further covered by ependyma. It contains choroid
epithelium which is simple cuboidal or low columnar epithelium. The
extensive folding of the membrane gives the structure an expansive
surface area.

The capillaries of the plexus are fenestrated with specific

permeability. The choroid plexuses in each ventricle are responsible
for the synthesis of CSF. The fluid consists of water, and other plasma
components, amino acids, glucose that nourishes brain tissue. CSF
travels through the ventricles and eventually surrounds the entire
brain in the sub arachnoid space. It therefore acts as a shock
absorbent in instances of mild or severe head injury. The choroid
plexus of the lateral ventricles produces most of the CSF, followed by
that of the 3rd ventricle.
There are two ‘c shaped’ cavities called the lateral ventricles one in
each cerebral hemisphere. These ventricles have three horns
projecting into the lobes for which they are named. The central part
of the lateral ventricle is located in the region of the parietal lobe. It
is roofed by the corpus Callosum and floored by the dorsal thalamus
and the tail of the caudate nucleus, inferolaterally. The floor of the
central part of also has the thalamostriate vein and the stria
terminalis (fibres from the amygdaloid body) and the fornix
inferomedially. In between is the choroid fissure. Not only do the
choroid plexuses of the lateral ventricles lie here but this region
which is also complete with ependyma and pia mater from each
lateral ventricle forms the medial boundary of the ventricle.

FRONTAL HORN

An anterior projection form the level of the interventricular

foramen of Monro extends into the frontal lobe. It’s known as the
frontal horn and is also roofed by the corpus callosum. The frontal
horn of each lateral ventricle are separated medially from each other
by the septum pellucidum (bridge between corpus callosum
superiorly and fornix inferiorly) on the medial side.

Anteriorly, the Genu of the corpus callosum borders the space, its
floor contain the head of the caudate nucleus.

TEMPORAL HORN

This is the most inferior aspect of the cavity. It extends into the
temporal lobe and houses its own choroid plexus. Additionally, it
contains parts of the limbic system. The tail of the caudate nucleus is
adjacent to the temporal horn. The anterior part of its floor contains
the pes hypppocampus that resemble a lion’s paw. The middle part
of the floor contains the dentate gyrus, the fimbrae of the
hippocampus, the hippocampus and collateralll eminence (proximal
part of collateral trigone) form medial to lateral.

OCCIPITAL HORN

This extends variably as a finger-like projection from the

posterior aspect of the concavity of the ventricle. Its floor contains
the calcar avis (related to the calcaline fissure) and the collateral
trigone.

3RD VENTRICLE

This is located in the diencephalic part of the brain. It is a

narrow slit bordered laterally by the medial nuclei of each thalamus,
the hypothalamus and interrupted anteriorly by the interthalamic
adhesion. The roof of the cavity is formed anteriorly by the fornix
and posteriorly by the splenium of the corpus callosum; anteriorly it
is limited by the lamina terminalis and the anterior commissure
inferiorly. It continues into the infundibular and supraoptic recess of
the hypothalamus and the tuber cinereum. Postero-superiorly, the
cavity extends into the pineal recess with the Habenular commissure
making an impression. The lateral wall is indented by the
hypothalamic sulcus running from the foramen of Monro to the
opening of the cerebral aqueduct of Sylvius. It should also be noted
that the foramen of Monro provides a passage way for the choroid
plexus of the lateral ventricles to enter the 3rd ventricle. The plexus
then resides in a groove inferior to the fornix and splenium of the
corpus callosum.

4TH VENTRICLE

This is the most inferior of the four ventricles. It is situated in

the brainstem where the ventricular surface of the
rhombencephalon constitutes its floor (rhomboid fossa) inferior to
the midbrain, posterior to the pons, anterior to the cerebellum and
superior to the medulla oblongata.

The nuclei of several cranial nerves make important

impressions on the floor of the 4th ventricle. Protuberances of equal
sizes known as the median eminence are observed on either surface
of the floor extending craniocaudally. The left and right medial
eminences are separated by a dorsal median sulcus. At the inferior
part of the median eminence, the fibres of each facial nerve produce
a larger bulge known as the facial colliculus lateral to the medial
eminence and facial colliculus (on either side) in the sulcus limitans.
It continues caudally to the termination of the region. The locus
cornileus (pigmented area that responds to stress) is anterolateral to
the medial eminence are the hypoglossal trigone, the vagal trigone
and the obex (in that cranio-caudal order). A bundle of of fibres
called the striae medullares, cross the floor horizontally at its
midpoint towards the foramen of Luschka. The roof of the 4th
ventricle is formed by the superior and inferior medullary vela of the
cerebellum. Laterally, the inferior cerebellar peduncle limits the
space. On either side are apertures (foramina of Luschka) that open
into the quadrigeminal cistern. Similarly, in the inferior roof of the
4th ventricle is another aperture known as the foramen of Magendie
that opens into the cerebello-medullary cistern. The subarachnoid
space is described as a cistern at points where spaces exist between
it, and the underlying pia mater. At different points around the brain,
the cisterns are described with respect to adjacent anatomical
landmarks.

Notable cisterns include the:

 Suprasellar or chiasmatic cistern

 Interpenduncular cistern
 Pre pontine cistern
 Cistern of the corpus callosum
FLOW OF CSF

Once CSF is produced in the lateral ventricles, it fills the cavity

then leaves to enter the 3rd ventricle by way of the interventricular
foramen of Monro. In addition to the CSF from the lateral ventricles,
the CSF produced in the 3rd ventricle then exits the space through
the cerebral aqueduct of Sylvius to enter the fourth ventricle. Very of
little CSF is produced in the fourth ventricle. However it along with
that coming from the above ventricle to either enter the central
canal of the spinal cord or by the foramina of Luschka and foramen
of Magendie to enter the cistern. CSF surrounds the brain, and then
leaves by way of arachnoid granulations to enter the superior sagittal
sinus and subsequently join the systemic circulation.
 DIENCEPHALON

The diencephalon is the region of the embryonic vertebrate neural

tube that gives rise to posterior forebrain structures including the
thalamus, hypothalamus, posterior portion of the pituitary gland and
the pineal gland. The diencephalon encloses a cavity called the 3rd
ventricle.

The diencephalon connects the midbrain to the forebrain. It is

located deep within the brain and comprises the epithalamus,
thalamus, sub-thalamus and hypothalamus.

The diencephalon mediates sensations, manages emotions and

commands whole internal systems viz sense impulses, autonomic
function, endocrine function, motor function, homeostasis, hearing,
vision, smell and taste, touch perception. It is a primary relay and
processing center for sensory information. The diencephalon can be
found just above the brainstem between the cerebral hemispheres.
It forms the walls of the third ventricle.

The components of the diencephalon are distributed

symmetrically on both sides of the 3rd ventricle. The hypothalamus
consists of specific nuclei that are located lateral and ventral to the
ventral portion of the third ventricle, ventral to the interthalamic
adhesion. The subthalamus is between the thalamus and substantia
nigra of the mesencephalon. It is composed of the subthalamic body
and zona incerta.

The thalamus is composed of a plethora of nuclei that make up the

major part of the diencephalon located dorsal to the ventral portion
of the third ventricle and medial to the internal capsule. The
metathalamus consist of the medial and lateral geniculate nuclei.
The epithalamus includes the habenular nuclei and their connection
and the pineal gland. For teaching purposes, the metathalamic nuclei
are considered part of the thalamus.

Whereas the corpus striatum (lentiform nucleus and caudate

nucleus) is gray matter within the cerebrum, the diencephalon is
gray matter between the cerebrum and brain stem. It is an
independent component. As the main part of the diencephalon, the
thalamus comprise plenty of nuclei, pulvinar is the posterior part of
the thalamus above the medial and lateral geniculate nuclei.
The interthalamic adhesion connects the bilateral thalami. The
interthalamic adhesion, which has no particular function, has a
landmark role. The other parts of the diencephalon are the
epithalamus, hypothalamus and subthalamus.

EPITHALAMUS

Superoposterior to the thalamus, there is the epithalamus

which consist of the stria medullaris of thalamus, habenular nucleus,
and pineal gland. Functionally, they are influenced by the limbic
system. PINEAL gland looks like a PINE CONE, secretes a hormone
(melatonin) so it belongs to the endocrine system.

Infero-anterior to the thalamus is the hypothalamus which is

independent gray matter, the border between the thalami adhesion
and the hypothalamus including mammillary body in the
hypothalamic sulcus.
 The pituitary gland, a part of the endocrine system, is
suspended from the hypothalamus by the pituitary stalk. The
pituitary gland aka ‘hypophysis’ is cradled within “hypophyseal”
fossa of the sphenoid bone. The sellar diaphragm covers the pituitary
gland from above. The pituitary gland is about the size of a pea but is
divided into two segments; neurohypophysis and adenohypophysis.

The spindle shaped subthalamus is located lateral to the

hypothalamus, so the subthalamus is invisible to medial view of gthe
diencephalon. In terms of function, the subthalamus belongs to the
bard nuclei.

Structures connecting the bilateral cerebral hemispheres are

discernible; the lamina terminalis, the anterior commissure, the
corpus callosum which is the largest one and the posterior
commissure. The commissural neurons pass through these
structures.

Around the anterior commissure and corpus callosum is the

septal nucleus which is part of the frontal lobe. The septal nucleus is
under the septum pellucidum.

 The epithalamus forms the roof of the diencephalon

 Habenular nuclei associated with limbic system as it connects
to the septal nucleus via a tract called the stria terminalis
thalami.
 The sub-thalamus is located dorsolateral to the hypothalamus
and has two notable cell groups; the subthalamic nuleus and
zona incerta.

The entire diencephalon is supplied largely by the branches of the

posterior cerebral arteries. Due to its extensive role in conduction of
information, homeostasis, and endocrine function. The diencephalon
presents a difficult target for tumor therapy.

The thalamus is an oval-shaped collection of nuclei that serve

as the primary relay center for motor, sensory and limbic pathways.
It’s the largest component of the diencephalon; the thalamus has
extensive and reciprocal connection to the cerebral cortex, with
essentially each thalamic nucleus having efferent and afferent
projects to a particular part of the cerebral cortex. The thalamus also
has a vast array of inputs from virtually every sensory, motor,
cerebellar and limbic pathway, and subsequently projects these
inputs to the appropriate part of the cortex. Therefore the thalamus
principally acts as a gateway for inputs to communicate with and be
modified by particular areas of the cortex.

The hypothalamus contrasts the thalamus’ somatic function by

acting as the neural center for the homeostatic and endocrine
control of the body. The function of the hypothalamus are adhered
by having neurons capable of monitoring and responding to
deviation in a variety of tightly regulated bodily targets such as
temperature, hunger, sleep etc. another fundamental role of the
hypothalamus is the regulation of the pituitary gland (hypophysis),
the principal neuro-endocrine gland of the body located in the
hypophyseal fossa of the sella turcica in the sphenoid bone.
Hypothalamic function is greatly affected fibrocystic tumor activity
i.e Langerhans cell lymphocytosis.

The next portion of the diencephalon is the ventral thalamus

(subthalamus). As are integral part of the basal ganglia, the ventral
thalamus receives input from the motor cortex of the cerebrum as
well as the globus pallidum (external) and projects back to the
substantia nigra. Therefore the ventral thalamus is a principal actor
in the control and function of motor movement.

The last part of the diencephalon is the epithalamus which

consist of the pineal gland, habenular nuclcei and the stria medullaris
thalami. The pineal gland is made up of pinealocytes that synthesize
melatonin in response to indirect retinal stimulation of the
suprachiasmatic nucleus of the hypothalamus. Thus playing a
important role in the establishment and maintenance of the
circadian rhythm. Tumors that occur here are collectively classified
as tumors of the pineal region and may cause obstructive
hydrocephalus.

BLOOD SUPPLY TO THE CEREBRUM

The brain receives blood from two sources; the internal carotid
arteries, which arise at the point in the neck where the common
carotid arteries bifurcate, and the vertebral arteries. The internal
carotid arteries branch to form two major cerebral arteries, the
anterior and middle cerebral arteries. The artery supplies a portion
of the frontal and the lateral surface of the temporal and parietal
lobes, including the primary motor and sensory areas of the face
throat, hand and arm, and in the dominant hemisphere, the areas for
speech. The middle cerebral artery is the artery most often occluded
in stroke. At the circle of Willis, the internal catrotid arteries branch
into smaller arteries that supply oxygenated blood to over 80% of
the cerebrum.

The brain receives blood from two sources: the internal carotid
arteries which arise at the point of bifurcation of the common
carotid arteries in the neck, and the vertebral arteries. The internal
carotid arteries branch to form two major cerebral arteries, the
anterior and middle cerebral arteries.
 The right cerebral artery supply blood to the anterior temporal
lobes and the insular cortices. The left and right meets pie from
bifurcation of the internal carotid arteries and then are connected to
the anterior cerebral arteries and the posterior communicating
arteries, which connect to the posterior cerebral arteries.

CBF

Cerebral blood flow (CBF) refers to the rate of delivery of

arterial blood to the capillary bed in brain tissue and quantified in
millilitres per of blood per 100g of brain tissue per minute.

The three main cerebral arteries are anterior, middle and posterior
cerebral arteries. They each supply a different portion of the
cerebrum. The anterior cerebral arteries supply the antero-medial
portion of the cerebrum. The middle cerebral arteries are situated
laterally, supplying the majority of the lateral part of the brain.

ARTERIAL CIRCLE OF WILLIS