The SCALP & Cranial Meninges

The skin & subcutaneous tissue that covers the cranial vault Extent: sup. Nuchal lines (post.) Supraorbital margins (ant.) Zygomatic arches (lat.)

5 layer: indicated by its letters

S: Skin
thin except?? many hair follicles & ? rich in bld. Supply

C: Connective tissue
thick, dens C.T. septa & fat lobules rich in bld. Supply * Bld. Vessels of scalp are running within this layer

A: Aponeurosis

(flat tendon)

Epicranial aponeurosis Galea Aponeurotica strong tendinous sheet provides attachment for: occipitofrontalis m. & ?? laterally

*1st 3 layers move together as one unit & called: Scalp proper

L: Loose C.T.
has many potential spaces ⇒ sponge like layer * allows free movement of scalp proper over bone.

P: Periosteum
outer C.T. layer that surrounds the bones of calvaria firmly attached to the bone

Innervations to The Scalp
Ant.: Supratrochlear & Supraorbital n. (from ??) Lat.: Zygomaticotemporal n. (from?) Auriculotemporal n. (from?) Post.: lesser occipital n. (C2, ant. ramus) Greater occipital n. (C2, post. ramus)

Arteries of The Scalp
In Which Layer?
Ant.: Supratrochlear & Supraorbital a. (ICA) Lat.: Superficial temporal a. (ECA) Post.: Post. Auricular a. Occipital a. (ECA) * Scalp is an area of anastomosis between branches of ICA & ECA

Clinical: Injuries to The Scalp
* The scalp is one of the richest areas of bld. Supply in the body. 2 Sources: ECA & ICA Small inj. to the scalp can result in sever prolonged bleeding Due to: 1. rich blood supply 2. separation of vessel ends by C.T. Septa & the aponeurosis Rx.: suturing the injury

Scalp Infections
- Pus or blood spreads easily in The loose connective tissue layer of SCALP (Danger area of scalp) - Infection or fluid in this layer (pus or bld.) cannot pass posteriorly or laterally, WHY?? Post.: Lat.: - instead, Infection or fluid in this layer (pus or bld.) can spread either: anteriorly  eyelids & root of nose ⇒ black eye or Ecchymosis into the cranial cavity through emissary veins  meninges

The Cranial Meninges
3 layers of C.T., that: 1. protect the brain 2. provide supporting framework for a. & v. 3. enclose fluid-filled cavity (CSF)

3 layers: Dura mater Arachnoid mater Pia mater

Dura Mater
most external part double layered membrane 2 layers: ext. periosteal layer (periosteum of calvarian bones) Int. meningeal layer - tough, thick fibrous membrane continues at F. magnum to SC

* Brain Venous Sinuses are located between periosteal & meningeal layers of dura

Dural Reflections
Foldings of internal meningeal layer between brain compartments (septa) to restrict the rotatory displacement of the brain (fxn.) 4 main reflections: falx cerebri falx cerebelli tentorium cerebelli sellar diaphragm

Arachnoid Mater
Thin, intermediate layer that attaches to pia mater through web-like arachnoid trabeculae Avascular layer Held against dura by pressure of CSF

Subarachnoid space: between arachnoid & pia contains: arachnoid trabeculae & Cerebrospinal fluid (CSF)

Pia Mater
Very thin & delicate membrane that is highly vascularized Adheres to brain surface & follows its contours

Meningeal Spaces
Epidural Space: between dura & bone not present normally happens pathologically (as hemorrhage) Subdural Space: between ? not present normally Subarachnoid Space: a real space contains CSF

Arterial Supply to Meninges (Dura & Calvaria)
Middle Meningeal a. & Accessory Meningeal a.: Main meningeal artery From?? Pass through?? 2 Anterior meningeal a.: From ethmoidal a. ⇒ from ?? 4 Post. Meningeal a.: 2 from ascending pharyngeal a. Pass through ?? & 2 smaller branches from??

Clinical: Epidural Hemorrhage
Due to injury to a meningeal artery

 middle meningeal a. (pterion)
Bld. Collects between: bones of clavaria & periosteal layer or  periosteum & meningeal layers Complications:  bld. Mass  compress the brain  loss of consciousness & coma Rx.: draining bld. & closure of the artery (ligation)
Read the clinical note in your textbook “Intracranial Hemorrhage”

Dural Venous Sinuses
Blood filled spaces within dura matter that lined with endothelium and drain all bld. from brain and meninges. Location: Between the periosteal and meningeal layers of dura, where dural infoldings attach. Main : Sup. Sgittal sinus Inf. Sagittal sinus Straight sinus Transverse sinus (2) Sigmoid sinus (2) ⇒ IJV Cavernous sinus (2): venous plexus lat. to sella turcica Receives sup. & inf. Ophthalmic v. From the orbit