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Presented by
Jega Subramaniam
Guided by Dr Mannah Chandra and Dr Venugopal
SPACES FORMED BY MENINGES AND
MENINGEAL COVERINGS OF SPINAL CORD
Extradural, Subdural,
Subarachnoid Spaces in Brain
Subarachnoid Cisterns
Meningeal Coverings of Spinal Cord
Clinical Anatomy
Outline
= Extradural Space
Potential Space between the inner aspect of skull bone and the endosteal layer of dura mater
Normally absent or very minute space
Epidural Space
Epidural Hematoma• Blood escapes from the
ruptured blood vessel --Meningeal Artery
• Lucid Interval
Subdural Space
Potential Space between the dura mater and arachnoid mater
Traversed by cerebral veins before draining into dural venous sinuses
Subdural Space
Head injury that tears a blood vessel
Blood escapes from the ruptured blood vessel --- Cerebral Veins
Subdural Hematoma
Space between the arachnoid and pia mater
Surrounds brain and spinal cord – Ends at Lower Border of S2 vertebra
Contains - Cerebrospinal Fluid , large vessels of brain
Collagen and elastic fibrous tissue arranged in network manner
Cranial nerves passes through the space
At base of the brain and around the brain the stem , It opens/enlarges into Cisterns
Subarachnoid Space
Blood clot in the subarachnoid space
Can be due to Bleeding from a cerebral aneurysm
Head injury
SUBARACHNOID HEMATOMA
Latin = “ Box ”
Intercommunicating pools at the base and around the brain stem
Enlarged Subarachnoid Space
Function – Having more amount of CSF it can give extra protection to underlying tissue . Forms cushions around the medulla oblongata.
Subarachnoid Cisterns
Cerebellomedullary Cistern /
Cisterna Magna *
Cisterna Pontis *
Interpeduncular Cistern
Lumbar Cistern *
Cistern of Great
Cerebral Vein
Cistern of Lateral Sulcus
Cerebellomedullary Cistern / Cisterna Magna
Largest
Connects the inferior surface of cerebellum and medulla oblongata
Receives the CSF from the fourth ventricle through Median Foramen of Magendie
Cisterna Pontis On the ventral aspect pons
Contains Basilar artery and its branches
Interpeduncular Cistern
• Between two temporal lobes
• Contains important Circle of Willis
Cistern of Great Cerebral Vein• Between the splenium
of corpus collosum and superior surface of cerebellum
• Contains pineal gland and great cerebral vein
Lumbar Cistern At Lumbar Region. Distal to
termination of spinal cord(LB of L1)
Lumbar Puncture – Space between L3 and L4
Communicates through apertures in the 4th ventricles
- Median Foramen of Megendie -
Drains the CSF to Subarachnoid Space mainly to Cisterna Magna
- 2 Lateral Foramina of Luschka Opening in each lateral extremity of the lateral recess of the fourth ventricle
How CSF flows from Ventricular System to Subarachnoid Space
Fourth Ventricle
Lateral Foramen
Median Foramen
Third Ventricle
Lateral Ventricle
Foramen of Monro
Cerebral Aqueduct
Spinal Cord is surrounded by 3 meninges . Dura , Arachnoid and Pia mater
Dura Mater
Arachnoid Mater
Pia Mater
Subdural Space
Subarachnoid Space --- contains CSF
Vertebral Canal
Epidural Space --- Epidural anaesthesia is given
Dura Mater , Arachnoid Mater , Subarachnoid
Space extends up to S2 vertebra.
Meningeal Covering Of Spinal Cord
Spinal Cord ends at lower border of L1 as conus medularis . So Below L2 – Lumbar Puncture is done without any damage to the spinal cord
Below Conus Medularis - Only pia mater is continued as thin fibrous cord = filum terminale ---attach to periosteum of dorsal surface of Co 1 segment
Conus Medular
is
Filum Terminal
e
l.B of L 1
Co 1
Lateral projection of pia mater to the dura mater = denticulate ligament – 21 pairs –teeth like projection – keeps the spinal cord in position
Linea splendens – thickening at anteromedian sulcus
denticulate
ligament
Cauda Equina ---- Resembles horse tail
Dorsal and Ventral nerve roots of right and left sides of L2 to S5 nerves lies almost vertically around the filum terminale
Cauda Equina = This nerves roots + conus medularis + filum terminale
( bundle )
Clinical Anatomy
Conus Medularis Syndrom
e
Cadua Equina
Syndrome
Epidural Hematoma
Subdural Hematoma
Subarachnoid
Hematoma
Injury to S2,S3,S4 spinal segment --- Anaesthesia in Perineum . Sexual Fx effected --- lower bowel and bladder dysfunction
Injury to Cauda inguina . Maybe due to compression. Leads to Lower Motor Neurone type of paralysis--- Anaesthesia to lower extremity
DearLecturers and Friends
Reference Sincere thanks to lecturers from Anatomy Department of IMS – MSU , Shah Alam. Each of you have helped me
a lot by explaining the concepts and guided my presentation too. Thank you
Dr Mannah – Dr Venu – Dr Gargi – Dr Thim – Dr Ravi
Gratitude