Cerebrospinal Fluid System

The cerebrospinal fluid (CSF) is located within the ventricles and subarachnoid spaces in the brain and spine. Its composition schematically contains 0-5/^1 (0-5 x 106 /l) cells, 40-80 mg/dl glucose, 15-60 mg/dL protein. The principal source of CSF is represented by the choroid plexi of the lateral, third and fourth ventricles. The total volume is approximately 140-150 ml, 30-40 of which is in the ventricular system, with a production rate of about 20 ml/h and a turnover rate of about 5 h. The CSF moves within the ventricles and subarachnoid spaces under the influence of hydrostatic pressure generated by its production and a complex pushing system dependent on internal carotid pulsation in systole and negative pressure in the superior sagittal sinus during diastole. The CSF cushions the brain, regulates brain extracellular fluid, and allows the distribution of neuroactive substances. The choroid plexi are fringe-like processes of the pia mater which project into the ventricular cavity. They consist of minute and highly vascular villous processes, each with an afferent and an efferent vessel. The arteries of the plexus are the anterior choroidal artery, a branch of the internal carotid that enters the plexus at the end of the temporal horn, and the posterior choroidal arteries, branches of the posterior cerebral artery. The veins of the choroid plexus join the internal cerebral vein. The tela choroidea of the fourth ventricle lies on the roof of the ventricle and adheres to it, reaching the foramen of Magendie. Two lateral thickenings, the choroid plexuses, extend along the lateral foramina of Lusch-ka. Under normal conditions, 90% of CSF is drained by dur-al venous sinuses. The remaining rate is mostly absorbed by white matter deep veins. The CSF circulates from the lateral and third ventricles toward the fourth ventricle through the cerebral aqueduct, and from here it reaches the cerebral convexity, the granulation of Pacchioni, and the superior sagittal sinus. The flow is pulsatile and synchronized with the heartbeat.

Pineal recess

Interthalamic mass

Lateral ventricles: bodies

Lateral ventricles: frontal horns

IV ventricle

IV ventricle: lateral recess IV ventricle: lateral foramen of Luschka

Obex

Pineal recess

Interthalamic mass

Lateral ventricles: bodies

Lateral ventricles: frontal horns

Interventricular foramina of Monro

III ventricle Optic recess Infundibular recess Cerebral aqueduct of Sylvius

IV ventricle

IV ventricle: lateral recess IV ventricle: lateral foramen of Luschka

Obex

Suprapineal recess

Suprapineal recess

Lateral ventricles; trigones

Lateral ventricles: occipital horns

Lateral ventricles: temporal horns

Lateral ventricles; trigones

Lateral ventricles: occipital horns

Lateral ventricles: temporal horns

IV ventricle: midline foramen of Magendie - Central canal of spinal cord

Posterior basal cistern

Choroid plexus of the IV ventricle In the foramen of Luschka

Foramen of Magendie

Cisterna magna (cerebello-medullaris cistern)

Posterior basal cistern

Choroid plexus of the IV ventricle In the foramen of Luschka

Foramen of Magendie

Cisterna magna (cerebello-medullaris cistern)

Basilar artery Pontine cistern

Cerebellopontine angle cistern

IV ventricle

Lateral recess of the IV ventricle with choroid tela

Cistern of sylvian fissure (insular cistern)

I ventricle

Optic recess

Infundibular recess

Temporal horn of lateral ventricle and choroid plexus

Amblens cistern

Cerebral aqueduct of Sylvius

Tectal cistern (quadrigeminal cistern)

Superior cerebellar cistern

Cistern of sylvian fissure (insular cistern)

I ventricle

Cistern of the great vein (of Galen)

Glomus of choroid plexus of the lateral ventricle

Lateral ventricle, trigone

Quadrigeminal Bodies

Lateral ventricle, occipital horn

Choroid vein

Glomus of choroid plexus of the lateral ventricle

Vein of Galen

Lateral ventricle, frontal horn

Lateral ventricle

Intraventricular foramen (of Monro) containing choroid tela

Stria medullars thalami

Superior sagittal Lateral ventricle, sinus trigone

Pericaliceal cistern

Choroid vein

Glomus of choroid plexus of the lateral ventricle

Vein of Galen

Superior sagittal Lateral ventricle, sinus trigone

Lateral ventricle, frontal horn

Lateral ventricle

Intraventricular foramen (of Monro) containing choroid tela

Stria medullars thalami

Cistern of velum interpositum

Interhemispheric cistern

Lateral ventricles, bodies

Choroid plexuses of lateral ventricles

Interhemispheric cistern

Pertcallosal cistern

Lateral ventricle

III ventricle -

Cistern of the lamina terminalis -

Chiasmatic cistern --

Interpeduncular cistern

Pontine cistern

Pertcallosal cistern

Lateral ventricle

III ventricle -

Cistern of the lamina terminalis -

Chiasmatic cistern --

Interpeduncular cistern

Pontine cistern

Cistern of velum interpositum (cistern of transverse fissure)

Cistern of the great cerebral vein (of Galen)

Tectal cistern (quadrigeminal cistern)

Superior cerebellar cistern Cerebral aqueduct of Sylvius IV ventricle

Choroid tela of IV ventricle Foramen of Magendie

Cisterna magna (cerebello-medullaris cistern)

Cistern of velum interpositum (cistern of transverse fissure)

Cistern of the great cerebral vein (of Galen)

Tectal cistern (quadrigeminal cistern)

Superior cerebellar cistern Cerebral aqueduct of Sylvius IV ventricle

Choroid tela of IV ventricle Foramen of Magendie

Cisterna magna (cerebello-medullaris cistern)

Lateral ventricle

Interpeduncular cistern

Lateral ventricle

Interpeduncular cistern

Choroid tela of lateral ventricle

Tectal cistern (quadrigeminal cistern)

Lateral recess of the IV ventricle

Choroid tela of IV ventricle

Choroid tela of lateral ventricle

Tectal cistern (quadrigeminal cistern)

Lateral recess of the IV ventricle

Choroid tela of IV ventricle

Inferior sagittal sinus —

Choroid tela of the lateral ventricle

Choroid tela of the interventricular foramen (of Monro)

Lamina terminals

Infundibular recess

Optic recess -

Optic chiasm -

Pituitary stalk

Inferior sagittal sinus —

Choroid tela of the interventricular foramen (of Monro)

Lamina terminals

Infundibular recess

Optic recess -

Optic chiasm -

Pituitary stalk

Interthalamic mass

Internal cerebral vein

Pineal recess of the 111 ventricle

Suprapineal recess / of the iii ventricle

Vein of Galen

HQ Pineal gland

Posterior commissure

Choroid tela of the IÎI ventricle

Suprapineal recess / of the iii ventricle

Vein of Galen

HQ Pineal gland

Posterior commissure

Choroid tela of the IÎI ventricle

Choroid teta in the III and lateral ventricles

Interventricular foramen (of Monro)

Internal cerebral vein I

Anterior perforated substance

Lamina terminalis

Interventricular foramen (of Monro)

Internal cerebral vein I

Anterior perforated substance

Lamina terminalis

Inferior sagittal sinus

Cerebral aqueduct of Sylvius

Straight sinus

Vein of Galen

6 Vascular Anatomy

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