Neuroanatomy of ventricular system and CSF circulation also include CSF composition CSF production CSF circulation CSF absorption Intracranial pressure Raised ICP Hydrocephalus

1. Moderator : DR. Namita Kaushik (PT)
Assistant professor of NIHS, KOLKATA
DR. Mainak Patra (PT)
Assistant professor of NIHS, KOLKATA

2. Two Lateral ventricle
• Communicates with 3rd ventricle by Foramina Of Monro
3rd Ventricle
• Communicates with the 4th ventricle through Aqueduct Of
Sylvius
4th Ventricle
• Continues with the central canal of the spinal cord &
archnoid space of the brain through the Foramina
Luschka And Foramina Magendie
The central canal in the spinal cord has a small dilatation at the terminal end it is referred to as the terminal
ventricle

4. Lateral ventricle is a ‘C’ shaped cavity that is divided into the body that occupies the parietal lobe from which the
anterior and posterior horn extends into frontal, occipital & and temporal lobes respectively and the inferior horn lies in
the temporal pole
The lateral ventricle wraps itself around the thalamus, the
lentiform nucleus, and the caudate nucleus
It is lined with ependyma and filled with cerebrospinal fluid. It has
a capacity of about 7-10 ml
The main part of two ventricles are separated from each other by
a septum extending between corpus callosum and fornix called
septum pellucidum
Anterior horn Body Posterior horn Inferior horn
Parts of Lateral ventricle

5. The choroid plexus is an irregular lateral edge of the tela choroidea, which is a two-layered fold of pia mater situated
between the fornix superiorly and the upper surface of the thalamus. At the junction of the body of the lateral
ventricle and the inferior horn, the choroid plexus is continued into the inferior horn and projects through the
choroidal fissure. The function of the choroid plexus is to produce cerebrospinal fluid.

6. The third ventricle is a slit-like cleft that lies in the diencephalon between the two thalami. It communicates
anteriorly with the lateral ventricles through the interventricular foramina (of Monro) and posteriorly with the
fourth ventricle through the cerebral aqueduct (of Sylvius)
Recess of the 3rd ventricle
Infundibular recess.
• Optic (or chiasmatic) recess.
Anterior recess (vulva of ventricle)
• Supra pineal recess
Pineal recess
Choroid Plexuses of the Third Ventricle
The choroid plexuses are formed from the tela choroidea situated above the roof of the ventricle.

7. The fourth ventricle is a tent-shaped cavity filled with cerebrospinal fluid. It is situated anterior to the
cerebellum and posterior to the pons and the superior half of the medulla oblongata
Fourth Ventricle
Recess of
4th
ventricle
• Two lateral recess
• Median dorsal recess
• Lateral dorsal recess
Angles
• Superior angle
• Inferior angle
• Two lateral angles
Choroid
plexus
• T shaped
• Suspended from roof of the
ventricle
Important structure of 4th
ventricle

8. Rhomboid
fossa
Upper triangular part formed by
posterior surface pons
Lower triangular part formed by
posterior superior surface of medulla
Lies at the junction of medulla and pons
is prolonged laterally on either side
over the inferior cerebellar peduncle
Facial
colliculus
Vegas nerve
nucleus
Hypogloss
al nucleus
Vestibular
nerve
neuclei

9. Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma contained within the ventricles of the brain and the subarachnoid
spaces of the cranium and spine
Physical
characteri
stics of
CSF
Composition – Protein
 Glucose
 Chloride
Rate of production- 0.5 mL/minute
Volume – 150 mL
Pressure – 60-150 mm H20
Number of cells- 0-3
lymphocytes/cumm
Protects CNS
• Support the brain
Nourishes CNS
• Removes the metabolites
Pathway for pineal gland secretions to
reach pituitary gland
Function of CSF
CSF production
Choroid epithelium
Plasma
CSF
Sodium, chloride, glucose,
H20
Do you know
the weight of
human brain
in dry air?
1400gm

10. Polymorphonuclear leukocytes or an excessive
quantity of protein
Cloudy appearance
Inflammation of the meninges or encephalitis
Raised WBC
Gama globulin
Raised protein
content
Reduced glucose
level
Tuberculous meningitis and Poliomyelitis
• Traumatic spinal Tap
Gross blood in CSF
• Sub Arachnoid
Uniform blood staining
Multiple sclerosis
Acute bacterial meningitis

11. Lateral
ventricle
3rd
ventricle
4th
ventricle
Foramina Of
Monro
Aqueduct Of Sylvius
Foramen of
Magendie&
Foramina
Luschka
Sub
arachno
id space
Arachno
id villi
Superio
r
sagittal
sinus
Central canal
Internal
jugular vein

12. Approximately 150 mL of CSF are contained within the ventricles and
surrounding the brain and spinal cord
cerebral blood volume is also ∼150 mL
Significant increases in volume eventually result in increased ICP
Obstruction
in CSF
circulation
Reduced CSF
absorption
Tumor Hemorrhage
Cerebral
edema
Meningitis
encephalitis

13. Raised
ICP
Headache
Papilledema
Projectile
vomiting
Cushing’s
triad
Don’t Go For Spinal Tap Or Lumbar Puncture
Low GCS
Do you know optic
nerve is not a
peripheral nerve
rather it is a tract of
CNS?

14. The term herniation refers to the dislocation of a portion of the cerebral or
cerebellar hemisphere from its normal position to an adjacent compartment
 If ICP is elevated because of a mass lesion, brain swelling, or a
block in ventricular CSF outflow (obstructive hydrocephalus),
then lumbar puncture carries the potential risk of brain
herniation.
Central tentorial herniation is a vertical
displacement of the brainstem and
diencephalon through the tentorial notch
Tonsillar herniation is the
protrusion cerebellar tonsil
through the foramen magnum

15. Hydrocephalus is an abnormal increase in the volume of the cerebrospinal fluid within the skull
Increased
production
of CSF
Reduced
absorption of
CSF
Blockage of
CSF
circulation
Hydrocephalus with
Raised ICP
Types
Communicating
Non
communicating
Normal-pressure Hydrocephalus
CSF production
CSF absorption
Clinical triad
Slowly progressive gait disorder
Altered mental function
Sphincteric incontinence.

16. CT
• MRI
Ventriculogram
• Encephalogram

17. Reference
1. Clinical Neuroanatomy by Richard S Snell
2. Textbook of Clinical Neuroanatomy by Vishram singh
3. Harrison's Neurology in Clinical. Medicine by Stephen L. Hauser, and
S. Andrew Josephson
4. Adams and Victor's Principles of Neurology, by Allan H. Ropper