Anatomy (2022-2023) ‫ محمد ماجد‬.

‫د‬

The brain

Nervous System

The nervous system is divided structurally into two main parts: the central
nervous system, which consists of the brain and spinal cord, and the peripheral
nervous system, which consists of 12 pairs of cranial nerves and 31 pairs of spinal
nerves and their associated ganglia. Functionally, the nervous system can be further
divided into the somatic nervous system, which controls voluntary activities, and
the autonomic nervous system, which controls involuntary activities. The nervous
system integrates and regulates many body activities such as circulation and
respiration. It usually acts quite rapidly and can also modulate effects of the
endocrine and immune systems.

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

The Brain

 Gross Anatomy of the Brain

The brain consists of the following parts:

A. Forebrain: It is further subdivided into cerebrum and diencephalon

 Cerebrum: It is the largest part of the brain and consists of two cerebral
hemispheres connected by a mass of white matter called the corpus callosum.
The surface layer of each hemisphere is called the cortex and is composed of gray
matter. The cerebral cortex is thrown into folds, or gyri, separated by fissures, or
sulci. In addition, four lobes can be recognized (frontal, parietal, occipital, and
temporal)
 Diencephalon: It is almost completely hidden from the surface of the brain. It
consists of a dorsal thalamus and a ventral hypothalamus.
B. Midbrain: The midbrain is the narrow part of the brain that passes through the
tentorial notch and connects the forebrain to the hindbrains.

C. Hindbrain: It is made up of pons and medulla oblongata (ventrally) and

cerebellum (dorsally).

 The pons is situated on the anterior surface of the cerebellum below the midbrain
and above the medulla oblongata.
 The medulla oblongata is conical in shape and connects the pons above to the
spinal cord below.
 The cerebellum lies within the posterior cranial fossa beneath the tentorium
cerebelli. It is situated posterior to the pons and the medulla oblongata.

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

Parts of brain

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

Cranial Meninges
The brain and spinal cord are surrounded by three membranous connective
tissue layers called the meninges. The cranial meninges protect the brain, form the
supporting framework for blood vessels and venous sinuses, and enclose the
subarachnoid space (a fluid-filled cavity), which is vital to the normal function of
the brain. The three layers include the following:
1. Dura mater: tough, thick external fibrous layer that is richly innervated by
sensory nerve fibers. The cranial dura is distinguished from the spinal dura by its
two layers. The outer periosteal layer is attached to the inner aspect of the
cranium; the inner meningeal layer is in close contact with the underlying
arachnoid mater.
Four septa (falx cerebri, falx cerebelli, tentorium cerebelli, and diaphragma
sellae) extend inward from the meningeal layer and divide the cranial cavity into
freely communicating spaces lodging major subdivisions of the brain. The septa
stabilize the position of the brain by restricting its rotatory displacement during
movement of the head.
The falx cerebri is a large, sickle-shaped fold of dura mater that lies in the
midline between the two cerebral hemispheres.
The falx cerebelli is a small, midline, sickle-shaped fold of dura mater that
projects between the two cerebellar hemispheres.
The tentorium cerebelli is a crescent-shaped fold of dura mater that roofs over
the posterior cranial fossa. It covers the upper surface of the cerebellum and
supports the occipital lobes of the cerebral hemispheres. An anterior gap, the
tentorial notch, allows for passage of the midbrain.
The diaphragma sellae is a small circular fold of dura mater that forms the roof
for the sella turcica.

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

2. Arachnoid mater: thin intermediate avascular layer directly beneath the dural
surface; it is separated from the dura by a potential space, the subdural space.
The space between the arachnoid and the underlying pia is called the
subarachnoid space and contains CSF, which bathes and protects the central
nervous system.
3. Pia mater: delicate internal vasculated layer of connective tissue that intimately
envelops the brain and spinal cord.

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

Dural Nerve Supply

Branches of:
 Trigeminal (CN V)
 Vagus (CN X)
 First three cervical nerves (C1-C3)
 Branches from the sympathetic system.
 Glossopharyngeal nerve (CN IX) and hypoglossal nerve (CN XII) (supply
portion of the dura in the posterior cranial fossa).
*The arachnoid and pia mater lack sensory innervation.
Dural Arterial Supply
Numerous arteries supply the dura mater from the internal carotid, maxillary,
ascending pharyngeal, occipital, and vertebral arteries. From a clinical standpoint,
the most important is the middle meningeal artery, which is commonly damaged
in head injuries.
Dural Venous Drainage
The meningeal veins lie in the endosteal layer of dura. The middle meningeal
vein follows the branches of the middle meningeal artery and drains into the
pterygoid venous plexus or the sphenoparietal sinus.

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

Venous (Dural) Blood Sinuses

The endosteal and meningeal layers of the dura mater are inseparable, except
in certain places where they do separate to form venous channels (venous sinuses;
dural sinuses). These are lined by endothelium; their walls are thick and composed
of fibrous tissue; they have no muscular tissue and no valves. They receive
tributaries from the brain, the diploë of the skull, the orbit, and the internal ear.
All blood from the brain drains into the dural sinuses and then out of the
cranium via true veins. Most of the blood from the brain drains to the internal
jugular veins.
The dural venous sinuses are:
 The superior sagittal sinus lies in the upper fixed border of the falx cerebri.
 The inferior sagittal sinus lies in the free lower margin of the falx cerebri.
 The straight sinus lies at the junction of the falx cerebri with the tentorium
cerebelli.
 The confluence of sinuses overlies the internal occipital protuberance. This is a
point of convergence where the superior sagittal and straight sinuses join
together. The confluence gives rise to the transverse sinuses.
 The right transverse sinus originates from the confluence of sinuses as a
continuation of the superior sagittal sinus.
 The left transverse sinus comes off the confluence and is usually a continuation
of the straight sinus.
 The sigmoid sinuses are direct continuations of the transverse sinuses.
 The occipital sinus lies in the attached margin of the falx cerebelli.
 Each cavernous sinus lies on the lateral side of the body of the sphenoid bone
(sella turcica).The sinus drains posteriorly into the transverse sinus through the

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

superior petrosal sinus and into the sigmoid sinus through the inferior petrosal
sinus.
 Intercavernous sinuses connect the two cavernous sinuses through the sella
turcica.
 The cavernous sinus also drains into the basilar sinus plexus, which drains
through the foramen magnum and connects to the vertebral venous plexuses.
 Further, the cavernous sinus has several emissary vein connections through the
floor of the middle cranial fossa into the pterygoid and pharyngeal venous
plexuses in the infratemporal fossa.

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

Ventricles
The ventricles of the brain consist of the two lateral ventricles, the third
ventricle, and the fourth ventricle. The two lateral ventricles communicate with the
third ventricle through the interventricular foramina. The third ventricle
communicates with the fourth ventricle by the cerebral aqueduct. The fourth
ventricle, in turn, is continuous with the narrow central canal of the spinal cord
and, through the three foramina in its roof, with the subarachnoid space.
The ventricles are filled with cerebrospinal fluid, which is produced by the
choroid plexuses of each ventricle. It protects the brain by providing a cushion
against blows to the head. The CSF in the subarachnoid space provides the buoyancy
that prevents the weight of the brain from compressing the cranial nerve roots and
blood vessels against the internal surface of the cranium. In addition, it removes the
waste products that associated with neuronal activity.

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

Blood Supply of the Brain

The two internal carotid and the two vertebral arteries supply blood to the
brain. The four arteries anastomose on the inferior surface of the brain and form the
cerebral arterial circle (circle of Willis; circulus arteriosus). Three pairs of cerebral
arteries branch off the circle and supply the cerebrum.
The terminal branches of the internal carotid arteries are the anterior and
middle cerebral arteries. The anterior cerebral arteries are connected by the
anterior communicating artery. Near their termination, the internal carotid arteries
are joined to the posterior cerebral arteries by the posterior communicating
arteries. The intracranial parts of the vertebral arteries unite at the caudal border of
the pons to form the basilar artery. It ends by dividing into the two posterior
cerebral arteries.
The veins of the brain have no muscular tissue in their thin walls, and they
possess no valves. They emerge from the brain and drain into the cranial venous
sinuses. Cerebral and cerebellar veins and veins of the brainstem are present. The
great cerebral vein is formed by the union of the two internal cerebral veins and
drains into the straight sinus.

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Anatomy (2022-2023) ‫ محمد ماجد‬.‫د‬

Clinical Focus
Numerous sensory endings are in the dura. The dura is sensitive to stretching, which
produces the sensation of headache.
 Meningitis
It is a serious condition defined as an inflammation of the arachnoid and pia mater.
It results from bacterial or viral infections, drug reactions, and systemic diseases.
 Epidural Hematomas
It is the collection of arterial blood between the periosteal dura and bony cranium.
 Subdural Hematomas
It is the collection of venous blood between the meningeal dura and arachnoid
mater.
 Subarachnoid Hemorrhage
It is the collection of arterial blood between the arachnoid and pia mater.
 Transient Ischemic Attack (TIA)
It is a temporary interruption of focal brain circulation that lasts less than 24 hours.
The most common cause is embolic disease which may temporarily block a
vessel.
 Stroke
Cerebrovascular accident (CVA) or stroke is a localized brain injury that lasts
more than 24 hours. Stroke is classified into the following two types:
 Ischemic (80%): infarction; thrombotic or embolic.
 Hemorrhagic: occurs when a cerebral vessel weakens and ruptures.

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