Venous Blood Sinuses

They are blood-filled spaces situated

between the layers of the dura mater.
They are lined by endothelium.
Their walls are thick and composed
of fibrous tissue. They have no
muscular tissue. They have no valves.
They receive tributaries from the
brain; the diploic veins of the skull;
.the orbit and the internal ear
Inferior Sagittal Sinus
It occupies the free lower margin of
the falx cerebri.
It runs backward and joins the great
cerebral vein which is formed by the
union of the 2 internal cerebral veins
at the free margin of the tentorium
cerebelli to form the straight sinus.
It receives cerebral veins from the
medial surface of the cerebral hemisphere.

N.B:
Veins have no valves ; no muscular tissue
in their wall and drain into venous sinuses

Superior Sagittal Sinus

It occupies the upper fixed border of the
falx cerebri. It begins in the front at the
foramen cecum where it receives a vein
.from the nasal cavity
It runs backward, grooving the vault of
the skull and at the internal occipital
protuberance it deviates to one side
( usually the right ) and becomes
.continuous with the transverse sinus
It communicates through small openings
with 2 or 3 venous lacunae on each side.
Numerous arachnoid villi and
granulations project into these lacunae
which also receive the diploic; emissary
. and meningeal veins
It receives the superior cerebral veins .
At the internal occipital protuberance it is
dilated to form the confluence of the
sinuses which is connected to the
opposite transverse sinus and receives
.the occipital sinus

Straight Sinus
It occupies the line of
junction of the falx cerebri
. with the tentorium cerebelli
It is formed by the union of
the inferior sagittal sinus
. with the great cerebral vein
It ends by turning to the left
( sometimes to the right ) to
. form the transverse sinus

Occipital Sinus
. It is a small sinus occupying the attached margin of the falx cerebelli
.It communicates with the vertebral veins near the foramen magnum
. Superiorly it drains into the confluence of sinuses

Transverse Sinus
. They are paired and begin at the internal occipital protuberance
. The right sinus usually continuous with the superior sagittal sinus
.The left is continuous with the straight sinus
Each sinus occupies the attached margin of the tentorium cerebelli , grooving the occipital
. bone and posteroinferior angle of the parietal bone
They receive the superior petrosal sinuses; inferior cerebral and cerebellar veins and diploic
. veins

Superior and Inferior Petrosal Sinuses

They are small and situated on the superior and inferior borders of the petrous
. part of the temporal bone on each side
.Each superior sinus drains the cavernous sinus into the transverse sinus
.Each inferior sinus drains the cavernous sinus into the internal jugular vein

Sigmoid Sinuses
They are a direct continuation of the transverse sinuses. Each sinus turns
downward and medially and grooves the mastoid part of the temporal bone.
.Here it lies behind the mastoid antrum
It then turns downward through the posterior part of the jugular foramen to
. become continuous with the superior bulb of the internal jugular vein

Cavernous Sinuses
They are situated in the middle cranial fossa on each side of the body of the
sphenoid bone.
Each sinus extends from the superior orbital fissure in front to the apex of the
petrous part of the temporal bone behind.
The 3rd ; 4th cranial nerves and the ophthalmic & maxillary divisions of the
trigeminal nerve run forward in the lateral wall of this sinus. They lie between the
endothelial and the dura mater .
The internal carotid artery, its sympathetic nerve plexus and abducent nerve run
. forward through it. They are separated from the blood by an endothelial covering

5
1

The tributaries are 1- Superior ophthalmic vein which communicates it with the facial V
2- Inferior ophthalmic vein.
3- Cerebral veins
Central vein of the retina
5- Sphenopareital sinus.
-4
The sinus drains posteriorly into the superior and inferior petrosal sinuses and
.inferiorly into the pterygoid venous plexus
The 2 sinuses communicate with one another by means of the anterior and
posterior intercavernous sinuses which run in the diaphragma sellae in front and
.behind the stalk of the hypophysis cerebri

Hypophysis Cerebri
The pituitary gland is an edocrine gland. It is
small, oval and attached to the undersurface
.of the brain by infundibulum
It is located in the sella turcica of the
. sphenoid bone
It is divided into an anterior lobe or
adenohypophysis and posterior lobe or
. neurohypophysis
Relations
Superiorly: The diaphragma sellae which has
a central aperture that allows the
passage of the infundibulum. This
sellae separates the anterior lobe
from the optic chiasma. Inferiorly:
The body of the sphenoid with its
sphenoid air sinuses.
Laterally: The
cavernous sinus and its
contents.
Posteriorly: The
dorsum sellae; basilar artery
and
.pons
Blood supply: The superior and inferior
hypophyseal arteries the branches of the
internal carotid artery.
.Veins drain into the intercavernous sinuses

Clinical Notes
Hypophyseal enlargement and Optic chiasma
A pituitary tumor pushes the diaphragma sellae upward and causes pressure on
the optic chiasma. This results in interference with the function of the nerve fibers
crossing in the chiasma ( from the inner quadrants of the retina ) and the patient
presents with bitemporal hemianopia. Further expansion of the pituitary tumor
.causes erosion of the body of the sphenoid bone

Extradural Hemorrhage
It results from injuries of the meningeal
arteries or veins. The most common is
the anterior branch of the middle
. meningeal artery
A minor blow to the side of the head
result in fracture of the anteroinferior
.portion of the parietal bone ( pterion )
The intracranial pressure rises. The
blood clot exerts local pressure on the
underlying motor area in the precentral
. gyrus
Blood may pass out through the
fracture line to form a soft swelling
.under the temporalis muscle
The burr hole through the skull wall
should be placed 2.5 to 4 cm above the
midpoint of the zygomatic arch to ligate
. or plug the torn artery or vein

Subdural Hemorrhage
It is more common than the middle meningeal artery hemorrhage. It results from tearing of
.
the superior cerebral veins at their entrance into the superior sagittal sinus
The cause is a blow on the front or back of the head causing anteroposterior displacement
of the brain within the skull. Blood under low pressure begins to accumulate in the space
%. between the dura and arachnoid. The case is bilateral in 50
Acute symptoms in the form of vomiting due to rise in the venous pressure may be present.
In the chronic form, over a several months, the small blood clot will attract fluid by osmosis
.so a hemorrhagic cyst is formed and gradually expands produces pressure symptoms

Intracranial Hemorrhage in the Infant

It occurs during birth and from excessive molding of the head. Bleeding occurs
from cerebral veins or venous sinuses
Excessive anteroposterior compression often tears the anterior attachment of the
. falx cerebri from the tentorium cerebelli
bleeding then takes place from the great cerebral veins; straight sinus or inferior
.sagittal sinus

Subarachnoid Hemorrahage
It results from leakage or rupture of a
congenital aneurysm on the circle of Willis or
.less commonly from an angioma
The sudden symptoms include severe
headache; stiffness of the neck and loss of
. consciousness
The diagnosis is established by withdrawing
heavily blood- stained CSF fluid through a
.lumbar puncture ( spinal tap )

Cerebral Hemorrhage
It is caused rupture of the thin-walled
lenticulostriate artery, a branch of the middle
cerebral artery. The hemorrhage involves the
vital corticobulbar & corticospinal fibers in
the internal capsule and produces hemiplegia
. on the opposite side of the body
The patient immediately loses consciouness
and paralysis is evident when consciousness
.regained