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Choroid Plexus

Many of us will have heard of cerebrospinal fluid (CSF) and are familiar with its important role in providing protection for the brain and spinal cord. But where is this colorless fluid found? And where is it produced?  

Our brain’s ventricular system is responsible for the production of CSF. This system is made up of four interconnecting cavities called ventricles. On the other hand, we have 3 membranous layers called the meninges that provide protection to the brain and spinal cord.

The innermost layer of the meninges, called the pia mater, forms invaginations in some parts of the ventricles. These vascularized invaginations, are lined by a plexus of specialised cells that produce our CSF. This plexus of cells is called the choroid plexus.

Recommended video: Choroid plexus
Anatomy and function of the choroid plexus.

The Ventricular System

Parts

The ventricular system consists of:

These ventricles are lined by a specialized type of glial cell called ependymal cells, or the ependyma. The choroid plexus is formed by these vascularized invaginations, bordered by the ependyma.

Choroid plexus - axial view

Lateral Ventricles

The two lateral ventricles are located in the brain parenchyma, one in each cerebral hemisphere. The lateral ventricles are roughly C shaped and consist of a body with an anterior, a posterior (occipital) and an inferior (temporal) horn.

Anterior horn of the lateral ventricle - lateral-left view

The inferior horn resides in the temporal lobe, while the body of the ventricle passes through the parietal lobe and into the frontal lobe. The anterior lobe extends even further into the frontal lobe, while the posterior horn projects backwards into the occipital lobe.

Inferior horn of the lateral ventricle - lateral-left view

The anterior end of the body of the lateral ventricle (before the beginning of the anterior horn) is demarcated by a twin opening called the interventricular foramen (foramen of Monro), which both connect and open into the third ventricle.

Body of the lateral ventricle - lateral-left view

Third Ventricle

The third ventricle is a narrow (unpaired) cavity that lies between the cerebral hemispheres. Specifically, this ventricle lies in the diencephalon where it is enclosed laterally by the hypothalamus and thalamus.

Third ventricle - lateral-left view

The third ventricle is connected to the fourth ventricle posteroinferiorly through the cerebral aqueduct (aqueduct of Sylvius). The cerebral aqueduct is a narrow tube-shaped channel that travels the length of the midbrain towards the pons.

Cerebral aqueduct - lateral-left view

Fourth Ventricle

The fourth ventricle is diamond-shaped and lies at the level of the brainstem, specifically within the pons or in the superior portion of the medulla. Lateral apertures (foramina of Luschka), and a median aperture (foramen of Magendie) in the roof of the fourth ventricle facilitates the exiting flow of CSF.

Fourth ventricle - lateral-left view

Cerebrospinal Fluid Circulation

While each ventricle produces CSF, it also receives CSF from the ventricle upstream. Therefore, CSF produced in the lateral ventricles travels to the third ventricle, while CSF produced in the third ventricle travels to the fourth ventricle. A combination of CSF produced by the lateral, third and fourth ventricles flow out to the subarachnoid spaces in order to protect the entire central nervous system.

Anatomy of the Choroid Plexus

Choroid Plexus in the Lateral Ventricles

The body, posterior horn, and inferior horn of each lateral ventricle join in a triangular area called the atrium (or collateral trigone). The choroid plexus of the lateral ventricles is found in the superomedial portion of the inferior horn and the anteromedial portion of the body. The plexus found in these areas also continue into the atrium.  

Collateral trigone - lateral-left view

At the junction of the body and inferior horn in the atrium, the choroid plexus becomes enlarged and more prominent, forming tufts called choroid glomus. In the lateral ventricles, the choroid plexus is always bound to a thin cleft called the choroid fissure.

Choroid plexus - cranial view

The choroid plexus of the lateral ventricles are supplied by the anterior choroidal arteries (branch of internal carotid artery) and the lateral posterior choroidal arteries (branch of the posterior cerebral artery).

Anterior choroidal artery - caudal view

Choroid Plexus of the Third Ventricle

As previously mentioned, the lateral ventricles are connected to the third ventricle by a twin opening called the interventricular foramen (or foramen of Monro). At the junction of the anterior horn and the inferior portion of the body of the lateral ventricles, the choroid plexus continues along the interventricular foramen on both sides.

Choroid plexus of third ventricle - axial view

The path of choroid plexus from each lateral ventricle joins along the roof of the third ventricle and projects into the superior part of the ventricle. The choroid plexus of the third ventricle is supplied by the medial posterior choroidal arteries (branch of posterior cerebral artery).

Choroid Plexus of the Fourth Ventricle

The third ventricle is connected to the fourth ventricle through the cerebral aqueduct. The cerebral aqueduct is void of choroid plexus. The choroid plexus is located in the posterior medullary velum which partially forms the roof of the fourth ventricle. The choroid plexus is supplied by the branches of the posterior inferior cerebellar arteries.

Choroid plexus of fourth ventricle - axial view

Development

The ventricular system is derived from the neural canal, which describes the lumen of the neural tube. By the fourth gestational week, three swellings or vesicles form around the neural canal. These swellings represent the prosencephalon (forebrain), mesencephalon (midbrain) and rhombencephalon (hindbrain). Between the fourth and sixth  weeks of gestation, the central nervous system is said to be in a five vesicle stage, as the prosencephalon is now divided into the telencephalon  and the diencephalon, while the rhombencephalon is now divided into the metencephalon and the myelencephalon. The lateral ventricles are derived from the telencephalon, while the third ventricle is derived from the diencephalon. The ventricles in the rhombencephalon become the fourth ventricle, while the cerebral aqueduct is derived from the mesencephalon.  

The ventricles, along with the epithelial cells of the choroid plexus, are derived from the neural tube. However, the endothelial cells of all the choroid plexuses, and the mesenchymal stem cells (cells that differentiate into other cell types) of the choroid plexus of the fourth ventricle are derived from the cephalic mesoderm.  On the other hand, mesenchymal cells of the lateral and third ventricles are derived from the mesencephalic neural crest. Signs of choroid plexus development of the fourth ventricle are evident around the 6th or 7th week of gestation, with the choroid plexus of the lateral ventricles developing at the same time, or shortly after in week 7. The choroid plexus of the third ventricle generally begins to develop a bit later in week 8. Over a 4 stage process, the epithelial cells of the choroid plexus and ventricles alternate in size and continue to develop right up until week 40 of gestation.

Histology of the Choroid Plexus

As mentioned above, if we were to look closely at the medial wall of the lateral ventricle or the roof of the third or fourth ventricle, small invaginations would be visible. The regions of the ventricles that contain invaginations of the pia mater are known as tela choroidea.

The deepest component of the choroid plexus is a layer of simple cuboidal epithelial cells, collectively known as the ependyma. This ependymal layer, with hair like projections, is composed of ependymal cells. These ependymal cells are specialized glial cells (derived from neural stem cells) that have the ability to produce cerebrospinal fluid, which is released into the ventricles. The apical side of the ependymal cells hosts many small processes called microvilli. The microvilli are responsible for increasing the surface area of the ependyma. There is also evidence of some larger villi on the apical surface which assist in the stirring of the CSF flow.

Choroid plexus

On the lateral surface of the ependymal cells, near the apical pole, desmosomes (junctions that are specialized for cell to cell adhesion) and tight junctions are responsible for holding the cells together, making up the blood-CSF barrier and preventing the passage of larger molecules.

On its basal side, the ependyma is surrounded by a basement membrane, which is anchored to the vascularized pia mater. The pia mater is composed of loose fibrous connective tissue. The proximal portion of this connective tissue houses fenestrated capillaries, while larger arterioles are evident at the base.

The choroid plexus receives sympathetic and parasympathetic innervation. Sympathetic fibers from the superior cervical ganglion control blood flow to the choroid plexus, while parasympathetic fibers reduce CSF production.

Clinical Notes

Choroid Plexus Papilloma

Choroid plexus papilloma describes the development of a rare benign tumor in the choroid plexus epithelium. This condition is most commonly seen in the lateral ventricle of children, with over 85% of cases occurring in children under the age of 5. Tumors can also develop in adulthood, however, they are most likely to develop in the fourth ventricle at this point.

Patients generally present with hydrocephalus, which describes an increase in cerebral ventricle volume as a result of increased CSF volume. A solid mass, with some calcifications, is generally evident on imaging. The most common treatment for choroid plexus papilloma is complete surgical excision.

Antenatal Choroid Plexus Cysts

Antenatal choroid plexus cysts are benign cysts that occur due to an infolding of the neuroepithelium in a fetus, most commonly in the lateral ventricles. Ranging from a few mm to 1-2cm in size, these cysts generally occur in approximately 2% of all pregnancies. They are described as pockets or bubbles of choroid plexus filled with CSF and cellular material. These cysts are typically visible during ultrasound in the 2nd trimester. Generally, the cysts disappear later in the pregnancy with no repercussions, however, the fetus should be monitored for other karyotypic abnormalities, particularly if there are large, multiple cysts.

Choroid Plexus - want to learn more about it?

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Sign up for your free Kenhub account today and join over 852,397 successful anatomy students.

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Show references

References:

  • M. Mortazavi et al: The Choroid Plexus: a comprehensive review of its history, anatomy, function, histology, embryology, and surgical considerations. Childs Nerv Syst (2014), volume 30, issue 2, p.205-214
  • W. Hendelaman, M.D: Atlas of Functional Neuroanatomy, 2nd Edition, CRC Press (2005), p. 60
  • S. Standring, Ph.D. et al: Gray’s Anatomy: The Anatomical Basis of Clinical Practice, 41st Edition, Elsevier (2015), p. 276
  • R. Snell: Clinical Neuroanatomy, 7th Edition, Lippincott Williams & Wilkins (2010), p. 458
  • J.R Jinkins, M.D: Atlas of Neuroradiologic Embryology, Anatomy, and Variants, 1st Edition, Lippincott Williams & Wilkins (2000), p. 226
  • E. Crisan, M.D. et al: Ventricles of the Brain. Medscape, (accessed 11th of September 2017)
  • A. Crossman, D.Neary: Neuroanatomy E-Book: An Illustrated Colour Text, Fifth Edition, Elsevier (2015), p.56-58
  • J. Newman, T. Chen: The Choroid Plexus and Cerebrospinal Fluid: Emerging Roles in CNS Development, Maintenance and Disease Progression, Elsevier (2016), p. 157
  • G. Cinalli, W Maixner, C. Sainte-Rose: Pediatric Hydrocephalus, Springer Science & Business Media (2012), p. 27
  • F Gaillard, P Desai: Choroid Plexus Papilloma. Radiopedia, (accessed 13th September 2017)
  • A Goel, Y Weerakkody et al. Choroid Plexus Cyst (antenatal). Radiopedia. (accessed 13th September 2017)

Article, Review and Layout:

  • Martha Byrne
  • Francesca Salvador
  • Adrian Rad

Illustrators:

  • Choroid plexus - axial view - Paul Kim
  • Anterior horn of the lateral ventricle - lateral-left view - Paul Kim
  • Inferior horn of the lateral ventricle - lateral-left view - Paul Kim
  • Body of the lateral ventricle - lateral-left view - Paul Kim
  • Third ventricle - lateral-left view - Paul Kim
  • Cerebral aqueduct - lateral-left view - Paul Kim
  • Fourth ventricle - lateral-left view - Paul Kim
  • Collateral trigone - lateral-left view - Paul Kim
  • Choroid plexus - cranial view - Paul Kim
  • Anterior choroidal artery - caudal view - Paul Kim
  • Choroid plexus of third ventricle - axial view - Paul Kim
  • Choroid plexus of fourth ventricle - axial view - Paul Kim
  • Choroid plexus - Natasha Mutch
© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are protected by German and international copyright laws. All rights reserved.

Related Atlas Images

Ventricles of the brain

Subarachnoid cisterns of the brain

Horizontal section of the brain

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