BRAIN

CISTERNS

Suresh Bishokarma, MCH ( Neurosurgery

NINAS

INTRODUCTION

• Microanatomy: Arachnoid membranes and the subarachnoid cisterns

• Minimally invasive neurosurgery

Brain Meninges

Cisterns

• Cisterns are openings in the subarachnoid space.

• These spaces are filled with CSF.

Brain Cisterns

Cisterna Magna

CRESCENTIC

CISTERNA MAGNA

4th vent

Content: Cisterna cerebellomedullarisventrolateralis

1. Vessels

2. Lower CNs.

3. The lateral medullary and post-olivary

Veins

4. The choroid plexus.

CLINICAL IMPLICATION

• PICA CLIPPING

• FORAMEN MAGNUM DECOMPRESSION: RSRM, IMPACTED CISTERNA MAGNA.

Pontine cistern

4th vent

Communicate with interpeduncular cistern and cisterna magna.

Pontine Cisterns

Pontine Cistern

CONTENTS

1. The basilar artery and origin of anterior

Inferior cerebellar artery;

2. The origin of the superior cerebellar

Arteries;

3. The sixth nerve; and

4. The anterior and anteromedian pontine

Veins.

Interpeduncular Cistern

TARIN SPACE

INNERMOST DEPTH OF THE CISTERN

Interpeduncular Cistern

• Cone shaped

• Lies between the cerebral peduncles and liliquist’s membrane.

• Confluent area of the supra- and infratentorialsubarachnoid space

• Continuous below with the pontine cistern, laterally with the ambient cisterns, superiorly with the suprasellar cistern.

Communication With Adjoining Cisterns

• Ambient cistern : space between the cerebral

peduncle and Liliequist membrane.

• Posterior communicating cistern or the carotid

cisterns : seams around the PCoAs that penetrate

Liliequist membrane.

• Prepontine and cerebellopontine cisterns : Foramina

of subarachnoid membranes.

DIVISION OF IP CISTERN

• The BA bifurcation membrane divides the cistern into two portions: deep and superficial.

• The superficial portion adjoins the oculomotorcisterns and the deep portion communicates with the ambient cisterns.

• The deep portion : subdivided by the posteriorperforated membrane: anterior and posterior areas.

CONTENTS

1. The bifurcation of the basilar artery and origin of AICA

2. PCA

3. SCA

4. Posterior cerebral arteries, branches: one meningeal branch, and the artery to CN3.

5. The PCoAs join the PCAs in the deep portion of the interpeduncular cistern

6. The basal vein of rosenthal;

7. The interpeduncular vein and posterior communicating vein;

8. CN3 in lateral wall : Pass between PCA and SCA

9. CN6

Yasargil et al 1976

Interpeduncular Cistern

Interpeduncular Cistern

CLINICAL IMPLICATION

• ETV

• RAISED ICP: DIPLOPIA, CN6

Quadrigeminal Cistern

QUADRIGEMINAL CISTERN

Quadrigeminal Cistern

The quadrigeminal cistern contains

1. The vein of galen;

2. The posterior pericallosal arteries;

3. The third portion of the superior cerebellar

Arteries;

4. Perforating branches of the posterior Cerebral

and the superior cerebellar arteries;

Ambient Cistern

• Cistern that extend around both sides of midbrain

• Anteriorly: Interpeduncular cistern

• Posteriorly: quadrigeminal cistern.

• Posterior cerebral artery and the basal vein lie in the anterior part of each ambient cistern.

Ambient Cistern

Ambient Cistern

CONTENTS

1. The basal vein; and

2. The posterior cerebral artery.

3. The superior cerebellar artery; and

4. The fourth nerve.

Suprasellar / Chiasmatic Cisterns

• Suprasellar cistern lies above the pituitary fossa and is continuous posteriorly with the interpeduncular cistern and laterally with the sylvian cistern.

• It contains the anterior part of the circle of Willis and the optic nerve as it passes to the chiasm.

• Chiasmatic cistern is the part of suprasellarcistern that is anterior to the optic nerve.

Suprasellar / Chiasmatic Cisterns

Suprasellar / Chiasmatic Cisterns

The cisterna chiasmatis contains

1. The anterior aspect of the optic chiasma

And optic nerves;

2. The hypophyseal stalk;

3. The origin of the anterior cerebral

Arteries; and

4. The anterior communicating vein.

Carotid Cistern

The carotid cistern contains

1. the internal carotid artery;

2. the origin of the anterior choroid artery;

3. the origin of the posterior communicating

artery.

Sylvian Cistern

• This is the area of sylvian fissure.

SYLVIAN FISSURE

SYLVIAN CISTERN

SYLVIAN CISTERN

SYLVIAN CISTERN CONTENTS

1. The middle cerebral artery;

2. Middle cerebral (sylvian) veins;

3. Fronto-orbital veins; and

4. Collaterals to the vein of rosenthal.

CISTERNA LAMINA TERMINALIS

CONTENTS

1. Anterior cerebral arteries; the A1 and proximal part of the A-2 segment

2. Acomm

3. Heubner's artery

4. The hypothalamic arteries

5. The origin of the fronto orbital arteries;

6. The venous system of the lamina terminalis.

PERICALLOSAL CISTERN

• The cistern of lamina terminalis is the superior extension of suprasellar and chiasmatic cisterns that extend to the superior surface of corpus callosum as the pericallosal (supracallosal) cistern.

• Pericallosal cistern is continuous posteriorly with the quadrigeminal cistern.

• It contains branches of the anterior cerebral artery(A4).

PERICALLOSAL CISTERN

Pericallosal Cistern

Cisterna Cruralis

• The cisterna cruralis contains

• 1. the anterior choroidal artery;

• 2. the medial posterior choroidal artery;

• and

• 3. the basal vein of Rosenthal.

Cisterna Pontocerebellaris

• The cisterna pontocerebellaris contains

• 1. the seventh and eighth nerves;

• 2. the anterior inferior cerebellar artery;

• 3. the lateral pontine veins; and

• 4. the fifth nerve and the petrosal vein

The cranial nerves are designated by Roman numerals. 1 = Olfactory cistern; 2 = Callosal cistern; 3 = Chiasmatic cistern with I and II nerves;4 = Carotid cistern; 5 = Sylvian cistern; 6 = Crural cistern; 7 = Interpeduncular cisterns with III nerves; 8 = Ambient cisterns with IV nerves; 9 = Prepontine cistern with VI nerves; 10 = Cerebellopontine cistern on each side with VII and VIII nerves; 11 = Lateral cerebellomedullary cistern on each side with IX, X, XI and XII nerves; 12 = Cervical subarachnoid space; 13 = Cisterna cerebellomedullaris.

Left.: Relation of cranial nerves to cisterns Right: Relation of arteries to cisterns.

ARTIST'S CONCEPT OF THE SUBARACHNOID CISTERNS AT THE BASE OF THE BRAIN.

• Cisterns exposed through a unilateral suboccipital craniectomy.

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