basal cisterns final.ppt

basic about Basal Cistern

1. BASAL CISTERNS
DR ANAS AHMED
PG TRAINEE,
NEUROSURGERY DEPARTMENT, JPMC

2. Cistern
Widening of subarachnoid space created by
separation of pia and arachnoid.
All the cranial nerves and major intracranial
arteries and veins pass through the cisterns.
Provide a natural pathway through which
most operations for intracranial aneurysms,
extra axial brain tumors and disorders of
cranial nerves are directed.

3. CSF Cisterns

4. Overview of CSF spaces
Normal:
All CSF spaces are visible
neither effaced or dilated.
Atrophy:
All CSF spaces are dilated.
Hydrocephalus:
Ventricles dilated.
Subarachnoid spaces effaced.
Edema:
All CSF spaces are effaced.

5. Liliequistclassification
of C.S.F cisterns
Ventral
Cisterns
Median
unpaired
Medullary
Pontine
Inter-
peduncular
Chiasmatic
Paramedian
paired
CP angle
Crural
Carotid
Sylvian
Dorsal
Cisterns
Median
unpaired
Peri-callosal
Quadrigemial
Supra-
cerebellar
Paramedian
paired
Ambient
Retro-
thalamic
Communicating
cisterns
Cisterna
magna
Lamina
terminalis
General
subarachnoid
space over the
convexities

6. P
M
IP
CH
SC
CM
Q
PC
LT

7. Cisterna magna

9. Supratentorialcisterns
Anterior
Carotid
Chiasmatic
Lamina
terminalis
Olfactory
Sylvian
Lateral
Crural
Ambient
Posterior
Quadrigeminal
Vellum
interpositum
Superior
Pericallosal
Hemispheric

10. Infratentorialcisterns
Anterior
Inter-peduncular
Pre-pontine
Premedullary
Lateral
Ambient
Superior CPA
Inferior CPA
Posterior
Cisterna magna
Superior
cerbellar
Superior
Vermian
Hemispheric

11. Perimesencephalic cistern
1.Interpeduncular C.
2.Crural C.
3.Ambient C.
4.Quadrigeminal C.

12. Pentagonal
cistern
Lamina terminalis
cistern
Sylvian
cistern
Inter-peduncular
cistern

13. Medullarycistern
premedullarycistern
•Anterior to the medulla.Location
•Vertebral arteries.
•PICA.
•Anterior spinal artery.
•Posterior spinal arteries.
•Pre-medullaryV.
•Cn12.
Contents

14. Medullary cistern

15. PICA
Cn12
VA

16. Pontine cistern
pre-pontinecistern
•Anterior to the pons.
•Receives CSF from lateral
apertures of 4
th
ventricle
(Luschka).
Location
•Basilar A.
•AICA.
•Ant. Ponto-mesencephalic V.
•Cn 5.
•Cn6.
Contents

17. Pontine cistern

18. Pontine Cisterns

19. Pre-pontine arachnoid cyst

20. Interpeduncularcistern
basal cistern
•Between the cerebral
peduncles.Location
•Basilar tip.
•SCbA.
•PCA.
•InterpeduncularV.
•Cn3.
Contents

21. Interpeduncular Cistern

22. Interpeduncular Cistern

23. Interpeduncular Cistern

24. Chiasmaticcistern
Suprasellarcistern
•Above the sella.Location
•Optic chiasm.
•Pituitary
infundibulum
Contents

25. Suprasellar arachnoid cyst

26. Liliequist membrane
The Liliequist membrane is the arachnoid
membrane separating the chiasmaticand
interpeduncularcisterns.
•Dorsum sellae.
Lower
attachment
•Mamillarybody.
Upper
attachment
•Arachnoidsheath surrounding the
oculomotornerve.
Lateral
attachment

27. Liliequist membrane
•Separates the
interpeduncular cistern from
the chiasmaticcistern.
Diencephalic
segment:
•Separates the
interpeduncular cistern from
the pre-pontine cistern.
Mesencephalic
segment:

29. CH
P
IP

30. Third
ventriculostomy
The key to success of an ETV
is the opening of the
membrane of Lilequest, at
least of its diencephalic
portion.

31. Lamina terminaliscistern
•Anteriorto the lamina terminalis,
•Inferiorto the rostrum of corpus callosum
&
•Superiorto the optic chiasm.
Location
•ACA.
•ACoA.Contents

33. Pericallosalcistern
•Above the corpus callosumand
•Between the cingulategyri.Location
•The pericallosalartery. Contents

34. Pericallosal artery aneurysm

35. Subarachnoid
hemorrhage

36. Quadrigeminal cistern
•Posterior to the quadrigeminal
plate of the midbrain
•Inferior to the spleniumof corpus
callosum&
•Superior to the cerebellum
•continuous with the
interpeduncular cistern anteriorly
through the ambient cisterns.
Location
•Vein of Galen .
•Pre-central V.
•P3 of PCA.
Contents

37. Quadrigeminal Cistern

38. Quadrigeminal Cistern

39. Vein of Galen aneurysm

40. Quadrigeminal cistern
epidermoid cyst

41. Suprasellar/ ChiasmaticCisterns
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 suprasellar
cistern that is anterior to the optic nerve.

42. Suprasellar/ ChiasmaticCisterns

43. Suprasellar/ ChiasmaticCisterns

44. Superior cerebellar cistern
•Between the tenotrium
cerebelliand superior
vermis.
Location
•Superior cerebellar
artery.
•Superior vermian
veins .
Contents

45. Vellum interpositumcistern
(double layered tela
choroidae)
•Superior to the roof of the third
ventricle.
•Inferior to the body of fornix.
•The anterior end of the vellum
interpositumis closed, posterior to the
interventricularforamen.
•The posterior end of the vellum
interpositumis open & continuous with
the quadrigeminalcistern.
Location
•Internal cerebral veins .Contents

46. Vellum interpositum cistern

47. Cavum viliinterpositi
Is ananatomic variationwhere there is a
dilatation of the normal cistern of thevelum
interpositum.

48. Lies behind the medulla and below the cerebellar
hemispheres.
Continuous with 4
th
ventricle through median aperture
of Magendie.
Its lateral part contains the vertebral artery and its
posterior inferior cerebellar branch.
CISTERNA MAGNA

49. Cisterna magna
Cerebellomedullarycistern

50. Cisterna Magna

51. Cisterna Magna

52. Mega cisterna magna
Mega
cisterna
magna
Enlarged posterior fossa secondary to an enlarged cisterna
magna. Normal vermis and fourth ventricle and no mass
effect on the cerebellum.

53. Vallecula cerebelli
•CSF cistern between
the cerebellartonsils.
•Connects the foramen
of Magendi& cisterna
magna.
Location
•PICA.Contents
Vallecula

54. CP angle cisterns
•Anterior to the CP angle.Location
•Superior CP angle cistern
•AICA.
•Cn7.
•Cn 8.
•Inferior CP angle cistern
•Cn9.
•Cn10.
Contents

56. Inferior CP angle arachnoid
cyst

57. Cruralcisterns
Location
•PCA.
•Superior cerebellarartery.
•Anterior choroidalartery.
•Basal vein of Rosenthal.
Contents
Between the
Cruscerebri
(cerebral
peduncles
Uncusof
temporallobe
Medially Laterally

59. Carotid cisterns
•Lateral to the sella,
•inferior the anterior clinoidprocess
&
•Superior to the cavernous sinus.
Location
•Internal carotid artery
•Origin of ACA, MCA, AchA& PCoA.
Contents

61. Sylviancisterns
•Between the carotid cistern &
sylvianfissure.
Location
•Middle cerebral artery.
•Superficial & deep sylvianveins.Contents

62. SylvianCistern

63. SylvianCistern

64. Ambient cisterns
•Ambient = surrounding.
•Extension of the quadrigeminal
cistern lateral to the midbrain.
Location
•P2 segment of PCA.
•SCA.
•AchA.
•Lateral mesencephalicV.
•Basal vein of Rosenthal .
•Cn4.
Contents

65. Ambient Cistern

66. Trochlear N.

68. Trochlear N. schwannoma

69. Retro-thalamic cisterns
wings of ambient cisterns
•Lateral extensions of the ambient
cisterns posterior to the thalamic
pulvinar.
Location
•Lateral posterior choroidalartery.Contents

71. Vellum interpositum
Retro-thalamic Cistern Retro-thalamic Cistern
Sup.cerebellar Cistern

72. Thank you