basalcisterns of brain

basal cisterns of brain

1. BRAIN
CISTERNS
Suresh Bishokarma, MCH ( Neurosurgery
NINAS

2. INTRODUCTION
•Microanatomy: Arachnoid membranes and
the subarachnoid cisterns
•Minimally invasive neurosurgery

3. Brain Meninges

4. Cisterns
•Cisterns are openings in the subarachnoid
space.
•These spaces are filled with CSF.

5. Brain Cisterns

6. Cisterna Magna
CRESCENTIC

7. CISTERNA MAGNA
4
th
vent

8. Content: Cisterna cerebellomedullaris
ventrolateralis
1. Vessels
2. Lower CNs.
3. The lateral medullary and post-olivary
Veins
4. The choroid plexus.

9. CLINICAL IMPLICATION
•PICA CLIPPING
•FORAMEN MAGNUM DECOMPRESSION:
RSRM, IMPACTED CISTERNA MAGNA.

10. Pontine cistern
4
th
vent
Communicate with interpeduncularcistern and cisterna magna.

11. Pontine Cisterns

12. Pontine Cistern

13. 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 anteromedianpontine
Veins.

14. InterpeduncularCistern
TARIN SPACE
INNERMOST DEPTH OF THE CISTERN

15. InterpeduncularCistern
•Cone shaped
•Lies between the cerebral peduncles and
liliquist’smembrane.
•Confluent area of the supra-and infratentorial
subarachnoid space
•Continuous below with the pontinecistern,
laterally with the ambient cisterns, superiorly
with the suprasellarcistern.

16. Communication With Adjoining Cisterns
•Ambient cistern : space between the cerebral
peduncle and Liliequistmembrane.
•Posterior communicating cistern or the carotid
cisterns : seams around the PCoAsthat penetrate
Liliequistmembrane.
•Prepontineand cerebellopontinecisterns : Foramina
of subarachnoid membranes.

17. DIVISION OF IP CISTERN
•The BA bifurcation membrane divides the cistern
into two portions: deep and superficial.
•The superficial portion adjoins the oculomotor
cisterns and the deep portion communicates with
the ambient cisterns.
•The deep portion : subdivided by the posterior
perforated membrane: anterior and posterior
areas.

18. CONTENTS
1. The bifurcation of the basilar arteryand origin of AICA
2. PCA
3. SCA
4. Posterior cerebral arteries, branches: one meningeal branch,
and the artery to CN3.
5. The PCoAsjoin the PCAs in the deep portion of the
interpeduncularcistern
6. The basal vein of rosenthal;
7. The interpeduncularvein and posterior communicating vein;
8. CN3 in lateral wall : Pass between PCA and SCA
9. CN6
Yasargilet al 1976

19. InterpeduncularCistern

20. InterpeduncularCistern

21. CLINICAL IMPLICATION
•ETV
•RAISED ICP: DIPLOPIA, CN6

22. QuadrigeminalCistern

23. QUADRIGEMINAL CISTERN

24. QuadrigeminalCistern

25. The quadrigeminalcistern contains
1. The vein of galen;
2. The posterior pericallosalarteries;
3. The third portion of the superior cerebellar
Arteries;
4. Perforating branches of the posterior Cerebral
and the superior cerebellar arteries;

26. Ambient Cistern
•Cistern that extend around both sides of
midbrain
•Anteriorly: Interpeduncularcistern
•Posteriorly: quadrigeminalcistern.
•Posterior cerebral artery and the basal vein lie
in the anterior part of each ambient cistern.

27. Ambient Cistern

28. Ambient Cistern

29. CONTENTS
1. The basal vein; and
2. The posterior cerebral artery.
3. The superior cerebellar artery; and
4. The fourth nerve.

30. Suprasellar/ ChiasmaticCisterns
•Suprasellarcistern lies above the pituitary
fossaand is continuous posteriorlywith the
interpeduncularcistern and laterally with the
sylviancistern.
•It contains the anterior part of the circle of
Willis and the optic nerve as it passes to the
chiasm.
•Chiasmaticcistern is the part of suprasellar
cistern that is anterior to the optic nerve.

31. Suprasellar/ ChiasmaticCisterns

32. Suprasellar/ ChiasmaticCisterns

33. The cisterna chiasmatiscontains
1. The anterior aspect of the optic chiasma
And optic nerves;
2. The hypophysealstalk;
3. The origin of the anterior cerebral
Arteries; and
4. The anterior communicating vein.

34. 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.

35. SylvianCistern
•This is the area of sylvianfissure.
SYLVIAN FISSURE

36. SYLVIAN CISTERN

37. SYLVIAN CISTERN

38. 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.

39. CISTERNA LAMINA TERMINALIS

40. CONTENTS
1. Anterior cerebral arteries; the A1 and
proximal part of the A-2 segment
2. Acomm
3. Heubner'sartery
4. The hypothalamic arteries
5. The origin of the frontoorbital arteries;
6. The venous system of the lamina terminalis.

41. PERICALLOSAL CISTERN
•The cistern of lamina terminalisis the superior
extension of suprasellarand chiasmaticcisterns
that extend to the superior surface of corpus
callosumas the pericallosal(supracallosal)
cistern.
•Pericallosalcistern is continuous posteriorlywith
the quadrigeminalcistern.
•It contains branches of the anterior cerebral
artery(A4).

42. PERICALLOSAL CISTERN

43. PericallosalCistern

44. Cisterna Cruralis
•The cisterna cruraliscontains
•1. the anterior choroidalartery;
•2. the medial posterior choroidalartery;
•and
•3. the basal vein of Rosenthal.

45. Cisterna Pontocerebellaris
•The cisterna pontocerebellariscontains
•1. the seventh and eighth nerves;
•2. the anterior inferior cerebellar artery;
•3. the lateral pontineveins; and
•4. the fifth nerve and the petrosalvein

47. The cranial nerves are designated by Roman numerals. 1 = Olfactory cistern; 2 = Callosalcistern; 3 =
Chiasmaticcistern with I and II nerves;4 = Carotid cistern; 5 = Sylviancistern; 6 = Cruralcistern; 7 =
Interpeduncularcisterns with III nerves; 8 = Ambient cisterns with IV nerves; 9 = Prepontinecistern
with VI nerves; 10 = Cerebellopontinecistern on each side with VII and VIII nerves; 11 = Lateral
cerebellomedullarycistern 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.

49. •Cisterns exposed through a unilateral suboccipitalcraniectomy.

50. Thank You
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