Cisterns of brain

All Cisterns of Brain, Descriptive

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. Brain Cisterns Cisterna magna ( cerebellomedullary ). Cisterna pontis ( pontine cistern). Interpeduncular cistern. Quadrigeminal cistern (superior cistern). Ambient cistern. Cistern of the velum interpositum . Suprasellar / Chiasmatic cistern. Cistern of lamina terminalis . Supracallosal cistern. Sylvian cister others

7. Cisterna Magna CRESCENTIC

8. CISTERNA MAGNA 4 th vent

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

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

11. Pontine cistern 4 th vent Communicate with interpeduncular cistern and cisterna magna.

12. Pontine Cisterns

13. Pontine Cistern

14. 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.

15. Interpeduncular Cistern TARIN SPACE INNERMOST DEPTH OF THE CISTERN

16. Interpeduncular Cistern Cone shaped Lies between the cerebral peduncles and liliquist’s membrane. Confluent area of the supra- and infratentorial subarachnoid space Continuous below with the pontine cistern, laterally with the ambient cisterns, superiorly with the suprasellar cistern.

17. 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.

18. DIVISION OF IP CISTERN T he 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.

19. Boundaries P osterior wall : posterior perforated substance. Superiorly: posterior edge of the mamillary bodies. Inferiorly: the junction of midbrain and pons. R ostrally and caudally by Liliequist’s membrane.

20. 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

21. Interpeduncular Cistern

22. Interpeduncular Cistern

23. CLINICAL IMPLICATION ETV RAISED ICP: DIPLOPIA, CN6

24. Quadrigeminal Cistern

25. QUADRIGEMINAL CISTERN

26. Quadrigeminal Cistern

27. 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;

28. 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.

29. Ambient Cistern

30. Ambient Cistern

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

32. 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 suprasellar cistern that is anterior to the optic nerve.

33. Suprasellar / Chiasmatic Cisterns

34. Suprasellar / Chiasmatic Cisterns

35. 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.

36. 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.

37. Sylvian Cistern This is the area of sylvian fissure. SYLVIAN FISSURE

38. SYLVIAN CISTERN

39. SYLVIAN CISTERN

40. 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 .

41. CISTERNA LAMINA TERMINALIS

42. 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 .

43. 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 ).

44. PERICALLOSAL CISTERN

45. Pericallosal Cistern

46. Cisterna Cruralis The cisterna cruralis contains 1. the anterior choroidal artery ; 2. the medial posterior choroidal artery; and 3. the basal vein of Rosenthal.

47. 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

48. 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.

49. Cisterns exposed through a unilateral suboccipital craniectomy .

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