cisterns of brain
TRANSCRIPT
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BRAIN
CISTERNS
Suresh Bishokarma, MCH ( Neurosurgery
NINAS
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INTRODUCTION
• Microanatomy: Arachnoid membranes and the subarachnoid cisterns
• Minimally invasive neurosurgery
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Brain Meninges
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Cisterns
• Cisterns are openings in the subarachnoid space.
• These spaces are filled with CSF.
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Brain Cisterns
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Cisterna Magna
CRESCENTIC
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CISTERNA MAGNA
4th vent
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Content: Cisterna cerebellomedullarisventrolateralis
1. Vessels
2. Lower CNs.
3. The lateral medullary and post-olivary
Veins
4. The choroid plexus.
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CLINICAL IMPLICATION
• PICA CLIPPING
• FORAMEN MAGNUM DECOMPRESSION: RSRM, IMPACTED CISTERNA MAGNA.
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Pontine cistern
4th vent
Communicate with interpeduncular cistern and cisterna magna.
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Pontine Cisterns
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Pontine Cistern
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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.
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Interpeduncular Cistern
TARIN SPACE
INNERMOST DEPTH OF THE CISTERN
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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.
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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.
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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.
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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
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Interpeduncular Cistern
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Interpeduncular Cistern
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CLINICAL IMPLICATION
• ETV
• RAISED ICP: DIPLOPIA, CN6
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Quadrigeminal Cistern
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QUADRIGEMINAL CISTERN
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Quadrigeminal Cistern
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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;
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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.
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Ambient Cistern
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Ambient Cistern
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CONTENTS
1. The basal vein; and
2. The posterior cerebral artery.
3. The superior cerebellar artery; and
4. The fourth nerve.
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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.
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Suprasellar / Chiasmatic Cisterns
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Suprasellar / Chiasmatic Cisterns
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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.
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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.
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Sylvian Cistern
• This is the area of sylvian fissure.
SYLVIAN FISSURE
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SYLVIAN CISTERN
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SYLVIAN CISTERN
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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.
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CISTERNA LAMINA TERMINALIS
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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.
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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).
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PERICALLOSAL CISTERN
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Pericallosal Cistern
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Cisterna Cruralis
• The cisterna cruralis contains
• 1. the anterior choroidal artery;
• 2. the medial posterior choroidal artery;
• and
• 3. the basal vein of Rosenthal.
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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
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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.
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• Cisterns exposed through a unilateral suboccipital craniectomy.
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Thank You