The document summarizes the anatomy and contents of various brain cisterns. It describes the locations and structures contained within several major cisterns, including: 1) The cisterna magna, which contains the cerebellar medullary veins and lower cranial nerves. 2) The interpeduncular cistern, which is divided by membranes and contains arteries including the basilar artery and branches of the posterior cerebral artery. 3) The ambient cistern, which surrounds the midbrain and contains the posterior cerebral artery and veins. 4) The suprasellar/chiasmatic cistern, located above the pituitary fossa, containing the optic nerves and arteries

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
4th 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
4th vent
Communicate with interpeduncular cistern 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 anteromedian pontine
Veins.

14. Interpeduncular Cistern
TARIN SPACE
INNERMOST DEPTH OF THE CISTERN

15. 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.

16. 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.

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 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

19. Interpeduncular Cistern

20. Interpeduncular Cistern

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

22. Quadrigeminal Cistern

23. QUADRIGEMINAL CISTERN

24. Quadrigeminal Cistern

25. 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;

26. 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.

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 / 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.

31. Suprasellar / Chiasmatic Cisterns

32. Suprasellar / Chiasmatic Cisterns

33. 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.

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. Sylvian Cistern
• This is the area of sylvian fissure.
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's artery
4. The hypothalamic arteries
5. The origin of the fronto orbital arteries;
6. The venous system of the lamina terminalis.

41. 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).

42. PERICALLOSAL CISTERN

43. Pericallosal Cistern

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

45. 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

47. 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.

50. Thank You
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