Cisterns of brain
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All Cisterns of Brain, Descriptive
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Cisterns of brain
- 1. BRAIN CISTERNS Suresh Bishokarma, MCH ( Neurosurgery NINAS
- 2. INTRODUCTION • Microanatomy: Arachnoid membranes and the subarachnoid cisterns • Minimally invasive neurosurgery
- 4. Cisterns • Cisterns are openings in the subarachnoid space. • These spaces are filled with CSF.
- 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
- 21. CLINICAL IMPLICATION • ETV • RAISED ICP: DIPLOPIA, CN6
- 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.
- 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).
- 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
Editor's Notes
- An understanding of the microanatomy of the arachnoid membranes and the subarachnoid cisterns is of vital importance in modern neurosurgery, especially in minimally invasive neurosurgery.
- 3 layer system of membranes which envelops the central nervous system. Layers are: Dura mater Arachnoid mater Pia mater
- Cisterns are openings in the subarachnoid space of the brain created by a separation of the arachnoid and Pia mater.
- There are many cisterns in the brain, but the notable ones include:
- Lies behind the medulla and below the cerebellar hemispheres. Crescentic shaped Continuos with 4th ventricle through median aperture of Magendie. Its lateral part contains the vertebral artery and its posterior inferior cerebellar branch.
- 1. The vertebral artery and origin of posterior inferior cerebellar artery 2. The 9th, 10th, 11th and the 12th CNs. 3. The lateral medullary and post-olivary Veins 4. The choroid plexus.
- IMPACTED CISTERNA MAGNA WITHOUT SYRINX OR PLUS MINUS BASILAR IMPRESSION.
- Lies between the pons and the clivus. Receives CSF from lateral apertures of 4th ventricle (Luschka).
- The roof of the interpeduncular cistern is formed by the inferior surface of the diencephalon from the anterior edge of the mammillary bodies to the junction of the diencephalon and mesencephalon. Its posterior wall is formed by the cerebral peduncles, the posterior perforated substance, and the ventral surface of the upper portion of the pons. The interpeduncular fossa lies at the innermost depth of the cistern. The posterior perforated substance is the most posterior border of the cistern. The anterosuperior wall of the interpeduncular cistern is the diencephalic leaf of the Liliequist membrane, which separates the cistern from the chiasmatic cistern, the posterior communicating cisterns, or the carotid and posterior communicating cisterns. Its anteroinferior wall is the mesencephalic leaf of the Liliequist membrane, which separates the cistern from the dorsum sellae and clivus. Its lateral walls are formed by a pair of diencephalic–mesencephalic leaves of the Liliequist membrane, which separate the interpeduncular cistern from the oculomotor cisterns. The bottom of the interpeduncular cistern is situated at the midpoint or between the upper one third and lower two thirds of the BA. It is formed by the medial pontomesencephalic membrane and a pair of lateral pontomesencephalic Membranes. It separates the cistern from the prepontine cistern and the cerebellopontine cisterns.
- It is situated between the cerebral peduncles and the leaves of Liliequist’s membrane at the confluence of the supra- and infratentorial parts of the subarachnoid space The interpeduncular cistern straddles the anterior portion of the tentorial incisura . It occupies the interpeduncular fossa and is situated in the midline, across the anterior portion of the incisura of the tentorium. The cistern is surrounded by the cerebral peduncles, the posterior perforated substance, the pons, the diencephalons, and several arachnoid membranes.
- The interpeduncular cistern is encircled by the chiasmatic, posterior communicating, or carotid and posterior communicating cisterns, as well as by the oculomotor, crural, ambient, prepontine, and cerebellopontine cisterns. Ambient cistern via the narrow space between the cerebral peduncle and the posterior edge of the diencephalic–mesencephalic leaf of the Liliequist membrane. It communicates freely with the crural cisterns or is separated from them by sparse arachnoidal trabeculae. The interpeduncular cistern communicates with the posterior communicating cistern or the carotid and posterior communicating cisterns only through seams around the PCoAs, where the vessels penetrate the diencephalic leaf of the Liliequist membrane. The interpeduncular cistern communicates with the prepontine and cerebellopontine cisterns via the windows and foramina of the medial and lateral pontomesencephalic membranes. Because the diencephalic leaf and the diencephalic–mesencephalic leaves of the Liliequist membrane are always thick and intact, the interpeduncular cistern cannot communicate freely with the chiasmatic and oculomotor cisterns.
- 1. The bifurcation of the basilar artery; 2. Peduncular segments of the posterior cerebral arteries; 3. Peduncular segments of the superior cerebellar arteries; 4. Perforating branches of the posterior cerebral arteries, one meningeal branch, and the artery to the third cranial nerve; 5. Posterior communicating arteries that connect with the midpoint of the peduncular segments of the posterior cerebral arteries; 6. The basal vein of rosenthal; 7. The interpeduncular vein and posterior communicating vein; and 8. The third cranial nerve which is situated on each side in the lateral wall of the cistern and passes between the posterior cerebral and superior cerebellar arteries.
- lies posterior to quadrigeminal plate of the midbrain and between the splenium above and the vermis below. It is continuous with the interpeduncular cistern anteriorly through the ambient cisterns. Contains the great cerebral vein of Galen.
- 5. The third portion of the posterior cerebral Arteries. The two arteries approach each other and then continue posteriorly beneath the splenium corporis callosi to the apex of the isthmus gyri fornicati to divide into two Cortical branches, the calcarine and parietooccipital Branches.
- A. Anterior view. The arachnoid membrane has been removed to expose the following cisterns: olfactory, carotid, chiasmatic, ambient, crural, interpeduncular, prepontine, premedullary, cerebellopontine, and cerebellomedullary and the cisterna magna. The oculomotor nerves course in an arachnoidal intersection situated in the junction of the walls of the carotid, chiasmatic, prepontine, interpeduncular, and cerebellopontine cisterns. The medial carotid membrane separates the carotid and chiasmatic cisterns. The crural membrane separates the crural and ambient cisterns. The anterior pontine membrane separates the prepontine and cerebellopontine cisterns. The lateral pontomesencephalic membrane separates the ambient and cerebellopontine cisterns. The medial pontomedullary membrane separates the prepontine and premedullary cisterns, and the lateral pontomedullary membrane separates the cerebellopontine and cerebellomedullary cisterns. The interpeduncular cistern is situated between the diencephalic and mesencephalic leaves of Liliequist’s membrane. The bifurcation of the basilar artery is in the interpeduncular cistern. The carotid and posterior communicating arteries course within the carotid cisterns. The anterior choroidal artery arises in the carotid cistern and courses through the crural cistern. The optic nerves and chiasm and the stalk of the pituitary gland are situated in the chiasmatic cistern. The olfactory cisterns enclose the olfactory tracts. The SCAs arise at the junction of the interpeduncular and prepontine cisterns. The PCAs and trochlear nerves course through the ambient cisterns. The AICAs arise in the prepontine cistern. The premedullary cistern contains the hypoglossal nerves and vertebral arteries and the origin of the PICAs and anterior spinal arteries. The abducens, trigeminal, facial, and vestibulocochlear nerves and a segment of the SCA and AICA pass through the cerebellopontine cisterns. The cerebellomedullary cisterns contain the glossopharyngeal, vagus, and accessory nerves and a segment of the PICAs. The veins that course through the cisterns include the peduncular, transverse pontine, transverse medullary, lateral medullary, and median anterior pontomesencephalic veins and the veins of the pontomedullary sulcus, cerebellopontine fissure, and middle cerebellar peduncle. The veins in the cerebellopontine or cerebellomedullary cisterns join to form the superior petrosal veins. A., artery; A.C.A., anterior cerebral artery; Ant., anterior; Arach., arachnoid; Bas., basilar; Car., carotid; Cer., cerebellar; Cer. Med., cerebellomedullary; Cer. Pon., cerebellopontine; Chiasm., chiasmatic; Chor., choroid; Cist., cistern, cisterna; Comm., communicating; Fiss., fissure; Front., frontal; Interped., interpeduncular; Lat., lateral; Lilieq., Liliequist’s; M.C.A., middle cerebral artery; Med., medial, medullary; Memb., membrane; Mid., middle; N., nerve; Olf., olfactory; P.C.A., posterior cerebral artery; Ped., peduncular; Pet., petrosal; P.I.C.A., posteroinferior cerebellar artery; Pon., pontine; Pon. Med., pontomedullary; Pon. Mes., pontomesencephalic; Premed., premedullary; Prepon., prepontine; S.C.A., superior cerebellar artery; Sig., sigmoid; Sp., spinal; Sulc., sulcus; Temp., temporal; Tent., tentorium; Tr., trunk; Trans., transverse; V., vein; Vert., vertebral.