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Similar to Cisterns of brain and its contents along with its classification and approach to different form of lesion like tumour , aneurysm and neuronal disease.
Similar to Cisterns of brain and its contents along with its classification and approach to different form of lesion like tumour , aneurysm and neuronal disease. (20)
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Cisterns of brain and its contents along with its classification and approach to different form of lesion like tumour , aneurysm and neuronal disease.
- 1. Cisterns of brain Dr.Rajeev Bhandari
- 2. History • In 1920 Ayer Suboccipital punture or cisternal puncture . • First procedure in humans to collect a sample of CSF for analysis and to relieve increased ICP • In 1934, Walter dandy- lateral suboccipital craniectomy for trigeminal neuralgia-draining the cistern • In 1976 , Peter Janetta popularized the MVD procedure for trigeminal neuralgia.
- 3. Introduction • The subarachnoid spaces appear on the 32nd day at the ventral aspect of the rhombencephalon, then extend caudally and dorsally • The fourth ventricle is not yet open and CSF circulation is only effective on the 41st day. • The three meningeal layers differentiate at the third month of intrauterine life.
- 4. Introduction Numerous trabeculae, septa, and membranes cross the space between the pia mater and the outer arachnoid membrane divide the subarachnoid space -cisterns. All of the cranial nerves and major intracranial arteries and veins pass through the cisterns. The cisterns provide a natural pathway through which most operations for intracranial aneurysms, extra-axial brain tumors, and disorders of the cranial nerves. Some cisterns have sheet-like membranes, whereas others have indistinct porous trabeculated walls with openings of various sizes.
- 5. Widening of subarachnoid space created by separation of pia and arachnoid. Dura -adherent to the skull Pia-adherent to the brain surface Arachnoid-covers only superficial surface of the brain
- 6. CSF Cisterns Median un-paired Cisterns Para-median paired cisterns 1. Premedullary 12. Inferior CP angle 2. Prepontine 13. Superior CP angle 3. Interpeduncular 14. Crural 4. Chiasmatic 15. Ambient 5. Lamina terminalis 16. Carotid 6. Pericallosal 17. Sylvian 7. Quadrigeminal 8. Vellum interpositum 9. Superior Cerebellar 10. Cisterna Magna 11. Vallecula
- 7. CSF Cisterns
- 9. Liliequist Classification of CSF Cisterns
- 13. Perimesencephalic Cistern Interpeduncular C Crural C Quadrigeminal C Ambient C
- 16. Medullary Cistern Location Anterior to the medulla Contents Vertebral arteries PICA Anterior Spinal artery Pre-medullary V. CN-12
- 17. Pontine Cistern Location Anterior to the pons Contents Basilar Artery AICA Ant. Ponto-mesencephalic V. CN- 5,6
- 18. Pontine Cistern
- 20. Interpeduncular Cistern Basal Cistern Location Between the cerbral Peduncles Contents Basilar tip SCA PCA Interpenducular V. CN-3
- 22. Chiasmatic Cistern Suprasellar Cistern Location Above the sella Contents Optic Chiasma Pituitary infundibulum Suprasellar cyst
- 23. Liliequist Membrane The Liliequist membrane is the arachnoid membrane separating the Chiasmatic and interpeduncular Cisterns. Lower Attachment Dorsum Sellae Upper Attachment Mamillary body Lateral Attachment Arachnoid Sheath Surrounding the occulomotor nerve
- 24. Liliequist membrane Diencephalic Segment Separates the interpeduncular cistern from the chiasmatic cistern Mesencephalic Segment Separates the interpeduncular cistern from the prepontine cistern
- 26. PNSAH-Perimesencephalic/Pre-truncal Non-aneurysmal SAH Brain stem= Truncus Cerebri Low pressure bleeding Source: perimesencephalic vein
- 27. Lamina terminalis cistern Location Anterior to the lamina terminalis Inferior to the rostrum of corpus callosum and Superior to the optic chiasm. Contents ACA ACOA
- 28. Pericallosal Cistern Location Above the corpus callosum Between the cingulate gyri Contents The pericallosal artery
- 30. Quadrigeminal Cistern vein of Galen cistern Location Posterior to the quadrigeminal plate Inferior to the splenium of corpus callosum and Superior to the cerebellum Contents Vein of Galen Precentral V. P3 of PCA aneurysm
- 32. Superior Cerebellar Cistern Location Between the tentorium cerebelli and superior vermis Contents Superior cerebellar artery Superior vermian veins Quadrigeminal Cistern
- 33. Vellum interpositum Cistern (Double layered tela choroidae) Location Superior to the roof of the third ventricle Inferior to the body of fornix The anterior end of the vellum interpositum is closed , posterior to the interventricular foramen The posterior end of the vellum interpositum is open and continous with the quadrigeminal cistern Contents Internal cerebral veins
- 34. Cavum vili interpositi Cavum septum pellucidum and cavum vergae Cavum villi interpositi
- 35. Cisterna magna
- 36. Vellecula Cerebelli Location CSF cistern between the cerebellar tonsils Connects the foramen of Megendi and cisterna magna Contents PICA
- 37. CP angle cisterns Location Anterior to the CP angle Contents Superior CP angle cistern AICA Cn 7,Cn 8 Inferior CP angle cistern Lateral cerebello-medullar cistern Cn 9,Cn 10
- 39. Crural cisterns Location Between the Crus cerebri (cerebral peduncles - uncus of temporal lobe Contents P2 segment of PCA Superior cerebellar artery Anterior choroidal artery Basal vein of Rosenthal
- 41. Carotid Cisterns Location Lateral to the sella Inferior the anterior clinoid process and Superior to the cavernous sinus Contents Internal carotid artery Origin of ACA, MCA, AchA & PCoA
- 42. Sylvian Cisterns Location Between the carotid cistern and sylvian fissure Contents Middle cerebral artery Superficial and deep sylvian veins
- 43. Ambient Cisterns Locations Ambient= surrounding Extension of the quadrigeminal cistern –lateral to the midbrain Contents P2 segment of PCA SCA AchA Lateral mesencephalic V. Basal vein of Rosenthal Cn.4 Cn-4
- 46. Retro-Thalamic Cisterns-wings of ambient cisterns Location Lateral extensions of the ambient cisterns posterior to the thalamic pulvinar Contents Lateral posterior choroidal artery
- 47. Overview of CSF Spaces Normal: All CSF spaces are visible Neither effeaced or dialated Atrophy All CSF spaces are dilated Hydrocephalus Ventricles dilated Subarachnoid spaces effeaced Edema All CSF spaces are effaced
- 48. Hypertrophy vs Atrophy Features that favour hydrocephalus Dilatation of the temporal horns Peri-ventricular interstitial oedema Intra-ventricular flow void from CSF movement on MR Widening of the third ventricular recesses: mid sagittal plane Upward bowing of the corpus callosum- mid sagittal plane Decreased mammillo-pontine distance: mid sagittal Plane
- 49. • Thank you