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DR/ Hytham Nafady
Cistern
• Widening of subarachnoid space created by separation of pia and arachnoid.
Dura
Pia
Arachnoid
adherent to the skull
adherent to the brain surface
covers only superficial surface of the brain
Cistern
• Widening of subarachnoid space created by separation of pia and arachnoid.
Subarachnoid hemorrhage
P
M
IPCH
SC
CM
VI
Q
PC
LT
P
M
IPCH
SC
CM
VI
Q
PC
LT
P
M
CH
CM
VI
PC
LT
Perimesencephalic cistern1. Interpeduncular C.2. Crural C.3. Ambient C.4. Quadrigeminal C.
Perimesencephalic cistern1. Interpeduncular C.2. Crural C.3. Ambient C.4. Quadrigeminal C.
Perimesencephalic cistern1. Interpeduncular C.2. Crural C.3. Ambient C.4. Quadrigeminal C.
Perimesencephalic cistern1. Interpeduncular C.2. Crural C.3. Ambient C.4. Quadrigeminal C.
Perimesencephalic cistern1. Interpeduncular C.2. Crural C.3. Ambient C.4. Quadrigeminal C.
CSF cisternsMedian 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
Medullary cisternpremedullary cistern
Medullary cistern
PICA
Cn12
VA
Pontine cistern pre-pontine cistern
Pontine cistern
Pontine cistern
Basilar AAnt. Pontomesencephalic V
Petrosal VSuperior petrosal sinus
Pontine cistern
Pontine cistern
AICA
BACn6 Cn6
BA
Pre-pontine arachnoid cyst
Interpeduncular cisternbasal cistern
Interpeduncular cistern
Interpeduncular cistern
Cn 3
Interpeduncular cistern
Interpeduncular cistern
Basal v.
Interpeduncular VDMCV Ponto-
mesencephalic V Basilar A.
Interpeduncular V
DMCV
Chiasmatic cisternSuprasellar cistern
Chiasmatic cisternSuprasellar cistern
Suprasellar arachnoid cyst
Liliequist membraneThe Liliequist membrane is the arachnoid
membrane separating the chiasmatic and interpeduncular cisterns.
Liliequist membrane
CH
P
IP
Third ventriculostomy
Third ventriculostomy
PNSAH• Peri-mesencephalic Non-aneurysmal Sub-Arachnoid Hemorrhage.• Pre-truncal Non-aneurysmal Sub-Arachnoid Hemorrhage.
• Brain stem = truncus cerebri.• Low pressure bleeding.• Source: perimesencephalic vein.
Lamina terminalis cistern
Pericallosal cistern
Pericallosal artery aneurysm
Subarachnoid hemorrhage
Quadrigeminal cisternvein of Galen cistern
Vein of Galen aneurysm
Precentral V Precentral VPrecentral V
Precentral V
Quadrigeminal cistern epidermoid cyst
Superior cerebellar cistern
Vellum interpositum cistern(double layered tela choroidae)
Embryologic Basis for the Development and Anatomy of the Cavum Veli Interpositi
Vellum interpositum cistern
Cavum vili interpositi
Cavum villi interpositi Cavum septum pellucidum & cavum vergae
Cisterna magna Cerebellomedullary cistern
Mega cisterna magna
Mega cisterna magna
Vallecula cerebelli
Vallecula
Dandy walker variant
CP angle cisterns
CP angle cistern
AICA
Superior CP angle cistern
AICA
AICAAICA
AICA
Inferior CP angle cistern
Cn 9/10
Cn 10
Cn 9
Inferior CP angle arachnoid cyst
Crural cisterns
Between the Crus cerebri (cerebral peduncles
Uncus of temporal lobe
Medially Laterally
AchA AchAAchA
SCAPCA
PCA
Carotid cisterns
Sylvian cisterns
Ambient cisterns
Trochlear N.
PCA
Basal vein of Rosenthal
Basal vein of Rosenthal
Basal vein of Rosenthal
Cn 4
epidermoid
Trochlear N. schwannoma
Retro-thalamic cisternswings of ambient cisterns
Vellum interpositum
Retro-thalamic Cistern
Retro-thalamic Cistern
Sup.cerebellar Cistern
Overview of CSF spaces
Overview of CSF spaces
Normal:All CSF spaces are visible neither effaced or dilated.
Overview of CSF spaces
Normal:All CSF spaces are visible neither effaced or dilated.
Atrophy:All CSF spaces are dilated.
Hydrocephalus:Ventricles dilated.Subarachnoid spaces effaced.
Edema:All CSF spaces are effaced.
Overview of CSF spaces
Normal:All CSF spaces are visible neither effaced or dilated.
Atrophy:All CSF spaces are dilated.
Overview of CSF spaces
Normal:All CSF spaces are visible neither effaced or dilated.
Atrophy:All CSF spaces are dilated.
Hydrocephalus:Ventricles dilated.Subarachnoid spaces effaced.
Overview of CSF spaces
Normal:All CSF spaces are visible neither effaced or dilated.
Atrophy:All CSF spaces are dilated.
Hydrocephalus:Ventricles dilated.Subarachnoid spaces effaced.
Edema:All CSF spaces are effaced.
Benign external hydrocephalus
3 years10 months
Benign external hydrocephalus
Benign external hydrocephalusbenign enlargement of subarachnoid spaces in infancy
Etiology:• Immature arachnoid granulations.C.P:• Macrocephaly.• Normal developmental milestones.
1. Widening of the bifrontal subarachnoid space and anterior interhemispheric fissure (>5mm).
2. Usually normal subaracnoid space posteriorly.3. No flattening of adjacent gyri.4. The anterior fontanelle is frequently enlarged.5. The ventricular system is within normal limits or slightly dilated.6. There are no pressure effects on the surrounding brain tissue
or cerebral atrophy.7. No blood products on MRI study.8. another key distinction between benign enlargement of the
subarachnoid spaces and a subdural fluid collection is that in the former the cortical veins will be adjacent to the inner table of the calvarium on MR and ultrasound; whereas in the latter the veins are displaced away from the inner table, as the arachnoid membrane and subarachnoid space are displaced.
Benign external hydrocephalus
Benign external hydrocephalus
External hydrocephalus vs subdural hematoma
Hydrocephalus versus atrophyFeatures that favor 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
Mid-sagittal findings of hydrocephalus
• Widening of the third ventricular recesses.
• Upward bowing of the corpus callosum.
• Decreased mammillo-pontine distance .
Periventricular leukomalacia
