Mega cisterna magna 

refers to a normal variant characterised by a truly focal enlargement

of the CSF-filled subarachnoid space in the inferior and posterior portions of the posterior cranial
fossa. It is an incidental finding on neuroimaging, and no imaging follow up is necessary. 

Epidemiology
A mega cisterna magna is thought to occur in ~1% of all brains imaged postnatally. 

Associations
Especially if noted antenatally, a mega cisterna magna has been associated with:

 infarction
 inflammation/infection: particularly cytomegalovirus
 chromosomal abnormalities: especially trisomy 18

However, when a mega cisterna magna occurs as an isolated finding with normal ventricles the
prognosis is good.

Clinical presentation
There are no specific symptoms related to this condition. 

Pathology
Some authors have proposed that mega cisterna magna is a result of a delayed Blake pouch
fenestration; when fenestration does not occur, it results in a Blake pouch cyst 6. 

Radiographic features
Ultrasound
In antenates, mega cisterna magna refers to an enlarged retrocerebellar CSF space:

 usually >10 mm in antenatal imaging (some consider up to 12 mm within normal limits)

 septa may be seen within a mega cisterna magna, which are thought to be Blake pouch
vestigial remnants 3
 vermis should be closely evaluated to exclude Dandy-Walker continuum abnormalities

CT/MRI

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Typically seen as prominent retrocerebellar cerebrospinal fluid (CSF) appearing space with a
normal vermis, normal 4th ventricle, and normal cerebellar hemispheres. An enlarged cisterna
magna usually measures >10 mm on midsagittal images. An enlarged posterior fossa can
sometimes be present 6. 

History and etymology

The term was first coined by Gonsette et al in 1962, in patients with cerebellar atrophy. 

Differential diagnosis
Mega cisterna magna needs to be distinguished from other causes of an enlarged retrocerebellar
CSF space:

 arachnoid cyst
 epidermoid cyst: often shows a heterogeneous/dirty signal on FLAIR and restricted
diffusion
 cerebellar atrophy / cerebellar hypoplasia
 Dandy-Walker malformation: vermis not intact
 Blake pouch cyst: usually a hydrocephalus is present 
 pilocytic astrocytoma: if very posterior and predominantly cystic

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