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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
IP
CH
SC
CM
VI
Q
PC
LT
P
M
IP
CH
SC
CM
VI
Q
PC
LT
Liliequist classification
of C.S.F cisterns
Ventral
Cisterns
Median
unpaired
Medullary
Pontine
Inter-
peduncular
Chiasmatic
Paramedian
paired
CP angle
Crural
Carotid
Sylvian
Dorsal
Cisterns
Median
unpaired
Peri-callosal
Quadrigemial
Supra-
cerebellar
Paramedian
paired
Ambient
Retro-
thalamic
Communicating
cisterns
Cisterna
magna
Lamina
terminalis
General
subarachnoid
space over the
convexities
P
M
CH
CM
VI
PC
LT
CSF cisterns
Supra-tentorial
cisterns
Infra-tentoiral
cisterns
Supratentorial cisterns
Anterior
Carotid
Chiasmatic
Lamina
terminalis
Olfactory
Sylvian
Lateral
Crural
Ambient
Posterior
Quadrigeminal
Vellum
interpositum
Superior
Pericallosal
Hemispheric
Infratentorial cisterns
Anterior
Inter-peduncular
Pre-pontine
Premedullary
Lateral
Ambient
Superior CPA
Inferior CPA
Posterior
Cisterna magna
Superior
cerbellar
Superior
Vermian
Hemispheric
Perimesencephalic cistern
1. Interpeduncular C.
2. Crural C.
3. Ambient C.
4. Quadrigeminal C.
Perimesencephalic cistern
1. Interpeduncular C.
2. Crural C.
3. Ambient C.
4. Quadrigeminal C.
Perimesencephalic cistern
1. Interpeduncular C.
2. Crural C.
3. Ambient C.
4. Quadrigeminal C.
Perimesencephalic cistern
1. Interpeduncular C.
2. Crural C.
3. Ambient C.
4. Quadrigeminal C.
Perimesencephalic cistern
1. Interpeduncular C.
2. Crural C.
3. Ambient C.
4. Quadrigeminal C.
Pentagonal
cistern
Lamina terminalis
cistern
Sylvian
cistern
Inter-peduncular
cistern
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
Medullary cistern
premedullary cistern
Anterior to the medulla.
Location

Vertebral arteries.
PICA.
Anterior spinal artery.
Posterior spinal arteries.
Pre-medullary V.
Cn 12.
Contents
Medullary cistern
PICA
Cn12
VA
Pontine cistern
pre-pontine cistern
Anterior to the pons.
Location

Basilar A.
AICA.
Ant. Pontomesencephalic V.
Cn 5.
Cn 6.
Contents
Pontine cistern
Pontine cistern
Basilar A
Ant. Pontomesencephalic V
Petrosal V
Superior petrosal sinus
Pontine cistern
Pontine cistern
AICA
BA
Cn6 Cn6
BA
Pre-pontine arachnoid cyst
Interpeduncular cistern
basal cistern
Between the cerebral peduncles.
Location

Basilar tip.
SCA.
PCA.
Interpeduncular V.
Cn3.
Contents
Interpeduncular cistern
Interpeduncular cistern
Cn 3
Interpeduncular
cistern
Interpeduncular cistern

Basal v.
Interpeduncular V
DMCV
Ponto-
mesencephalic V
Basilar A.
Interpeduncular V
DMCV
Chiasmatic cistern
Suprasellar cistern
Above the sella.
Location

Optic chiasm.
Pituitary
infundibulum
Contents
Chiasmatic cistern
Suprasellar cistern
Above the sella.
Location

Optic chiasm.
Pituitary
infundibulum
Contents
Suprasellar arachnoid cyst
Liliequist membrane
The Liliequist membrane is the arachnoid
membrane separating the chiasmatic and
interpeduncular cisterns.
Dorsum sellae.
Lower
attachment
Mamillary body.
Upper
attachment
Arachnoid sheath surrounding the
oculomotor nerve.
Lateral
attachment
Liliequist membrane
Separates the
interpeduncular cistern from
the chiasmatic cistern.
Diencephalic
segment:
Separates the
interpeduncular cistern from
the prepontine cistern.
Mesencephalic
segment:
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
Anterior to the lamina terminalis,
Inferior to the rostrum of corpus callosum &
Superior to the optic chiasm.
Location
ACA.
ACoA.
Contents

Pericallosal cistern
Above the corpus callosum and
Between the cingulate gyri.
Location

The pericallosal artery.
Contents
Pericallosal artery aneurysm
Subarachnoid
hemorrhage
Quadrigeminal cistern
vein of Galen cistern
Posterior to the
quadrigeminal plate,
Inferior to the splenium
of corpus callosum &
Superior to the
cerebellum
Location

Vein of Galen .
Precentral V.
P3 of PCA.
Contents
Vein of Galen aneurysm

Precentral V
Precentral V Precentral V

Precentral V
Quadrigeminal cistern
epidermoid cyst
Superior cerebellar cistern
Between the tenotrium
cerebelli and superior
vermis.
Location

Superior cerebellar artery.
Superior vermian veins .

Contents

Vellum interpositum cistern
(double layered tela choroidae)
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 & continuous with
the quadrigeminal cistern.
Location

Internal cerebral veins .

Contents
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

CSF cistern between
the cerebellar
tonsils.
Connects the
foramen of Magendi
& cisterna magna.
Location

PICA.

Contents
Vallecula
Dandy walker variant
CP angle cisterns
Anterior to the CP angle.
Location
Superior CP angle cistern
AICA.
Cn 7.
Cn 8.
Inferior CP angle cistern
(lateral cerebello-medullary cistern):
Cn 9.
Cn 10.
Contents
CP angle cistern
AICA
Superior CP angle cistern
AICA
AICA
AICA
AICA
Inferior CP angle cistern
Cn
9/10
Cn 10
Cn 9
Inferior CP angle arachnoid cyst



Crural cisterns

Location
P2 segment of PCA.
Superior cerebellar artery.
Anterior choroidal artery.
Basal vein of Rosenthal.
Contents
Between the
Crus cerebri
(cerebral
peduncles
Uncus of
temporal lobe
Medially Laterally
AchA AchA
AchA
SCA
PCA
PCA
Carotid cisterns

Lateral to the sella,
inferior the anterior clinoid process &
Superior to the cavernous sinus.
Location

Internal carotid artery
Origin of ACA, MCA, AchA & PCoA.
Contents

Sylvian cisterns

Between the carotid cistern & sylvian
fissure.
Location

Middle cerebral artery.
Superficial & deep sylvian veins.
Contents
Ambient cisterns

Ambient = surrounding.
Extension of the quadrigeminal cistern
lateral to the midbrain.
Location
P2 segment of PCA.
SCA.
AchA.
Lateral mesencephalic V.
Basal vein of Rosenthal .
Cn 4.
Contents
Trochlear N.


PCA

Basal vein of Rosenthal

Basal vein of Rosenthal

Basal vein of Rosenthal
Cn 4
epidermoid
Trochlear N. schwannoma
Retro-thalamic cisterns
wings of ambient cisterns
Lateral extensions of the ambient
cisterns posterior to the thalamic
pulvinar.
Location
Lateral posterior choroidal artery.
Contents
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 years 10 months
Benign external hydrocephalus
Benign external hydrocephalus
benign 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 atrophy
Features 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