Cerebral Cisterns

This web page presents the anatomy of cisterns and subarachnoid spaces by means of MRI.

Prepontine cistern

Premedullary cistern

Cerebellopontine cistern

Cisterna magna

Superior cerebellar cistern

Interpeduncular cistern

Ambient cistern

Quadrigeminal cistern

Suprasellar cistern

What Are Cerebral Cisterns 

Cisterns, commonly known as subarachnoid cisterns, are enlarged pockets of cerebrospinal fluid located in the subarachnoid spaces in the brain(1). Cerebrospinal fluid (CSF) refers to the clear liquid surrounding the brain and spinal cord.

Aside from cisterns, the subarachnoid spaces contain CSF and major blood vessels(2). This fluid is located between the arachnoid, one of the brain and spinal cord’s protective membranes, and pia mater, a fibrous tissue that allows blood vessels to nourish the brain(3).

These cisterns are formed due to the pia mater’s firm adherence to the spinal cord and brain surface and its loose attachment to the arachnoid mater(4).

Even though these naturally enlarged CSF-filled cisterns are described as distinct compartments, they are only separated by a porous wall with multiple openings(5). These cisterns transport intracranial vessels with the cranial nerves (nerves at the bottom of the brain)(6).

Some of the significant cisterns include(7)

  • Cistern of the lamina terminalis 
  • Sylvian cistern
  • Suprasellar cistern
  • Interpunducular cistern
  • Pontine cistern
  • Cerebellopontine cistern
  • Cerebellomedullary cistern
  • Lumbar cistern

Cistern of the Lamina Terminalis

This tent-shaped cistern is located between the cerebrum’s frontal lobes(8). The cistern is where the anterior cerebral artery and the anterior communicating artery travel(9).

A study suggested that the constant shape of the cistern of lamina terminalis may contribute to the prediction of the direction of aneurysm hemorrhage of the anterior communicating artery(10)

Moreover, this cistern can help identify the fibrous, vascular, and neural contents of the anterior communicating artery(11).

Sylvian Cistern

The Sylvian cistern, which is known as the insular cistern, is located between the temporal (lower lobe of the cortex) and frontal lobes (control essential human cognitive functions)(12). This cistern contains some arteries, including the middle cerebral artery (terminal branch of the internal carotid artery)(13).

Suprasellar Cistern

Suprasellar or chiasmatic cistern is located under the hypothalamus (the portion of the brain that connects the nervous and endocrine system through the pituitary gland) and above the sella turcica (the depression seen in the sphenoid bone of the human skull)(14).

This cistern contains the pituitary stalk and the X-shaped structure formed by the crossing of two optic nerves (optic chiasm)(15).

Interpenducular Cistern 

The interpeduncular cistern is located between the cerebral peduncles (connects the remainder of the brain stem to the brain’s thalamus)(16). This cistern is known to eminently communicate with the chiasmatic cistern and abjectly communicate with the pontine cistern(17).

Pontine Cistern

The pontine cistern contains the basilar artery (carries oxygenated blood), abducens nerve (controls the movement of the lateral rectus muscle), and the beginning of the superior cerebellar artery (a major brand of the basilar artery)(18).

Cerebellopontine Cistern 

This relatively small cerebellopontine cistern is located between the cerebellum (primary structure of the hindbrain) and the pons (part of the brain stem)(19)

This cistern contains the posterior inferior cerebellar artery, facial nerves (supply muscles with facial expressions), trigeminal nerves (relay sensations from the face), and vestibulocochlear nerves (for balance and hearing)(20).

Cerebellomedullary Cistern

The cerebellomedullary cistern is the largest subarachnoid cistern located between the cerebellum and the medulla oblongata (responsible for involuntary functions)(21). It receives cerebrospinal fluid through the median and lateral apertures from the fourth ventricle(22).

Lumbar Cistern

The lumbar cistern is not seen in the skull. Instead, it is located within the spinal canal(23). It contains the cauda equina (responsible for motor and sensory innervations) and the filum terminale (anchors the spinal cord to the sacrum)(24).

Clinical Relevance of Cerebral Cisterns

The subarachnoid cisterns are significant in precluding injuries to the neurovascular structures during neurosurgical procedures(25)

A study used computed tomography (CT) to evaluate subarachnoid spaces and cisterns in teenagers and children. The CT examination images showed linear indices that can be calculated to identify the typical subarachnoid spaces’ sizes within the specific age group(26).

Another study used cranial ultrasound in assessing the role of enlarged subarachnoid space (ESS) in preterm infants. The cranial ultrasound results showed that the ESS is potentially associated with possible neurodevelopmental delays among preterm infants(27)

Functional and structural neuroimaging play an essential role in determining the cerebrospinal fluid’s hydrodynamics(28). The CSF flow and CSF spaces are associated with diseases such as hydrocephalus (fluid buildup in the ventricles of the brain)(29).

Using magnetic resonance imaging (MRI) sequences, high-resolution anatomical and CSF flow details are provided to diagnose hydrocephalus types and determine the adequate treatment to use for this condition(30).

31 sources

  1. Harnsberger HR, Osborn AG, Ross JS, Moore KR, Salzman KL, Carrasco CR, Halmiton BE, Davidson HC, Wiggins RH. Diagnostic and Surgical Imaging Anatomy: Brain, Head and Neck, Spine. 3rd ed. Salt Lake City, Utah. Amirsys. 2007.
  2. Shafique S, Rayi A. Anatomy, Head and Neck, Subarachnoid Space. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557521/
  3. Ibid.
  4. Kayalioglu, G., (2009), Chapter 3 – The Vertebral Column and Spinal Meninges, The Spinal Cord, retrieved from https://www.sciencedirect.com/science/article/pii/B9780123742476500079
  5. Shafique, S., Op. Cit.
  6. Shahid, S., (August 2020), Subarachnoid cisterns, retrieved from https://www.kenhub.com/en/library/anatomy/cisterns
  7. Shafique, S., Op. Cit.
  8. Ibid.
  9. IMAIOS Anatomy, (n.d.), Cistern of lamina terminalis – Cisterna laminae terminalis, retrieved from https://www.imaios.com/en/e-Anatomy/Anatomical-Parts/Cistern-of-lamina-terminalis#:~:text=The%20cistern%20of%20lamina%20terminalis,frontal%20lobes%20of%20the%20cerebrum.&text=The%20anterior%20cerebral%20artery%20and,artery%20travel%20within%20this%20cistern.
  10. Ibid.
  11. Wang SS, Zheng HP, Zhang FH, Wang RM. The microanatomical structure of the cistern of the lamina terminalis. J Clin Neurosci. 2011 Feb;18(2):253-9. doi: 10.1016/j.jocn.2010.03.065. PMID: 20926296.
  12. Ibid.
  13. Shahid, S. Op. Cit.
  14. Ibid.
  15. Ibid.
  16. Ibid.
  17. Shafique, S., Op. Cit.
  18. Ibid.
  19. Ibid.
  20. Shahid, S. Op. Cit.
  21. Ibid.
  22. Shafique, S., Op. Cit.
  23. Shahid, S. Op. Cit.
  24. Ibid.
  25. Ibid.
  26. Shafique, S., Op. Cit.
  27. Wilk, R., Kluczewska, E., & Likus, W. (2019). Evaluation of subarachnoid space and subarachnoid cisterns in children and teenagers based on computed tomography studies. Polish journal of radiology, 84, e295–e306. https://doi.org/10.5114/pjr.2019.87806
  28. Yum, S. K., Im, S. A., et. al., (2019), Enlarged subarachnoid space on cranial ultrasound in preterm infants: Neurodevelopmental implication, retrieved from https://www.nature.com/articles/s41598-019-55604-x#auth-In_Kyung-Sung
  29. Farb R, Rovira À. Hydrocephalus and CSF Disorders. 2020 Feb 15. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 2. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554339/ doi: 10.1007/978-3-030-38490-6_2
  30. Ibid.
  31. Ibid.
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