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Cisterns

Contents

Introduction

The brain is bathed in fluid during life. The name of this substance is cerebrospinal fluid (CSF). It provides the brain with nutrients, allows for solute exchange, and provides basic mechanical and functional support to the organ. There are areas where the CSF will accumulate due to spaces between the two innermost brain layers (meninges). These areas are known as the subarachnoid cisterns. In this article we will discuss the anatomy, contents, function and clinical relevance of these structures. 

Falx cerebri
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Meninges

The central nervous system comprises the brain, cerebellum, brainstem and spinal cord. All components of the system are encased within the three meninges:

  • Arachnoid mater - cross-sectional view The pia mater is closely adherent to the brain, and closely follows the contours of the sulci and gyri on the cerebral cortex.
  • The arachnoid mater (spider-like, hence its name) is loosely adherent to the brain.
  • The dura mater is in close contact with the periosteum that forms the innermost layer of the cranium. The CSF is found in the subarachnoid space.

The subarachnoid space is not of uniform depth across the entire brain. It varies from place to place within the central nervous system. In some of these areas the pia mater and arachnoid mater are not in close contact. In these locations, the subarachnoid tissue is not as dense or plentiful as in other areas. Here we can find expanded areas filled with cerebrospinal fluid (CSF) known as the cisterns from the Latin word for ‘box.’

Cisterns

Although the subarachnoid cisterns are frequently described as distinct compartments, they are not in fact anatomically separate. In reality only a porous wall that has numerous openings or various sizes separates the cisterns. All the arteries and veins of the brain as well as the cranial nerves must pass through the subarachnoid space to leave the skull, and carry their meningeal layers until the very point at which they leave the skull.

Cisterna magna

The cisterna magna (also known as the cerebellomedullary cistern) is the largest of the subarachnoid cisterns. It is located between the medulla anteriorly and the cerebellum posteriorly. The cistern receives CSF from the diamond shaped fourth ventricle via the median and lateral apertures. The cistern contains numerous structures, including the following:

Pontine cistern

The pontine cistern can be found anterior to the pons. It contains the following:

  • basilar artery, which is formed by the unification of the two vertebral arteries at the caudal border of the pons
  • anterior inferior cerebellar artery
  • abducens nerve (cranial nerve 6), which innervates the lateral rectus muscle and abducts the eye
  • superior cerebellar arteries

Suprasellar cistern

The suprasellar cistern is located above the sella turcica and below the hypothalamus. It contains the optic chiasm and pituitary stalk.

Interpeduncular cistern

The interpeduncular cistern is a relatively wide and cone-shaped cistern occupying the interpeduncular fossa. It is located at the confluence of the supra- and infratentorial subarachnoid space between the two temporal lobes. The cistern is surrounded by the cerebral peduncles and contains the following:

  • Oculomotor nerve - caudal viewthe bifurcation of the basilar artery
  • proximal parts of the posterior cerebral arteries, together with some of their perforating branches
  • proximal parts of the superior cerebellar arteries
  • oculomotor nerves, which pass between the posterior cerebral and superior cerebellar arteries
  • mammillary bodies, which are found in the anterior area of the deep portion of the cistern

Quadrigeminal cistern

The quadrigeminal cistern is also known as the superior cistern, ambient cistern or cistern of the great cerebral vein. The precise location is between the splenium of the corpus callosum and the upper surface of the cerebellum, i.e. dorsal to the midbrain. The cistern extends laterally around the midbrain, from the great cerebral vein to the third ventricle. This cistern contains:

  • Pineal gland - cranial viewthe pineal gland
  • part of the trochlear nerves (cranial nerve 4) 
  • the great cerebral vein
  • the third portion of the posterior cerebral arteries, together with some of their perforating branches
  • the third portion of the superior cerebellar arteries, together with some of their perforating branches

The infratentorial portion contains the posterior cerebral artery and the 4th cranial nerve (the trochlear nerve ). This nerve innervates the superior oblique muscle, which moves the eye down and out. It is vulnerable to damage in raised intracranial pressure due to its long winding course from the back of the brainstem to the superior orbital fissure, as well as its relatively thin caliber.

Crural and carotid cisterns

The crural cistern can be found surrounding the ventrolateral aspect of the midbrain, between the parahippocampal gyrus and the cerebral peduncle. Within it, the medial posterior choroidal artery can be found.

Optic nerve - caudal viewThe cisternal segment of the anterior choroidal artery runs through the basal cisterns (carotid, crural and ambient cisterns). The carotid cistern is located anterior to the crural cistern between the internal carotid artery and the ipsilateral optic nerve. It contains the first part of the posterior communicating artery, together with the internal carotid artery, which supplies the anterior part of the circle of Willis.

Insular cistern

The Sylvian or insular cistern can be located between the temporal lobes and the frontal lobes. It is bordered by the arachnoid surface of the Sylvian fissure and contains several arteries, including the middle cerebral artery.

Cerebellopontine angle cistern

Another relatively small cistern is the cerebellopontine angle cistern. The precise location is between the pons and the cerebellum. It contains the following:

  • Facial nervethe facial nerve (cranial nerve 7), which supplies the muscles of facial expression and taste to the anterior two thirds of the tongue  (via the chorda tympani branch). It also gives off the nerve to stapedius, and many more
  • vestibulocochlear nerve (cranial nerve 8), which has a vestibular branch for balance, and a cochlear branch for hearing
  • trigeminal nerve (cranial nerve 5), which relays sensation from the face and innervates the muscles of mastication i.e. masseter, medial and lateral pterygoids, and the temporalis
  • posterior inferior cerebellar arteries

Cistern of the lamina terminalis

Next we have the cistern of the lamina terminalis, which can be found in the shape of a high-top tent just anterior to the lamina terminalis. It contains:

  • anterior cerebral arteries, as well as the vessel that connects them
  • anterior communicating artery
  • arteries to the hypothalamus

Lumbar cistern

Medullary cone - dorsal viewFinally we have the lumbar cistern, which is not located within the skull, but rather within the spinal canal at its very termination. It can be found extending from the conus medullaris , (the termination of the spinal cord) around vertebral level L1-L2, to the S2 sacral foramina level.

It contains the filum terminale (a thin cord of non neural tissue that anchors the spinal cord to the sacrum), as well as the cauda equina (from the Latin for ‘horse tail’, which means the sacral spinal nerves). This is the precise location that CSF is drawn from for lumbar puncture.

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Show references

References:

  • Frank H.Netter MD: Atlas of Human Anatomy, 5th Edition, Elsevier Saunders, Chapter 1 Head and Neck.
  • Chummy S.Sinnatamby: Last’s Anatomy Regional and Applied, 12th Edition, Churchill Livingstone Elsevier.
  • Richard L. Drake, A. Wayne Vogl, Adam. W.M. Mitchell: Gray’s Anatomy for Students, 2nd Edition, Churchill Livingstone Elsevier.
  • Elliiot L.Manchell: Gray's Clinical Neuroanatomy: The Anatomic Basis for Clinical Neuroscience.

Author, Review and Layout:

  • Shahab Shahid
  • Jérôme Goffin
  • Catarina Chaves

Illustrators:

  • Arachnoid mater - cross-sectional view - National Library of Medicine
  • Vertebral artery - dorsal view - Yousun Koh
  • Oculomotor nerve - caudal view - Paul Kim
  • Pineal gland - cranial view - Paul Kim
  • Optic nerve - caudal view - Paul Kim
  • Facial nerve - Paul Kim
  • Medullary cone - dorsal view - Rebecca Betts
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