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Neuroimaging
Published in Sarah McWilliams, Practical Radiological Anatomy, 2011
o Ambient cistern and quadrigeminal cisterns surround the midbrain. The quadrigeminal cistern is the CSF space surrounding the quadrigeminal bodies, which are also called the superior and inferior colliculi. The vein of Galen lies in the quadrigeminal cistern. The ambient cistern is the CSF continuation around the side of the midbrain (Fig. 1.17).
Central nervous system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Figure 11.25b is a midline sagittal section of the brain, imaged through the line of S3 of Fig. 11.25a, with lines showing the most common six standard coronal planes, C1–C6. The anterior part of the brain is to the left of the image, and the following structures are demonstrated, as numbered: Cingulate gyrus.Corpus callosum.Cavum septum pellucidum.Fornix.Thalamus.Third ventricle.Frontal base of the skull.Interpeduncular fossa.Mesencephalon.Aqueduct.Quadrigeminal cistern.Pons.Fourth ventricle.Cerebellum.Medulla oblongata.Foramen magnum.Occipital base of the skull.Cisterna magna.
Transcortical transventricular transchoroidal-fissure approach to distal fusiform hyperplastic anterior choroidal artery aneurysms
Published in British Journal of Neurosurgery, 2023
Caleb Rutledge, Soren Jonzzon, Ethan Andrew Winkler, Steven William Hetts, Adib Adnan Abla
The aneurysm location is equivalent to a P2p aneurysm within the middle- and posterior- ambient cistern. Selection of a surgical approach to the ambient cistern requires a detailed understanding of the relationship of the aneurysm to the midbrain, cisterns, and mesial temporal lobe structures. A transsylvian approach is limited to lesions in the anterior ambient cistern (e.g. P2a aneurysms). A subtemporal approach can be used for more distal P2p aneurysms, but disadvantages of this approach include limited access to posterior and superiorly located lesions in the ambient cistern, as well as injury to the vein of Labbé, optic radiations, and speech areas in the dominant hemisphere from temporal lobe retraction. Finally, while occipital interhemispheric transtentorial or infratentorial supracerebellar approaches provide access to the quadrigeminal cistern and distal P2p aneurysms in the posterior ambient cistern, proximal control of the PCA is challenging.
Compressive trochlear nerve palsy caused by ischaemic stroke
Published in Clinical and Experimental Optometry, 2021
CN IV palsies result in a vertical deviation in primary gaze that worsens in contralateral gaze, ipsilateral head tilt, with increased excyclotorsion noted in the affected eye.5,6 This excyclotorsion can be measured objectively (i.e. fundus photography) as in this case.5,7,8 Aetiologies of adult CN IV palsies are reported to be: congenital (38 per cent), trauma (29 per cent), ischaemic (23 per cent), tumour (one per cent), and other (one per cent).2 This underscores the rarity of CN IV palsies caused by cerebellar oedema. Other lesions with transient compression of the trochlear nerve within the quadrigeminal cistern, such as subarachnoid haemorrhage, have been previously described.9 It is important to rule out skew deviations in cases like this one as skew deviations can mimic CN IV palsies, but the key differentiating feature is the hypertropic eye being incyclotorted with skew deviations and excyclotorted with CN IV palsies, as in this case.10
Pure endoscopic resection of pineal region tumors through supracerebellar infratentorial approach with ‘head-up’ park-bench position
Published in Neurological Research, 2023
Wei Hua, Hao Xu, Xin Zhang, Guo Yu, Xiaowen Wang, Jinsen Zhang, Zhiguang Pan, Wei Zhu
The supracerebellar infratentorial space was first inspected with a 0-degree endoscope (Storz, Germany), and the superficial and deep drainage veins above the vermis were coagulated and transected. The cerebellum was untethered to create space. Below the vein of Galen and between the basal veins, the quadrigeminal cistern was sharply opened to expose the tumor. In most cases, the tumors can be exposed clearly, and some tumor samples were collected for rapidly frozen pathology. The precise plane between the neoplasm and healthy brain tissue needed to be carefully identified, for which approaching observation had an advantage. Devascularization could be attempted first to obtain a clean view. Debulking might be easy with a CUSA ultrasonic dissector if necessary.