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Published in: Neuroradiology 11/2013

01-11-2013 | Diagnostic Neuroradiology

The human foramen magnum—normal anatomy of the cisterna magna in adults

Authors: Nathaniel Whitney, Hai Sun, Jeffrey M. Pollock, Donald A. Ross

Published in: Neuroradiology | Issue 11/2013

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Abstract

Introduction

The goal of this study was to radiologically describe the anatomical characteristics of the cisterna magna (CM) with regard to presence, dimension, and configuration.

Methods

In this retrospective study, 523 records were reviewed. We defined five CM types, the range of which covered all normal variants found in the study population. Characteristics of the CM were recorded and correlations between various posterior fossa dimensions and CM volume determined.

Results

There were 268 female (mean age 50.9 ± 16.9 years) and 255 male (mean age 54.1 ± 15.8 years) patients. CM volume was smaller in females than in males and correlated with age (Pearson correlation, r = 0.1494, p = 0.0006) and gender (unpaired t test, r 2 = 0.0608, p < 0.0001). Clivus length correlated with CM volume (Pearson correlation, r = 0.211, p < 0.0001) and gender (unpaired t test, r 2 = 0.2428, p < 0.0001). Tentorial angle did not correlate with CM volume (Pearson correlation, r = −0.0609, p < 0.1642) but did correlate with gender (unpaired t test, r 2 = 0.0163, p < 0.0035). The anterior–posterior dimension of cerebrospinal fluid anterior to the brainstem correlated with CM volume (Pearson correlation, r = 0.181, p < 0.0001) and gender (unpaired t test, r 2 = 0.0205, p = 0.001).

Conclusion

The anatomical description and simple classification system we define allows for a more precise description of posterior fossa anatomy and could potentially contribute to the understanding of Chiari malformation anatomy and management.
Literature
1.
go back to reference Osborn A (ed) (2010) Diagnostic imaging—brain. Amirsys, Altona Osborn A (ed) (2010) Diagnostic imaging—brain. Amirsys, Altona
2.
go back to reference Yaşargil M (1984) Microneurosurgery: microsurgical anatomy of the basal cisterns and vessels of the brain, diagnostic studies, general operative techniques and pathological considerations of the intracranial aneurysms.vol I. Thieme, New York, p 52 Yaşargil M (1984) Microneurosurgery: microsurgical anatomy of the basal cisterns and vessels of the brain, diagnostic studies, general operative techniques and pathological considerations of the intracranial aneurysms.vol I. Thieme, New York, p 52
3.
go back to reference Tortori-Donati P, Fondelli MP, Rossi A et al (1996) Cystic malformations of the posterior cranial fossa originating from a defect of the posterior membranous area. Mega cisterna magna and persisting Blake's pouch: two separate entities. Childs Nerv Syst 12(6):303–308PubMedCrossRef Tortori-Donati P, Fondelli MP, Rossi A et al (1996) Cystic malformations of the posterior cranial fossa originating from a defect of the posterior membranous area. Mega cisterna magna and persisting Blake's pouch: two separate entities. Childs Nerv Syst 12(6):303–308PubMedCrossRef
4.
go back to reference Newton TH (1968) Cisterns of posterior fossa. Clin Neurosurg 15:190–246PubMed Newton TH (1968) Cisterns of posterior fossa. Clin Neurosurg 15:190–246PubMed
5.
go back to reference Markunas CA, Tubbs RS, Moftakhar R et al (2012) Clinical, radiological, and genetic similarities between patients with Chiari type I and type 0 malformations. J Neurosurg Pediatr 9(4):372–378PubMedCrossRef Markunas CA, Tubbs RS, Moftakhar R et al (2012) Clinical, radiological, and genetic similarities between patients with Chiari type I and type 0 malformations. J Neurosurg Pediatr 9(4):372–378PubMedCrossRef
6.
go back to reference Sekula RF Jr, Jannetta PJ, Casey KF et al (2005) Dimensions of the posterior fossa in patients symptomatic for Chiari I malformation but without cerebellar tonsillar descent. Cerebrospinal Fluid Res 2:11PubMedCrossRef Sekula RF Jr, Jannetta PJ, Casey KF et al (2005) Dimensions of the posterior fossa in patients symptomatic for Chiari I malformation but without cerebellar tonsillar descent. Cerebrospinal Fluid Res 2:11PubMedCrossRef
7.
go back to reference Meadows J, Kraut M, Guarnieri M et al (2000) Asymptomatic Chiari type I malformations identified on magnetic resonance imaging. J Neurosurg 92(6):920–926PubMedCrossRef Meadows J, Kraut M, Guarnieri M et al (2000) Asymptomatic Chiari type I malformations identified on magnetic resonance imaging. J Neurosurg 92(6):920–926PubMedCrossRef
8.
go back to reference Ciolkowski M, Sharifi M, Tarka S et al (2011) Median aperture of the fourth ventricle revisited. Folia Morphol (Warsz) 70(2):84–90 Ciolkowski M, Sharifi M, Tarka S et al (2011) Median aperture of the fourth ventricle revisited. Folia Morphol (Warsz) 70(2):84–90
9.
go back to reference Robinson AJ, Goldstein R (2007) The cisterna magna septa: vestigial remnants of Blake's pouch and a potential new marker for normal development of the rhombencephalon. J Ultrasound Med 26(1):83–95PubMed Robinson AJ, Goldstein R (2007) The cisterna magna septa: vestigial remnants of Blake's pouch and a potential new marker for normal development of the rhombencephalon. J Ultrasound Med 26(1):83–95PubMed
10.
go back to reference Inoue K, Seker A, Osawa S et al (2009) Microsurgical and endoscopic anatomy of the supratentorial arachnoidal membranes and cisterns. Neurosurgery 65(4):644–664PubMedCrossRef Inoue K, Seker A, Osawa S et al (2009) Microsurgical and endoscopic anatomy of the supratentorial arachnoidal membranes and cisterns. Neurosurgery 65(4):644–664PubMedCrossRef
12.
go back to reference Foroglou G, Oberson R, Zander E (1975) Variation in the dimensions of the cerebellomedullary cistern after ventriculo-cardiac shunting. Neurochirurgia (Stuttg) 18(3):85–90 Foroglou G, Oberson R, Zander E (1975) Variation in the dimensions of the cerebellomedullary cistern after ventriculo-cardiac shunting. Neurochirurgia (Stuttg) 18(3):85–90
13.
go back to reference Hedman AM, van Haren NE, Schnack HG et al (2012) Human brain changes across the life span: a review of 56 longitudinal magnetic resonance imaging studies. Hum Brain Mapp 33(8):1987–2002PubMedCrossRef Hedman AM, van Haren NE, Schnack HG et al (2012) Human brain changes across the life span: a review of 56 longitudinal magnetic resonance imaging studies. Hum Brain Mapp 33(8):1987–2002PubMedCrossRef
14.
go back to reference Long X, Liao W, Jiang C et al (2012) Healthy aging: an automatic analysis of global and regional morphological alterations of human brain. Acad Radiol 19(7):785–793PubMedCrossRef Long X, Liao W, Jiang C et al (2012) Healthy aging: an automatic analysis of global and regional morphological alterations of human brain. Acad Radiol 19(7):785–793PubMedCrossRef
15.
go back to reference Kilic K, Kars Z, Ozgen T et al (1988) Cisterna megamagna. Dimensions and relations to cerebral atrophy. Clinical and x-ray computed tomographic demonstration. Neurochirurgie 34(1):37–44PubMed Kilic K, Kars Z, Ozgen T et al (1988) Cisterna megamagna. Dimensions and relations to cerebral atrophy. Clinical and x-ray computed tomographic demonstration. Neurochirurgie 34(1):37–44PubMed
16.
go back to reference Heiss JD, Suffredini G, Bakhtian KD et al (2012) Normalization of hindbrain morphology after decompression of Chiari malformation type I. J Neurosurg 117(5):942–946PubMedCrossRef Heiss JD, Suffredini G, Bakhtian KD et al (2012) Normalization of hindbrain morphology after decompression of Chiari malformation type I. J Neurosurg 117(5):942–946PubMedCrossRef
17.
go back to reference Bejjani GK, Cockerham KP (2001) Adult Chiari malformation. Contemp Neurosurg 23(26):1–7CrossRef Bejjani GK, Cockerham KP (2001) Adult Chiari malformation. Contemp Neurosurg 23(26):1–7CrossRef
18.
go back to reference McLone DG, Knepper PA (1989) The cause of Chiari II malformation: a unified theory. Pediatr Neurosci 15(1):1–12PubMedCrossRef McLone DG, Knepper PA (1989) The cause of Chiari II malformation: a unified theory. Pediatr Neurosci 15(1):1–12PubMedCrossRef
19.
go back to reference Sweeney KJ, Caird J, Sattar MT et al (2013) Spinal level of myelomeningocele lesion as a contributing factor in posterior fossa volume, intracranial cerebellar volume, and cerebellar ectopia. J Neurosurg Pediatr 11(2):154–159PubMedCrossRef Sweeney KJ, Caird J, Sattar MT et al (2013) Spinal level of myelomeningocele lesion as a contributing factor in posterior fossa volume, intracranial cerebellar volume, and cerebellar ectopia. J Neurosurg Pediatr 11(2):154–159PubMedCrossRef
20.
go back to reference Aboulezz AO, Sartor K, Geyer CA et al (1985) Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with MR imaging. J Comput Assist Tomogr 9(6):1033–1036PubMedCrossRef Aboulezz AO, Sartor K, Geyer CA et al (1985) Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: a quantitative approach with MR imaging. J Comput Assist Tomogr 9(6):1033–1036PubMedCrossRef
21.
go back to reference Barkovich AJ, Wippold FJ, Sherman JL et al (1986) Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol 7(5):795–799PubMed Barkovich AJ, Wippold FJ, Sherman JL et al (1986) Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol 7(5):795–799PubMed
22.
go back to reference Milhorat TH, Chou MW, Trinidad EM et al (1999) Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 44(5):1005–1017PubMedCrossRef Milhorat TH, Chou MW, Trinidad EM et al (1999) Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 44(5):1005–1017PubMedCrossRef
23.
go back to reference Iskandar BJ, Hedlund GL, Grabb PA et al (1998) The resolution of syringohydromyelia without hindbrain herniation after posterior fossa decompression. J Neurosurg 89(2):212–216PubMedCrossRef Iskandar BJ, Hedlund GL, Grabb PA et al (1998) The resolution of syringohydromyelia without hindbrain herniation after posterior fossa decompression. J Neurosurg 89(2):212–216PubMedCrossRef
24.
go back to reference Chern JJ, Gordon AJ, Mortazavi MM et al (2011) Pediatric Chiari malformation type 0: a 12-year institutional experience. J Neurosurg Pediatr 8(1):1–5PubMedCrossRef Chern JJ, Gordon AJ, Mortazavi MM et al (2011) Pediatric Chiari malformation type 0: a 12-year institutional experience. J Neurosurg Pediatr 8(1):1–5PubMedCrossRef
25.
go back to reference Tubbs RS, Elton S, Grabb P et al (2001) Analysis of the posterior fossa in children with the Chiari 0 malformation. Neurosurgery 48(5):1050–1054PubMedCrossRef Tubbs RS, Elton S, Grabb P et al (2001) Analysis of the posterior fossa in children with the Chiari 0 malformation. Neurosurgery 48(5):1050–1054PubMedCrossRef
26.
go back to reference Kyoshima K, Kuroyanagi T, Oya F et al (2002) Syringomyelia without hindbrain herniation: tight cisterna magna. Report of four cases and a review of the literature. J Neurosurg 96(2 Suppl):239–249PubMed Kyoshima K, Kuroyanagi T, Oya F et al (2002) Syringomyelia without hindbrain herniation: tight cisterna magna. Report of four cases and a review of the literature. J Neurosurg 96(2 Suppl):239–249PubMed
27.
go back to reference Bogdanov EI, Heiss JD, Mendelevich EG et al (2004) Clinical and neuroimaging features of “idiopathic” syringomyelia. Neurology 62(5):791–794PubMedCrossRef Bogdanov EI, Heiss JD, Mendelevich EG et al (2004) Clinical and neuroimaging features of “idiopathic” syringomyelia. Neurology 62(5):791–794PubMedCrossRef
Metadata
Title
The human foramen magnum—normal anatomy of the cisterna magna in adults
Authors
Nathaniel Whitney
Hai Sun
Jeffrey M. Pollock
Donald A. Ross
Publication date
01-11-2013
Publisher
Springer Berlin Heidelberg
Published in
Neuroradiology / Issue 11/2013
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-013-1269-z

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