anatomy and radiological imaging of the brachial plexus and the subarachnoid cisterns

1. C.N.SC.N.S..
Brachial plexusBrachial plexus
Subarachnoid cisternsSubarachnoid cisterns

2. Dr.Mohamed Ashraf Zaitoun, MD
Interventional Radiology Consultant, Zagazig University
Hospitals, Egypt
FINR-Switzerland
zaitoun82@gmail.com
www.zaitounclinic.com

3. DedicationDedication
To the memory of my late father, Prof Ashraf ZaitounTo the memory of my late father, Prof Ashraf Zaitoun
Interventional
Radiology Unit,
Zagazig University,
Egypt

4. Brachial plexusBrachial plexus
Formed byFormed by::
--55roots derived from the ant. Rami of C5 to T1roots derived from the ant. Rami of C5 to T1..
--The roots lie between : ant. & middle scalene musclesThe roots lie between : ant. & middle scalene muscles..
--Units to form 3 trunksUnits to form 3 trunks<<<<
C5/6 : upperC5/6 : upper
C7 : middleC7 : middle
C8/T1 : lowerC8/T1 : lower

5. Brachial plexusBrachial plexus
Each trunk divides intoEach trunk divides into : ant. & post. Division: ant. & post. Division
**Ant. Division >> flexors of armAnt. Division >> flexors of arm
**Post. Division >> extensors of armPost. Division >> extensors of arm

6. Brachial plexusBrachial plexus
33cords are formedcords are formed::
**Ant. Of upper & middle >> lateral cordAnt. Of upper & middle >> lateral cord<<<<
Musculo-cutaneous nerveMusculo-cutaneous nerve
**Ant. Of lower >> medial cord >> ulnar nerveAnt. Of lower >> medial cord >> ulnar nerve
**Post. Of upper , middle & lower >> post. Cord >>Post. Of upper , middle & lower >> post. Cord >>
axillary & radial nervesaxillary & radial nerves
**N.B. : lateral & medial cords give fibers to >> medianN.B. : lateral & medial cords give fibers to >> median
nervenerve..

8. Brachial plexusBrachial plexus
Radiological findingRadiological finding::
**CT & MRICT & MRI<<<<
--Normally it appears in T1 MRI >> hypointenseNormally it appears in T1 MRI >> hypointense
as it is surrounded by fatas it is surrounded by fat..
--In traumatic plexopathyIn traumatic plexopathy::
Brachial plexus is imaged by C.T. or C.T.Brachial plexus is imaged by C.T. or C.T.
myelographymyelography..

9. Subarachnoid cisternsSubarachnoid cisterns
--They are deep spaces in the subarachnoid spaceThey are deep spaces in the subarachnoid space
mainly around the base of the brainmainly around the base of the brain..
--Named according to the nearby structures &Named according to the nearby structures &
contain CSF more than the ventriclescontain CSF more than the ventricles..

10. Subarachnoid cisternsSubarachnoid cisterns
--They includeThey include::
11--Cisterna magnaCisterna magna
22--Pre-pontine cisternPre-pontine cistern
33--Interpeduncular cisternInterpeduncular cistern
44--Quadrigeminal cisternQuadrigeminal cistern
55--Cistern of the velum interpositumCistern of the velum interpositum
66--Ambient cisternAmbient cistern
77--Suprasellar cisternSuprasellar cistern
88--Pericallosal cisternPericallosal cistern

11. Subarachnoid cisternsSubarachnoid cisterns
11--Cisterna magnaCisterna magna
--It is continuousIt is continuous::
Above with the 4Above with the 4thth
ventricleventricle
Below with spinal subarachnoid spaceBelow with spinal subarachnoid space..
--It receives CSF from 4It receives CSF from 4thth
ventricle through medianventricle through median
foramen of magendiforamen of magendi
--It lies below cerebral hemisphere & behind medullaIt lies below cerebral hemisphere & behind medulla
--On each side of its lateral part , it contains the vertebralOn each side of its lateral part , it contains the vertebral
artery & its PICA branchartery & its PICA branch..

12. <<<<<<

14. Subarachnoid cisternsSubarachnoid cisterns
22--Pre-pontine cisternPre-pontine cistern
--It is continuousIt is continuous::
Above with the the interpeduncular cisternAbove with the the interpeduncular cistern
Below with cisterna magnaBelow with cisterna magna
--It recieves CSF from : 4It recieves CSF from : 4thth
ventricleventricle
through >> latreral foramina of luschkathrough >> latreral foramina of luschka
--It contains the basilar artery & its pontine andIt contains the basilar artery & its pontine and
labyrinthine brancheslabyrinthine branches

15. Number 17Number 17

16. Subarachnoid cisternsSubarachnoid cisterns
33--Interpeduncular cisternInterpeduncular cistern
--It lies between : cerebral peduncles of midbrainIt lies between : cerebral peduncles of midbrain
--ContinuousContinuous
Above with >> suprasellar cisternAbove with >> suprasellar cistern
Below with >> pontine cisternBelow with >> pontine cistern
Lateral with >> ambient cisternLateral with >> ambient cistern
--It contains post. Part of the arterial circle of WillisIt contains post. Part of the arterial circle of Willis..

17. Number 5Number 5

18. Subarachnoid cisternsSubarachnoid cisterns
44--Quadrigeminal cisternQuadrigeminal cistern
--It lies behind the quadrigeminal plate of theIt lies behind the quadrigeminal plate of the
midbrainmidbrain
--It contains : confluence of internal cerebral veinIt contains : confluence of internal cerebral vein
& Basal vein >> great cerebral vein of galen +& Basal vein >> great cerebral vein of galen +
Inf. Sagittal sinus >> straight sinusInf. Sagittal sinus >> straight sinus

19. Number 2Number 2

21. Subarachnoid cisternsSubarachnoid cisterns
55--Cistern of velum interpositumCistern of velum interpositum
--Space between the layers of the tela choroidaeSpace between the layers of the tela choroidae
--It contains : internal cerebral veinsIt contains : internal cerebral veins

22. Yellow arrowYellow arrow

23. Subarachnoid cisternsSubarachnoid cisterns
66--Ambient cisternAmbient cistern
--Extend on both sides of the midbrain between :Extend on both sides of the midbrain between :
interpeduncular cistern & quadrigeminal cisterninterpeduncular cistern & quadrigeminal cistern
--Ambient wing cisterns >> lateral extensions ofAmbient wing cisterns >> lateral extensions of
the superior part of ambient cisternthe superior part of ambient cistern
--Contains : post. Cerebral arteryContains : post. Cerebral artery
basal veinbasal vein

24. Number 7Number 7

25. Subarachnoid cisternsSubarachnoid cisterns
77--Suprasellar cisternSuprasellar cistern
--Lies above the pituitary fossaLies above the pituitary fossa
--Continuous below with interpeduncular cisternContinuous below with interpeduncular cistern
--Chaismatic cistern : optic nerves pass to theChaismatic cistern : optic nerves pass to the
chiasmchiasm
--It contains : Ant.part of circle of WillisIt contains : Ant.part of circle of Willis

27. Subarachnoid cisternsSubarachnoid cisterns
88--Pericallosal cisternPericallosal cistern
--Continuation of the suprasellar cistern &Continuation of the suprasellar cistern &
chiasmatic cistern around the corpus callosumchiasmatic cistern around the corpus callosum
--It contains : branches of the ant. Cerebral arteryIt contains : branches of the ant. Cerebral artery

29. Subarachnoid cisternsSubarachnoid cisterns
Radiological findingsRadiological findings::
11--CT & MRICT & MRI
22--Cervical myelographyCervical myelography
33--PneumoencephalographyPneumoencephalography

30. Subarachnoid cisternsSubarachnoid cisterns
11--CT & MRICT & MRI
--The cisterns are visible on axial CT & MRI images as aThe cisterns are visible on axial CT & MRI images as a
CSF filled spaces between the parts of the brain and theCSF filled spaces between the parts of the brain and the
skullskull
--Interpeduncular , ambient & quadrigeminal cisterns areInterpeduncular , ambient & quadrigeminal cisterns are
seen at the level of midbrain surrounding itseen at the level of midbrain surrounding it
--RelationsRelations …… see beforesee before
--Small structures passing in cisterns can be seen in >>Small structures passing in cisterns can be seen in >>
T2WIsT2WIs

31. Subarachnoid cisternsSubarachnoid cisterns
22--Cervical myelographyCervical myelography::
--The contrast is introduced intoThe contrast is introduced into
Cisterna magnaCisterna magna
Spinal subarachnoid spaceSpinal subarachnoid space
--Needle is introducedNeedle is introduced above the level of C2above the level of C2
And directed upwards & then at the depth of 3 cmAnd directed upwards & then at the depth of 3 cm
the needle is felt to penetrate the atlanto-the needle is felt to penetrate the atlanto-
occipital membrane to enter the cisterna magnaoccipital membrane to enter the cisterna magna

32. Subarachnoid cisternsSubarachnoid cisterns
--Structures at riskStructures at risk::
**Spinal cordSpinal cord
**M.O. ant. To the cisternM.O. ant. To the cistern
**PICA artery and its branches within the cisternPICA artery and its branches within the cistern

33. Subarachnoid cisternsSubarachnoid cisterns
33--PneumoencephalographyPneumoencephalography
--In the past , the brain was imaged by viewing airIn the past , the brain was imaged by viewing air
in cisterns >> now replaced by CT & MRIin cisterns >> now replaced by CT & MRI..