[Safety needle for puncture of the cisterna magna].
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Cisterna Magna↗
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Spatial characteristics of cisterna magna in rats and novel technique for puncture with a stereotactic manipulator.
The actual size and sites for puncture of the cisterna magna in adult Wistar rats were estimated on acrylic models. We proposed a new method for obtaining cerebrospinal fluid from narcotized rats. This method consists in controlled introduction of a needle into the cisterna magna through the skin and/or dura mater above this structure using a stereotactic micromanipulator. Experiments on rats with focal and global cerebral ischemia showed that this technique ensures single and repeated sampling of at least 50 microl liquor not containing blood admixtures.
Animals↗
Schwannoma of the spinal accessory nerve in the cisterna magna.
BACKGROUND: Intracranial schwannoma of the accessory nerve can be divided into two types. One is a jugular foramen type arising from the accessory nerve of the jugular foramen, while the other is an intracisternal type, which arises from the spinal root of the accessory nerve and is separate from the jugular foramen. The latter type is rare, and only 9 cases have been reported previously. CASE DESCRIPTION: A 46-year-old female presented with a large, midline mass lesion in the posterior fossa manifesting as foramen magnum syndrome. Magnetic resonance imaging (MRI) revealed a huge tumor with cystic lesion located in the cisterna magna with extension to the C1 spinal level. The tumor was totally removed by a suboccipital craniectomy and C1 laminectomy. It originated from the spinal root of the right accessory nerve. Temporary slight atrophy of the right sternocleidomastoid muscle was observed, but the patient was free of disease 2 years after treatment. CONCLUSIONS: We report a schwannoma of the spinal accessory nerve in the cisterna magna. The clinical and neuroradiological findings are discussed with a review of the literature. The initial symptoms were variable without loss of function of the cranial nerve, and the tumor tended to grow in the cisterna magna without laterality. Because of the absence of typical neurologic symptoms, early neuroradiological investigation by MRI is recommended for accurate diagnosis of these tumors.
Accessory Nerve Diseases↗
Technique for collecting cerebrospinal fluid in the cisterna magna of non-anesthetized rats.
We developed a technique for collecting cerebrospinal fluid (CSF) from the cisterna magna in non-anesthetized adult and young pup rats. In the adults, CSF was collected through a previously implanted guide cannula without previous disruption of the cisterna magna. In the pups, CSF was directly aspirated through a syringe from the cisterna in awake animals without previous surgery. In the adults, the volume of CSF collected varied from 50 to 120 microl, and in pups 7 to 10 days old, it was approximately 25 microl. The technique can easily be done by anyone who is familiar with stereotaxic surgery, and the material needed is cheap and easy to obtain commercially. A simple procedure to calculate the parameters for the implantation of guide cannula in rats other than Wistar ones is also presented.
Age Factors↗
Intrathecal urokinase infusion through a microcatheter into the cisterna magna to prevent cerebral vasospasm: experimental study in dogs.
BACKGROUND AND PURPOSE: Our preliminary report on intrathecal urokinase (UK) infusion into the cisterna magna (CM) with a microcatheter showed good results in terms of vasospasm prevention in humans. In this study, we evaluated the relationship between different urokinase (UK) infusion sites and their effect on vasospasm prevention by using our canine subarachnoid hemorrhage (SAH) model. METHODS: At 24 hours after SAH induction, we injected 1000 IU/kg UK into the cisterna magna (CM) or lumbar sac (LS) of dogs by using a microcatheter inserted at the lumbar region. We then obtained serial angiograms and chronologically examined the changes in the mean diameter of the basilar artery (BA) during a 14-day period to determine the effect of the different injection sites on vasospasm prevention. At 24 hours after UK injection, one dog from each group was killed for gross inspection of the subarachnoid clot. To measure its concentration in the CM and sylvian fissure, UK (1000 IU/kg) was injected into the CM or LS of dogs without SAH; measurements were taken at 15-minute intervals until 4 hours after injection. RESULTS: At 24 hours after UK injection, subarachnoid clot in front of the brain stem persisted strongly in the LS group; it had almost disappeared in the CM group. In the LS group, there was severe and persistent BA constriction during the 14-day observation period. In the CM group, the BA was constricted on day 3; however, gradual dilatation occurred over time. The mean diameter of the BA on days 7, 10, and 14 was 48.2%, 53.9%, and 58.9% in the LS group and 62.6%, 70.5%, and 82.3% in the CM group. The difference between the two groups was significant on days 7, 10, and 14 (P <.05). In dogs without SAH, the average maximum UK concentration in the CM and the sylvian fissure was 2.5 and 6.7 times higher, respectively, in the CM group than in the LS group. CONCLUSIONS: In our canine SAH model, the administration of UK into the CM was significantly more effective in preventing cerebral vasospasms than was administration into the LS.
Animals↗
Radiology of a large cisterna magna cyst. A case report.
A case of a large cisterna magna cyst presented a problem in differential diagnosis. Characteristic changes were shown on plain skull roentgenograms and on radionuclide brain scan. The diagnosis was established on the basis of pneumoencephalography and isotope cisternography. The lesion responded well to surgical management.
Adolescent↗
Familial communicating hydrocephalus, posterior cerebellar agenesis, mega cisterna magna, and port-wine nevi. Report on five members of one family.
This report deals with a family in which the maternal grandmother, the mother, and all three male children have port-wine nevi and mega cisterna magna. Two of the three male children have, in addition, congenital communicating hydrocephalus associated with agenesis of the posterior cerebellar vermis. This case of familial communicating hydrocephalus, posterior cerebellar vermis agenesis, port-wine nevus, and mega cisterna magna represents a new neurocutaneous syndrome, possibly transmitted as an autosomal dominant.
Adult↗
Respiratory depression produced by glycine injected into the cisterna magna of cats.
Glycine (0.8-64.8 mumol) was administered into the cisterna magna of alpha-chloralose anesthetized cats to determine its effect on ventilation. Glycine caused a dose-related decrease in respiratory minute volume with the highest dose resulting in a decrease from 454 +/- 35 to 159 +/- 44 ml/min (p less than 0.05). This decrease was due primarily to a reduction in tidal volume which decreased from 31 +/- 2 to 12 +/- 2 ml (p less than 0.05). The two largest doses tested (21.6 and 64.8 mumol) also produced a decrease in respiratory rate from 14 +/- 1 to 11 +/- 1 and from 15 +/- 1 to 12 +/- 1 breaths/min (p less than 0.05), respectively. Apnea occurred in 2 of 7 animals given 64.8 mumol of glycine. No consistent dose-related changes in inspiratory and expiratory durations were observed. Intravenous administration of glycine (64.8 mumol) did not affect respiratory activity. These results indicate that glycine causes respiratory depression by an action in the central nervous system.
Animals↗
Cisterna magna microdialysis of 22Na to evaluate ion transport and cerebrospinal fluid dynamics.
Microdialysis is used in vivo for measuring compounds in brain interstitial fluid. The authors describe another application of this technique to the central nervous system, namely microprobe dialysis in the cisterna magna to study the dynamics of ion transport and cerebrospinal fluid (CSF) formation in the rat. The choroid plexus is the major source of CSF, which is produced by active transport of Na from blood into the cerebral ventricles. Formation of CSF is directly proportional to the blood-to-CSF transport of Na. By injecting 22Na into the systemic circulation and quantifying its movement into CSF by microdialysis, one can reliably estimate alterations in the rate of CSF formation. The sensitivity of this system was determined by administering acetazolamide, a standard inhibitor of CSF production. Because acetazolamide is known to decrease CSF formation by 40% to 50%, the cisternal microdialysis system in animals treated with this drug should detect a corresponding decrease in the amount of 22Na dialyzed. This hypothesis is supported by the 22Na uptake curves for control versus treated animals: that is, by the acetazolamide-induced average diminution of about 45% in both the rate and extent of tracer accession to dialysate. Bumetanide, a loop diuretic, reduced by 30% the 22Na entry into dialysate. Microprobe dialysis of fluid in the cisterna magna is thus a minimally invasive and economical method for evaluating effects of drugs and hormones on the choroid plexus-CSF system.
Acetazolamide↗
Enlarged cisterna magna in trisomy 18: prenatal ultrasonographic diagnosis.
Ultrasonographic visualization of an enlarged cisterna magna was the initial clue that led to the prenatal diagnosis of trisomy 18 in five patients. Prenatal diagnosis of trisomy 18, a lethal defect, is important for proper patient counseling and management.
Cerebellum↗
Differential effects of cisterna magna cannulation on beta-endorphin levels in rat plasma and cerebrospinal fluid.
The concentration of beta-endorphin-like immunoreactivity (beta-ELIR) was determined in plasma and cerebrospinal fluid (CSF) of rats at various times following the implantation under Hypnorm anesthesia of a permanent cannula into the cisterna magna. Plasma beta-ELIR levels were highly increased immediately after the operation, and gradually returned to basal within 6 h. The beta-ELIR concentration in CSF followed a completely different pattern. It appeared to be rather stable during the first hour after the operation, was decreased at 2 h, and showed a marked increase 24 h after surgery. Two days after the surgery, beta-ELIR levels in CSF had decreased to a stable basal level which was maintained for at least 7 days. When at this stage animals were treated with Hypnorm, plasma beta-ELIR was again highly increased 30 min and not 24 h after injection, but no changes were found in the beta-ELIR concentration in CSF. These data indicate that implantation of a cannula into the cisterna magna induces postoperative changes in the CSF levels of beta-endorphin that are detectable up to at least 24 h later. Moreover, the lack of correlation between CSF and plasma levels of beta-ELIR points towards differences in the regulation of brain and pituitary pro-opiomelanocortin cells.
Animals↗
Hereditary subependymal heterotopia associated with mega cisterna magna: antenatal diagnosis with magnetic resonance imaging.
Bilateral nodular subependymal heterotopia has recently been identified as a hereditary disease linked to the X-chromosome. The sonographic findings are very subtle and difficult to observe during the second trimester when the germinal matrix is at its largest. Fetal magnetic resonance imaging facilitates visualization of the periventricular area. We report a case of bilateral nodular heterotopia associated with mega cisterna magna diagnosed by ultrasound and magnetic resonance imaging at 29 weeks' gestation. Magnetic resonance imaging of the brain of the mother revealed similar findings to those observed in the fetus and neonate. This case confirms the association between mega cisterna magna and bilateral periventricular nodular heterotopia and demonstrates that neuroimaging studies of the mother can contribute to the fetal diagnosis.
Adult↗
Pseudotumor cerebri patients with shunts from the cisterna magna: clinical course and telemetric intracranial pressure data.
OBJECTIVE: Shunting of cerebrospinal fluid (CSF) to an extracranial site is the mainstay of treatment of absorptive hydrocephalus and pseudotumor cerebri. On occasion, both lateral ventricles and the lumbar space become unsuitable for placement of a functioning CSF drainage catheter. We have encountered several such patients and describe our strategy of shunting from the cisterna magna to the pleural space or cardiac atrium. METHODS: We report a retrospective review of the clinical course of five patients with cisternal shunts and intracranial pressure telemonitoring devices. RESULTS: Cisternal shunting was able to successfully drain CSF to a normal pressure in all five patients. CSF pressure data collected from those patients indicate that the CSF pressure dynamics in cisternal shunts is similar to that of ventricular shunts. However, the cisternal shunting and subsequent high revision rate did result in a significant number of complications and two shunt infections. CONCLUSION: Shunting CSF from the cisterna magna in the absence of another suitable drainage site does result in acceptable reduction of elevated intracranial pressure. However, the technique is associated with a high complication rate that may reflect the population of patients in whom this technique is required.
Adult↗
Hereditary nodular heterotopia accompanied by mega cisterna magna.
This is the first report of hereditary nodular heterotopia accompanied by mega cisterna magna. Magnetic resonance imaging documented multiple bilateral subependymal nodules, which were isointense to gray matter. This disease entity is considered a dominant trait, since the mother and two daughters, half-sisters, were affected.
Adult↗
Microdialysis in cisterna magna during cerebral air embolism in swine.
Arterial gas embolism may occur as a consequence of lung rupture, decompression sickness, following operative procedures or as accidental infusion of gas during various diagnostic procedures. It can lead to severe morbidity or even death. Microdialysis is a technique that has been extensively used for evaluating localized changes in the brain. The microdialysis probe is only capable of measuring changes in the immediate adjacent tissue. In arterial gas embolism the changes are multifocal. Thus a probe located in the cerebral cortex will not detect the total amount of damage. We used microdialysis in the cisterna magna of 9 anaesthetized pigs to study the diffuse injury following arterial gas embolism. After injection of 5.0 mL of air in the internal carotid artery, we found a significantly increased lactate-pyruvate ratio in the cerebrospinal fluid, lasting for 2 hours. This indicates anaerobic metabolism. Mean levels of glycerol were significantly increased, indicating membrane disruption. Glutamate levels were also elevated, although not significantly. The injection of air affected carotid flow. Flow in the carotid artery of the side of injection decreased significantly, but returned to baseline in 1 hour. Flow in the contralateral carotid was increased, but not significantly. We conclude that massive air embolism causes ischemia and reduced blood flow in the brain that can be detected in the cisterna magna.
Animals↗
Monitoring of neurotransmitter amino acids by means of an indwelling cisterna magna catheter: a comparison of two rodent models of fulminant liver failure.
Alterations of brain and cerebrospinal fluid amino acids have consistently been described in human and experimental fulminant liver failure. To evaluate the significance of such changes in the pathogenesis of hepatic encephalopathy in fulminant liver failure, brain and cerebrospinal fluid amino acids (glutamate, aspartate, GABA, glycine, taurine) were measured at various stages during the development of neurological dysfunction in rats after hepatic devascularization or thioacetamide treatment to induce acute liver failure. To facilitate repetitive removal of cerebrospinal fluid, a technique employing long-term implantation of cisterna magna catheters in conscious, freely moving rats was developed. Brain but not cerebrospinal fluid concentrations of the excitatory amino acids glutamate and aspartate were reduced in both animal models of fulminant liver failure in parallel with deterioration of neurological status. Brain and cerebrospinal fluid GABA levels were not significantly altered. Cerebrospinal fluid glycine levels were increased two to three times in parallel with increasing brain glycine content in the devascularized rat but were unchanged in thioacetamide-induced liver failure, suggesting distinct pathophysiological mechanisms in these two experimental situations. On the other hand, onset of coma in both animal models of fulminant liver failure was accompanied by significantly increased cerebrospinal fluid taurine levels. We suggest that such changes result from taurine release from astrocytes in brain into the extracellular fluid; this is consistent with taurine's role in the regulation of intracellular osmolarity in brain. Sequential measurements of amino acids in the cerebrospinal fluid of small rodents with indwelling cisterna magna catheters adds a useful new approach for exploring the neurobiology of hepatic encephalopathy in fulminant liver failure.
Amino Acids↗
Preferential hindquarter vasodilation in the hypotension induced by GABA injection into the cisterna magna of conscious rats.
Injection of GABA into the cisterna magna of conscious rats induced a vasodilation in the hindquarter without significant change in the renal and superior mesenteric areas, when arterial pressure and heart rate markedly decreased. This circulatory change indicates that GABA decreased arterial pressure as an effect on the CNS, in particular, through a hindquarter resistance reduction, along with a bradycardia.
Animals↗