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Superior cerebellar cistern

The superior cerebellar cistern is a subarachnoid CSF-filled space located on the upper surface of the cerebellar vermis, mostly without well-defined lateral limits. It represents a continuation of the quadrigeminal cistern posteriorly, and follows the straight sinus up to the confluence of sinuses (torcular of Herophilus). From here, it communicates inferiorly with the posterior cerebellomedullary cistern (cisterna magna).

It is an important anatomical corridor, containing vascular structures that supply and drain the superior cerebellar vermis, and serving as a site where CSF, blood, or pathology may accumulate.

Synonyms

  • Superior vermian cistern

  • Cistern of the great cerebral vein (historical overlap with quadrigeminal cistern)

  • Prepineal cistern (less precise)

Contents

  • Arteries: Superior vermian branch and medial branches of the superior cerebellar artery

  • Veins: Superior cerebellar vein, superior vermian vein

  • CSF: Filling the cistern, continuous with surrounding posterior fossa cisterns

Function

  • Reservoir for CSF within the subarachnoid space of posterior fossa

  • Provides cushioning and separation between cerebellum and overlying structures

  • Pathway for venous and arterial structures traversing the superior cerebellar surface

  • Serves as a radiological landmark for identifying pathologies in the pineal and posterior fossa regions

Clinical Significance

  • Hemorrhage: Subarachnoid hemorrhage often collects in cisterns, including this one

  • Tumors: Pineal region and vermian tumors may extend into or displace this cistern

  • Cysts: Arachnoid cysts may form here, causing local compression

  • Hydrocephalus: Enlargement or effacement of the cistern may reflect CSF flow obstruction

  • Infection: Meningitis may cause abnormal enhancement of the cisternal margins

MRI Appearance

T1-weighted images:

  • CSF in cistern appears dark (low signal)

  • Vessels seen as signal voids

  • Hemorrhage or proteinaceous fluid may appear bright

T2-weighted images:

  • CSF appears bright (high signal)

  • Vessels remain dark flow voids

  • Pathologies (cyst, tumor, edema) appear as abnormal signal within or displacing cistern

FLAIR (Fluid Attenuated Inversion Recovery):

  • Normal CSF suppressed, appearing dark

  • Hemorrhage, pus, or high-protein content fluid appears bright

  • Meningeal disease: abnormal bright signal or enhancement along cistern margins

CT Appearance

Non-Contrast CT:

  • Cistern appears as low-attenuation space (CSF density) above cerebellar vermis

  • Blood within cistern appears hyperdense

  • Masses displace or obliterate cistern boundaries

Post-Contrast CT:

  • CSF space itself does not enhance

  • Vessels within cistern enhance brightly

  • Pathologies:

    • Tumors: heterogeneous enhancement within cistern

    • Infection: leptomeningeal enhancement along cistern margins

    • Vascular lesions (AVM, aneurysm): strong contrast enhancement

MRI images

superior cerebellar cistern mri 3t axial image

MRI images

superior cerebellar cistern mri 3t coronal image

CT image

superior cerebellar cistern CT coronal anatomy image -img-00001-00001