The chiasmatic cistern (suprasellar cistern) is the subarachnoid CSF space surrounding the optic chiasm, the pituitary stalk, the anterior communicating artery complex, and the proximal internal carotid arteries above the sella. It communicates with the interpeduncular cistern posteriorly, the Sylvian cisterns laterally, and the lamina terminalis cistern anteriorly. The floor of the third ventricle forms its roof.
The chiasmatic cistern is the operating field for craniopharyngioma (the most common suprasellar tumour), pituitary macroadenoma with suprasellar extension, and ACOA aneurysm surgery. Suprasellar extension of pituitary tumours through the diaphragma sellae into the chiasmatic cistern is detected by MRI and determines surgical approach (transnasal endoscopic vs transcranial). Craniopharyngiomas within this cistern compress the optic chiasm from above, producing bitemporal hemianopia. CSF rhinorrhoea from skull base defects allows this cistern to communicate with the nasopharynx.
Craniopharyngioma arising in the chiasmatic cistern from Rathke's pouch remnants compresses the optic chiasm producing bitemporal hemianopia and disrupts the pituitary stalk causing hypopituitarism; MRI demonstrates a calcified cystic suprasellar mass that distorts the chiasmatic cistern anatomy.
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