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Quadrigeminal Cistern

cisterna quadrigeminalis

The quadrigeminal cistern is the subarachnoid space posterior to the midbrain tectum (quadrigeminal plate), bounded by the splenium of the corpus callosum superiorly and the vermis of the cerebellum inferiorly. It contains the vein of Galen and its tributaries (basal veins of Rosenthal, internal cerebral veins), the trochlear nerves (CN IV), and the quadrigeminal arteries from the PCA. The pineal gland projects into this space from the posterior third ventricle.

Region: Head & Skull

Clinical Relevance

Clinical Notes

The quadrigeminal cistern is the site of pineal gland tumours (germinoma, pineocytoma, pineoblastoma) that compress the superior colliculi producing Parinaud syndrome (impaired upgaze, convergence-retraction nystagmus, light-near dissociation). Vein of Galen malformations arise within this cistern and present in neonates with high-output cardiac failure from the arteriovenous shunt. Arachnoid cysts in the quadrigeminal cistern produce obstructive hydrocephalus from aqueductal compression and tectal plate distortion.

Pathology

Common Injuries & Conditions

Pineal Tumour Compressing the Quadrigeminal Cistern

Pineal region tumour expanding into the quadrigeminal cistern compresses the superior colliculi and cerebral aqueduct producing Parinaud syndrome and obstructive hydrocephalus; stereotactic biopsy confirms the tumour type and CSF tumour markers (AFP, beta-HCG) guide the decision between upfront chemoradiotherapy for germinoma versus surgical resection for non-germinomatous tumours.