The Sylvian cistern (cistern of the lateral sulcus) is the subarachnoid space within the Sylvian fissure (lateral sulcus), containing the middle cerebral artery (M1 and M2 segments), the MCA branches, the deep Sylvian veins, and the superficial middle cerebral vein running along the opercular lip. The insular cortex (Brodmann areas 13-16) lies at the depth of the cistern. Arachnoid cysts most commonly arise in this cistern.
The Sylvian cistern is the operative field for MCA aneurysm surgery (the most common cerebral aneurysm location): transsylvian pterional craniotomy opens the Sylvian cistern to expose the MCA bifurcation aneurysm. The MCA vessels in the cistern are the primary structures at risk during temporal lobe epilepsy surgery, where the Sylvian fissure defines the lateral limit of the temporal resection. Arachnoid cysts within the Sylvian cistern produce temporal lobe compression, seizures, and headache, treated by cystoperitoneal shunting or endoscopic cyst fenestration.
Congenital arachnoid cyst within the Sylvian cistern progressively expands by one-way CSF flow, compressing the temporal lobe and producing headache, seizures, and developmental delay in children; MRI demonstrates the non-enhancing fluid-signal mass deforming the temporal operculum and middle fossa; endoscopic fenestration or cystoperitoneal shunting decompresses the cistern.
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