Morphometric Analysis of the Brainstem and Subarachnoid Cisterns Using Midsagittal MRI: A Retrospective Study

Yıl 2025, Cilt: 51 Sayı: 3, 577 - 584, 08.12.2025

Hilal Gören , Atakan Kırteke , Nilgün Tuncel Çini

https://doi.org/10.32708/uutfd.1788912

Öz

This study aimed to evaluate comprehensively the morphometric characteristics of the brainstem and posterior fossa cisterns using midsagittal magnetic resonance imaging (MRI) and to investigate sex-related differences. A total of 200 adult participants aged 18 years and older (100 males, 100 females) were retrospectively included. High-resolution midsagittal T2-weighted MRI sequences were analyzed to measure the tentorial angle, clivus length, foramen magnum diameter, anteroposterior and superoinferior dimensions of brainstem segments, and the anteroposterior distances of the cisterna interpeduncularis, cisterna prepontis, cisterna magna, and cisterna quadrigeminalis. Data were analyzed using SPSS 28.0 with Mann–Whitney U and Spearman correlation tests. Females demonstrated greater tentorial angle and cerebellar height, whereas males exhibited larger mesencephalic and pontine dimensions as well as a wider interpeduncular cistern. No significant sex-related differences were observed in the remaining parameters. Correlation analysis revealed that the tentorial angle was positively associated with cerebellar height but negatively correlated with the widths of the interpeduncular and magna cisterns. Additional positive correlations were identified among brainstem segments and between posterior fossa cisterns. This study provides normative morphometric data on the brainstem and posterior fossa cisterns, offering reliable reference values for clinical and radiological assessments. The findings may contribute to improving diagnostic accuracy, refining surgical safety margins, and aiding in the differential diagnosis of pathological conditions. Furthermore, the data are expected to facilitate a more comprehensive anthropological evaluation of cranial morphology.

Anahtar Kelimeler

Brainstem , Subarachnoid cisterns , Posterior cranial fossa , Cranial morphometry

Etik Beyan

This retrospective study was approved by the Non-Interventional Clinical Research Ethics Committee of Bilecik Şeyh Edebali University (Approval No: E-10333602-050.04-353763, Decision No: 7, Meeting No: 8, Date: August 27, 2025).

Teşekkür

We would like to thank the Radiology Department of Özel Nev Hospital for their kind assistance throughout the study.

Midsagittal Manyetik Rezonans Görüntüler Kullanılarak Beyin Sapı ve Subaraknoid Cisternaların Morfometrik Analizi: Retrospektif Bir Çalışma

Öz

Bu çalışma, midsagittal manyetik rezonans (MR) görüntüleri kullanılarak beyin sapı ve posterior fossa cisternalarının morfometrik özelliklerini kapsamlı biçimde değerlendirmeyi ve cinsiyet farklılıklarını ortaya koymayı amaçlamaktadır. Retrospektif olarak planlanan araştırmaya 18 yaş ve üzeri 200 yetişkin bireyler (100 erkek, 100 kadın) dahil edildi. Yüksek çözünürlüklü midsagittal T2-ağırlıklı MRG kesitleri üzerinden tentorial açı, klivus uzunluğu, foramen magnum çapı, beyin sapı segmentlerinin anteroposterior ve superoinferior boyutları ile cisterna interpeduncularis, cisterna prepontis, cisterna magna ve cisterna quadrigeminalis’in anteroposterior mesafeleri ölçüldü. Veriler SPSS 28.0 programında Mann–Whitney U ve Spearman korelasyon testleri kullanılarak analiz edildi. Kadınlarda tentorial açı ve serebellum yüksekliği daha büyük bulunurken, erkeklerde mezensefalon ve pons boyutları ile cisterna interpeduncularis daha geniş ölçüldü. Diğer parametrelerde anlamlı cinsiyet farkı saptanmadı. Korelasyon analizinde, tentorial açının serebellum yüksekliği ile pozitif, cisterna interpeduncularis ve cisterna magna genişlikleri ile negatif ilişkili olduğu belirlendi. Ayrıca beyin sapı segmentleri arasında ve posterior fossa cisternaları arasında ek pozitif korelasyonlar saptandı. Bu çalışma, beyin sapı ve posterior fossa cisterna’larına ait normatif morfometrik veriler ortaya koyarak klinik ve radyolojik değerlendirmeler için güvenilir referans değerler sunmaktadır. Bulgular, tanısal doğruluğun artırılmasına, cerrahi güvenlik sınırlarının daha net tanımlanmasına ve patolojik durumların ayırıcı tanısına katkıda bulunabilir. Ayrıca, elde edilen verilerin kraniyal morfolojinin antropolojik açıdan daha kapsamlı değerlendirilmesine de olanak sağlayacağı öngörülmektedir.

Anahtar Kelimeler

Beyin sapı , Subaraknoid cisternalar , Posterior kranial fossa , Kranial morfometri

Etik Beyan

Bu retrospektif çalışma, Bilecik Şeyh Edebali Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Onay No: E-10333602-050.04-353763, Karar No: 7, Toplantı No: 8, Tarih: 27 Ağustos 2025).

Teşekkür

Çalışma boyunca bize yardımcı olan Özel Nev Hastanesi Radyoloji Bölümü'ne teşekkür ederiz.

Kaynakça

• 1. Smith LH, DeMyer WE. Anatomy of the brainstem. Semin Pediatr Neurol. 2003;10(4):235-240.
• 2. Hurley RA, Flashman LA, Chow TW, Taber KH. The brainstem: anatomy, assessment, and clinical syndromes. J Neuropsychiatry Clin Neurosci. 2010;22(1):1-7.
• 3. Benghanem S, Mazeraud A, Azabou E, Chhor V, Shinotsuka CR, Claassen J, Rohaut B, Sharshar T. Brainstem dysfunction in critically ill patients. Crit Care. 2020;24(1):5.
• 4. Sciacca S, Lynch J, Davagnanam I, Barker R. Midbrain, pons, and medulla: anatomy and syndromes. Radiographics. 2019;39(4):1110-1125.
• 5. Heiss JD. Cerebrospinal fluid hydrodynamics in Chiari I malformation and syringomyelia: modeling pathophysiology. Neurosurg Clin N Am. 2023;34(1):81-90.
• 6. Guan J, Yuan C, Zhang C, Ma L, Yao Q, Cheng L, Liu Z, Wang K, Duan W, Wang X, Wu H, Chen Z, Jian F. Intradural pathology causing cerebrospinal fluid obstruction in syringomyelia and effectiveness of foramen magnum and foramen of Magendie dredging treatment. World Neurosurg. 2020;144:e178-e188.
• 7. Plum F, Posner JB. The diagnosis of stupor and coma. Contemp Neurol Ser. 1972;10:1-286.
• 8. Laine FJ, Shedden AI, Dunn MM, Ghatak NR. Acquired intracranial herniations: MR imaging findings. AJR Am J Roentgenol. 1995;165(4):967-973.
• 9. Knight J, De Jesus O. Tonsillar herniation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
• 10. Bagci AM, Lee SH, Nagornaya N, Green BA, Alperin N. Automated posterior cranial fossa volumetry by MRI: applications to Chiari malformation type I. AJNR Am J Neuroradiol. 2013;34(9):1758-1763.
• 11. Alkoç OA, Songur A, Eser O, Toktas M, Gönül Y, Esi E, Haktanir A. Stereological and morphometric analysis of MRI Chiari malformation type I. J Korean Neurosurg Soc. 2015;58(5):454-461.
• 12. Bhimani AD, Esfahani DR, Denyer S, Chiu RG, Rosenberg D, Barks AL, Arnone GD, Mehta AI. Adult Chiari I malformations: an analysis of surgical risk factors and complications using an international database. World Neurosurg. 2018;115:e490-e500.
• 13. Hidalgo JA, Tork CA, Varacallo MA. Arnold-Chiari malformation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023–.
• 14. Yazici E, Kose S, Gunduz Y, Kurt EM, Yazici AB. Mega cisterna magna in bipolar mood disorder: a case report. J Yeungnam Med Sci. 2022;39(1):58-61.
• 15. Debnath J, Sharma V, Patrikar S, Krishna S, Shijith KP, Keshav RR. Normal measurements of brainstem and related structures for all ages: an MRI-based morphometric study. Med J Armed Forces India. 2023;79(4):428-438.
• 16. Elhussein N, Alkhathami AHA, Ayad CE. Norms for brain stem: a morphometric MRI-based study. IOSR J Dent Med Sci. 2017;16(6):74-79.
• 17. Murshed KA, Ziylan T, Seker M, Cicekcibasi AE, Acikgozoglu S. Morphometric assessment of brain stem and cerebellar vermis with midsagittal MRI: the gender differences and effects of age. Neuroanatomy. 2003;2:35-38.
• 18. Xiao K, Zhou L, Tang X, Liu S, Deng Z, Yang F. MRI imaging characteristics of brainstem and midbrain aqueduct in patients with iNPH. Sci Rep. 2025;15(1):94.
• 19. Syed HR, Jean WC. A novel method to measure the tentorial angle and the implications on surgeries of the pineal region. World Neurosurg. 2018;111:e213-e220.
• 20. Öksüzler M, Öksüzler Y, Tunç M, Polat S, Vuralli D, Göker P. The evaluation of cerebellum gross morphometric measurements in subjects having migraine, ataxia, dementia, vertigo. Int J Morphol. 2022;40(4):1067-1074.
• 21. Hara D, Maki F, Tanaka S, Sasaki R, Hasegawa Y. MRI-based cerebellar volume measurements correlate with the International Cooperative Ataxia Rating Scale score in patients with spinocerebellar degeneration or multiple system atrophy. Cerebellum Ataxias. 2016;3:14.
• 22. Chaurasia A, Katheriya G, Patil R. Radio-morphometric evaluation of clivus in Indian ethnicity: a cone beam computed tomography study. J Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;3(1):35-41.
• 23. Serindere G, Gunduz K, Avsever H. Morphological measurement and anatomical variations of the clivus using computed tomography. J Neurol Surg B Skull Base. 2021;83(Suppl 2):e75-e82.
• 24. Erçakmak Güneş B, Vatansever A. Türk toplumunda foramen magnum ve kafa tabanındaki oluşumların ilişkileri. Kafkas J Med Sci. 2018;8(3):207-213.
• 25. Basaran R, Efendioglu M, Senol M, Ozdogan S, Isik N. Morphometric analysis of posterior fossa and craniovertebral junction in subtypes of Chiari malformation. Clin Neurol Neurosurg. 2018;169:1-11.
• 26. Madadin M, Menezes RG, Al Saif HS, et al. Morphometric evaluation of the foramen magnum for sex determination: a study from Saudi Arabia. J Forensic Leg Med. 2017;46:66-71.
• 27. Columbano L, Stieglitz LH, Wrede KH, Samii A, Samii M, Luedemann WO. Anatomic study of the quadrigeminal cistern in patients with 3-dimensional magnetic resonance cisternography. Neurosurgery. 2010;66(5):991-998.
• 28. Dağtekin A, Avcı E, Kara E, Uz A, Özdemir C, Aktürk G, Tekdemir İ. Posterior cranial fossa morphometry in symptomatic adult Chiari I malformation: comparison with normal population. Clin Neurol Neurosurg. 2011;113(5):399–403.
• 29. Urbizu A, Poca MA, Vidal X, Rovira A, Sahuquillo J, Macaya A. MRI-based morphometric analysis of the posterior cranial fossa in the diagnosis of Chiari malformation type I. J Neuroimaging. 2014;24(3):250-256.